Campaign in Puerto Rico Encourages Uptake of Booster Vaccine

In October 2021, Puerto Rico led the nation in vaccination rates. At the time, about 57% of Americans were fully vaccinated; in Puerto Rico, the rate was more than 73%. Much of the credit for that high rate goes to the implementation of a Municipal Case Investigation and Contact Tracing System by the Health Department of the Puerto Rico, alliances with stakeholders to promote access to vaccines, and the successful community engagement strategies, including work by the Puerto Rico CEAL research team. 

“Historically, Puerto Rico has been receptive to vaccines and physician recommendations regarding their health, so we knew that the first vaccine would be greatly accepted, and for the most part, it was,” says Vivian Colón-López, Ph.D., M.P.H., professor at the University of Puerto Rico, Medical Sciences Campus, and Lead Investigator at the UPR Comprehensive Cancer Center. 

However, as the pandemic wore on, information fatigue set in. Even people eager to get their first doses were not always following through with getting their booster shots. The CEAL research team needed a strong, trusted voice to capture attention.

“We wanted to give a call to action to people who had received the primary doses of the vaccine also to get the booster and inspire their friends and family to do the same,” says Adriana Del Mar Pons, M.S., who coordinates the Puerto Rico CEAL community outreach team.

“Historically, Puerto Rico has been receptive to vaccines and physician recommendations regarding their health, so we knew that the first vaccine would be greatly accepted, and for the most part, it was.”

Vivian Colón-López, Ph.D., M.P.H.
Professor at the University of Puerto Rico, Medical Sciences Campus, and Lead Investigator at the UPR Comprehensive Cancer Center

Working in alliance with a marketing agency, Alterna Communications, they found their ideal trusted messenger to grab attention and inspire action — someone already very involved in the fight against COVID-19. Dr. Pedro Juan Vázquez — better known as PJ Sin Suela, Puerto Rican rapper and musician — has balanced practicing medicine with creating music for years. During the first two years of the pandemic, he put all his time and energy into caring for patients and fighting COVID-19. In late 2021, he released an album that drew from his experience as a physician. Taking the role as the spokesperson for the “Con Refuerzo” campaign fit right in with Vázquez’s identities as a physician, a rapper, and a proud Puerto Rican.

While the right messenger is essential, so is the right message.

Messaging about the vaccine can be complex and hard to follow, admits Cynthia M. Pérez, Ph.D., M.S., professor of the Department of Biostatistics and Epidemiology at the Graduate School of Public Health of the University of Puerto Rico. The team solicited feedback from community members to ensure the campaign and materials were scientifically sound and easy to understand. “The message needed to be clear so that everybody in Puerto Rico, regardless of their education, income, or where they live, was able to understand,” says Pérez. The campaign targeted adults of all ages with short messages on billboards, digital ads, and radio spots emphasizing the importance of the booster vaccine. 

Measuring the direct impact of the educational campaign on booster rates is not a straight line; however, the team has noted many markers of success. The campaign generated press from around the globe, with international news outlets reporting on it in Spain, Switzerland, and South America. The team is also using some messaging components of the campaign in a study to evaluate whether an educational program increases the uptake of the COVID-19 booster vaccine among adults. Preliminary findings suggest that participants who were exposed to the intervention, which consisted of health promoters, educational materials addressing the most emergent barriers towards COVID-19 booster vaccine uptake, and an additional support intervention via telephone two weeks after baseline, were more likely to receive the booster than participants who did not receive the intervention. 

Beyond the “Con Refuerzo” campaign, Puerto Rico CEAL continues engaging with its community and finding ways to support evidence-based research. Colón-López says, “We have seen a fantastic response regarding vaccination uptake in Puerto Rico. There is still a way to go, but hopefully, we will keep working towards that in the future with our outstanding community partners.”