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A strategic public service announcement (PSA) with counter-stereotypical vaccine messaging using real Fox News clips led to an uptake in COVID-19 vaccination in red counties, according to a large-scale randomized controlled trial.

Across 1,014 counties, an estimated 104,036 people were vaccinated who otherwise wouldn't have been had they not seen the PSA, for an average 103 additional vaccines per treated county (P=0.097), reported Timothy J. Ryan, PhD, of the University of North Carolina at Chapel Hill, and colleagues in .

Ryan's team created a using footage of former President Donald Trump endorsing the COVID vaccine on Fox News. They then placed tactical ads on YouTube in counties lagging in vaccine uptake. The PSA was viewed 11.6 million times among 6 million unique viewers. On the Fox News YouTube channel alone, the PSA played 200,000 times before clips of Fox News personalities.

Ryan and colleagues estimated that the campaign avoided 839 deaths, costing about $115 per life saved.

Co-author Bradley Larsen, PhD, of Washington University in St. Louis and the National Bureau of Economic Research, told 乌鸦传媒 that the ad spending went far, averaging one vaccine per dollar in advertising.

"This is something we can use in practice to try to overcome political polarization and attack social problems," he said.

Co-author Steven Green, PhD, of North Carolina State University in Raleigh, added that although there was resistance to using Trump as a messenger, their results showed the PSA worked and laid the groundwork for future research exploring counter-stereotypical public health messaging.

"The public health community is a very liberal community and is a community that is very skeptical and distrustful of Donald Trump," he told 乌鸦传媒. "There was just such resistance ... to using Donald Trump as the messenger."

The researchers noted that by Fall 2021, "counties that voted heavily for Donald Trump experienced COVID-related death rates nearly three times higher than counties that voted heavily for Joe Biden." After the PSA period in Trump-leaning counties, they found that "counties that are less heavily Trump-leaning were more responsive to the ad."

Vaccination rates varied among groups, but the uptake difference across the political divide was most stark.

"Ninety percent of Democrats were vaccinated and only 60% of Republicans were and that gap didn't seem to be shrinking," said Larsen. "We felt like there's a chance here ... that if you target correctly with the right messenger that the political right would trust, then you can really make a difference and increase vaccines."

Ryan and colleagues concluded that "whether the dividing line is politics or something else, our study suggests that public health proponents might do well to reflect on messengers whose voices might carry special weight among target populations."

Green noted that several of the co-authors had initially become interested in using the military as "cue-givers" for public health messaging during the peak COVID years because both sides of the political aisle hold respect for the military.

Amelia B. Finaret, PhD, a professor of global health studies at Allegheny College in Meadville, Pennsylvania, told 乌鸦传媒 that while the results were significant, the magnitude of impact -- about 100 vaccines per county -- was still relatively small.

"Even if someone is seeing an ad, they might not be really absorbing it ... it might not really pack the punch that you really want it to pack. And that might be why the magnitude of the effect is small," explained Finaret, who was not involved in the study.

However, she said she still thinks the study added insights into the relationship between public health messaging and misinformation.

"Right now, there's a lot of talk about how we deal with misinformation online -- especially how that affects people's health decisions," Finaret said. "I think that having some more knowledge about how people are affected by the messages they'd see, regardless of what they're telling them to do, or whether they're kind of more subconscious or more overt messages, I think understanding that is hugely important in our context of understanding misinformation online."

Over a 2-week period from mid-October 2021 through the end of the month, ads ran in more than 1,000 counties. The researchers used the county level so they could compare with CDC data. Trump-leaning counties were identified using 2016 voting data. The PSA was used as an advertisement on YouTube, and the authors acknowledged that the mysterious YouTube algorithm is one limitation to their work.

Larsen thinks future research in the U.S. and globally should use the same mechanism of counter-stereotypical political messengers to communicate other public health messages.

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