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Telling stories to give vaccines: the work of Sesame Workshop and the University of Southern CA

The first thing that catches your eye when looking at Jeanette Betancourt's office are Sesame Street character puppets. Elmo, Beto, Archibaldo, and their friends fill her workspace as she is the Vice President of Social Impact at Sesame Workshop, the non-profit organization behind the production of the renowned children's series that has been broadcast since 1969.


For its nearly 5,000 episodes, Sesame Street has focused on the entertainment and education of preschool-age children. Sesame Workshop, an initiative that operates in more than 150 countries, has helped the most vulnerable children through educational content and programs that make a difference in their well-being.


Some of the public health messages for children and adults that the organization has developed have focused on promoting vaccination to prevent getting the measles or influenza. In fact, Big Bird – one of the characters in the series – got one of these vaccines in one of the program's episodes in 1972.


In 2021, when vaccines against COVID-19 became available, Sesame Workshop knew they had to play a part in engaging people to get vaccinated through Sesame Street broadcasts. They had two major concerns: one was that the pandemic had affected the United States more than any other health crisis in the past, and another was that misinformation campaigns regarding vaccination were generating doubts in some groups, notably Latinos.


A survey conducted by Voto Latino in April 2021 revealed that just over 50% of unvaccinated Latinos thought the vaccine was unsafe. The most alarming thing was that the figure rose to 67% among Latinos who spoke mainly Spanish. In turn, an investigation by the First Draft group, published in December 2021, found that the practice of medical discrimination against Latinos and the lack of access to health care could have triggered doubts and mistrust about vaccines.


Moreover, a Nielsen study published in September of that same year indicated that Hispanics in the country represented a "perfect victim of disinformation" due to the use of social networks as a source of news and information. According to Nielsen Latinos were 57% more likely than non-Hispanics to use social networks as their primary source of information.


Online misinformation is already a problem in English but is worse in Spanish as the content is less likely to be reviewed and edited by the many social media platforms. This is compounded by the fact that, according to experts, Latinos, more than other groups, favor social media platforms like Facebook which in 2018 admitted flaws in its content moderation in the case of the violent acts in Myanmar or WhatsApp, which does not include its own mechanisms for fact-checking and content moderation.


A survey released in November 2022 by the New York University Center for Politics and Social Media found that Latinos were more likely than non-Hispanic whites to use WhatsApp as an information tool (53% vs. 14%). Also, while 53% of Latinos said they trust social networks a lot to learn about COVID-19, in non-Hispanic whites, the percentage was 34%. It was in this context that Sesame Street decided to create content in English and Spanish to promote COVID-19 vaccines.


Fighting misinformation with entertainment

Promoting vaccination against COVID-19 was a natural continuation of the work Sesame Workshop had been doing since the start of the pandemic. Sesame Street segments could be seen explaining the importance of staying at home and singing songs about hand washing. They also developed pieces in which the different characters of the series were vaccinated.


Image: Elmo and his father, Louie, received the COVID-19 vaccine during an episode of Sesame Street. Credits: Sesame Workshop.


In order to achieve and even greater social impact, and knowing that Sesame Street is a popular program among Hispanics, the organization worked hand in hand with the National Alliance for Hispanic Health (the Alliance), an institution that had already been implementing the “Vaccines for All” program, whose objective was to increase vaccination among Hispanics through community health workers: health workers linked to Latino communities.


“With the Alliance, we did an incredible program with all the community health workers that they have at the community level, and we delivered the information,” declared Betancourt. Previously, Sesame Workshop and the Alliance had collaborated around promoting healthy habits and mitigating childhood obesity.


The results of this association were successful: vaccination ads exceeded 4 million impressions on social networks, thanks to an effort focused on the most underserved Latino sectors and those with less access to vaccines. In Betancourt's opinion, the relationship between his organization and the community health workers demonstrated the importance of "reaching out to the people who do things in the communities" building on the strengths of their own culture and language in order to receive information on how to develop the most appropriate content.


Communication to save lives

In 2020, already having a career spanning many years combining medicine with communication, Dr. Lourdes Báezconde Garbanati, Ph.D., MPH, Associate Professor of Preventive Medicine at the Keck School of Medicine of the University of Southern California (USC), felt that the moment had arrived for which she had been trained throughout her life: to help as many Latinos as possible affected by COVID-19.


“When the pandemic began, I felt that it was my calling, that everything I had done and studied had reached its climax, and that this was my moment to do what I knew how to do to help our people,” he said.


Dr. Báezconde Garbanati is originally from the Dominican Republic and has lived in the United States for more than 40 years. Her specialty is preventive medicine, and at the university, she partnered with the schools of communication and cinematography. In the early 2000s, she realized that using narratives was the best way to communicate with people on health issues. COVID-19 and the subsequent vaccination process were a new opportunity to put this into practice.


“We decided that storytelling was the best way to educate and inform the population about the things they had to do or not do (…) It was a way to get more people to get vaccine boosters and finish vaccinating those who had not done so," she described.


As part of this strategy, Báezconde Garbanati participated in the production of two pieces: Team Player, a video in which a group of parents can be seen discussing misinformation about vaccines, and Of Reasons and Rumors, a video which tells the story of a young Latina who was hesitant to get vaccinated until her sister shows her the difference between rumors and the truth. This last video had the support of the Alliance through the “Vaccines for All” program.


These videos were disseminated through social networks, streaming platforms, and community health workers. While the videos motivated people and provided truthful information, community health workers personally answered the questions raised by the videos.


“This varied across the nation, each [community health workers] using it in their own way, but in many cases, if they went to a house with a laptop or an iPad, they could show it and start the conversations to examine what were the barriers that existed,” she described.


With this and other initiatives, the joint effort between USC and the Alliance managed to increase the Latino vaccination rate in Los Angeles by 30%. At the national level, the videos were presented in more than 30 cities, with an estimated reach of more than 50 million people.


Betancourt and Báezconde Garbanati know that entertainment with meaningful content can change people's behavior. The Sesame Street characters "are constantly modeling good practices" with which their audience have become familiar. Báezconde Garbanati believes that, as long as the contents appeal to reason and emotions and has characters and stories that people can identify with, changes in attitudes and health behaviors can be achieved.

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