Moving into the pandemic’s third year, as many settle into the notorious “new normal” of COVID, the challenge now is avoiding complacency and keeping attention and vaccination rates high enough to maintain protection against the still-evolving virus.

Six months after approving a first vaccine booster, the FDA has now authorized a second booster dose for older and immunocompromised people at greater risk of serious illness. With new variants like BA.2 on the horizon, there’s a strong likelihood that additional vaccine doses — even regular seasonal boosters — will be needed for all segments of the population.

The U.S. might be enjoying a spring respite of low COVID caseloads and hospitalization rates, but unvaccinated and immunocompromised individuals remain at elevated risk of serious illness and death.

Even as the U.S. vaccination rate nears 82 percent, global rates are still a long way off from anything resembling substantial population-level protection. Worldwide, the rate is still hovering at around 58 percent. In lower-income countries, the proportion of people who have received even a single dose plummets to barely 15 percent.

Meanwhile, the insidious long-term effects of COVID infection are becoming more apparent, with concerning evidence of lung scarring, heart complications, and brain shrinkage, among other complications.

The good news is that the tools to control the virus exist. The vaccine remains the single most important and effective defense against COVID. But after a year-plus deluge of ad campaigns, incentives and mandates in the all-out push for vaccination, the task is not about getting the message out anymore; it’s out.

To make it stick, now that message has to come not just from health officials and agencies but from individuals in their own families and communities.

As a researcher in public health and communication, I’ve heard the same thing from clinicians and organizations working on COVID vaccination efforts. They’re running into a wall with unvaccinated people they’re trying to persuade, who feel they’ve heard all they need to hear and are tired and increasingly wary — if not outright resentful — of the pitch.

But there’s still an immunological, social, and moral imperative to increase vaccination rates. Research in health communication and social psychology can help navigate a powerful, more indirect route to encouraging vaccination.

Perceptions of what’s standard or accepted among peers is one of the most important factors in how people make health decisions.

As mask mandates are being lifted around the country, a new ritual has emerged. A person approaches a store or restaurant, masks off but within ready reach. Entering the building, there’s a quick, furtive assessment of the landscape: how many other people are wearing masks?

If it looks like a good proportion, the mask goes on. If most people are maskless, it stays in a purse or pocket.

In the research, this is referred to as “normative influence.” What it comes down to is two intuitive questions: What are other people like me doing? and What would people I admire want me to do?

This deceptively simple idea turns out to be one of the greatest double-edged swords in public health. It can either be one of the most powerful tools to encourage vaccination, or it can be a major obstacle, driving people in precisely the opposite direction.

Ongoing research from my colleagues and I at Northwestern University confirms that these kinds of norms are tightly linked to people’s vaccination choices. Whether or not a person is vaccinated tends to align closely with their perceptions of their friends’ and peers’ attitudes and behaviors.

And this holds true across the board, regardless of political affiliation, geographic location or other demographic factors that we know are associated with vaccination rates.

The problem with norms is that what people perceive as the norm is not necessarily accurate or helpful. Research suggests that people who are unvaccinated tend to underestimate rates of vaccination more broadly.

This is why incidents like Florida Gov. Ron DeSantis chiding students for choosing to wear masks are so damaging — not only because it can put vulnerable people at risk, but because it feeds into a framework of what’s seen as acceptable or sanctioned behavior in certain circles.

It’s also why the significant negativity bias and disproportionate attention to “vaccine skeptics” in coverage of the pandemic can be problematic in making this group appear larger and more mainstream than they actually are.

The task now is to rebalance the scales by clarifying that vaccination really is the norm.

In the U.S., 217.5 million people are fully vaccinated. What’s more, despite a vocal minority of vaccine opponents, most adults report that they have either already received a booster dose or are planning to do so.

There’s no question that there are serious gaps and problems in COVID responses, especially in terms equitable access to vaccines and care, both globally and nationally. But in terms of sheer numbers, this is undoubtedly the most ambitious and successful mass vaccination campaign in history, with more than 560 million doses of the vaccine administered in the U.S.

At the interpersonal level, people can help to normalize vaccination as the standard among their friends and family–not by lecturing or hectoring, simply by openly sharing that they themselves are vaccinated. Health care providers also have a role to play in de-sensationalizing the issue and making discussions about COVID vaccination a more routine part of their standard practice.

Even as the U.S. looks forward to a summer of possibility, the true end of COVID is still a long way off. The virus will continue to evolve, perhaps in unpredictable ways.

Science has done the heavy lifting to create an extraordinarily effective vaccine; it will take individuals adapting to social norms to keep those defenses working.

This article is discussed on The Podcast by KevinMD: Health care communications during the pandemic era.

Stefanie Demetriades is a communications professor.

Image credit: Shutterstock.com