Understanding Vaccine Hesitancy and Building Healthy Lives

Brittany Zulkiewicz is on a mission to find the best ways to keep people healthy. The recent doctoral graduate at the Annenberg School for Communication at the University of Pennsylvania has dedicated both her professional and academic career to improving public health and reducing health disparities through communication.

Her dissertation, a culmination of her work studying how people make health decisions, explores how information about COVID-19 vaccines shared during the pandemic has shaped people's perceptions towards other vaccines, including routine childhood vaccines and vaccines for emerging pandemics.

"Although there is a narrative that vaccine hesitancy has increased because of the COVID-19 pandemic, there hasn't been much research pointing to why that is specifically," Zulkiewicz says. "I wanted to know whether the information that people were exposed to — specifically information about the possibility of side effects — had spillover effects on people's acceptance of other types of vaccines.”

The answer is complicated, Zulkiewicz says. “There’s not a clean story, but there was one common theme: while information about COVID-19 vaccines didn't necessarily affect people's perceptions of other vaccines directly, but it did decrease trust in federal agencies, which may, in turn, have affected people's willingness to get vaccinated,” she says. “Deciding to get a vaccination requires you to trust in the people who produce them, the people who recommend them, and the people who are giving them to you.”

Why Public Health

Zulkiewicz became interested in public health while an undergraduate at Duke University, studying both neuroscience and global health. “I was on your typical pre-med track, but then I became a Student Research Fellow with the Duke Global Health Institute. I worked with local partners in Tanzania to evaluate cervical cancer awareness and knowledge needs,” she says. “That really exposed me to the need for public health strategies as a complement to the standard medical system. I realized there is so much potential to address health disparities and broaden impact.”

After graduation, Zulkiewicz joined scientific research institute RTI International’s Center for Communication Science as a research analyst, working alongside several Annenberg alumni, including her mentor Brian Southwell (Ph.D. ‘02), to evaluate the effectiveness of a variety of public health communication projects, from the CDC's Let's Stop HIV Together campaign for HIV prevention and treatment to the agency’s tracking efforts during the 2015 Ebola epidemic.

“Evaluating these campaigns and interventions really solidified my desire to go for a Ph.D. in communication,” she says.  “While thinking through where I wanted to go, after getting my M.P.H. at Johns Hopkins, I thought of all the people whose work I most admired, and realized many were Annenberg alums. I figured if I didn't get into Annenberg, I would still have a career that I loved, but thankfully, I got in and moved to Philly.”

Life at Annenberg

She arrived at the Annenberg School in 2021 with an interest in developing tailored health communication campaigns and joined Associate Professor Andy Tan’s Health Communication & Equity Lab.

With the lab, she worked on Project RESIST, developing culturally tailored anti-smoking campaigns for LGBTQ+ young adult women, and Philly Community Engagement Alliance (CEAL), a program designed to improve COVID-19 vaccination uptake in Philadelphia through community partnerships and social media outreach. Working with Philly CEAL highlighted just how prevalent vaccine hesitancy is, Zulkiewicz says: “Ambassadors from the community would go out to vaccination events and try to address hesitancy. People really needed to be convinced to get vaccinated because they didn't trust the vaccines.” She also worked with students at West Philadelphia High School to develop and make a plan to evaluate their own public health intervention — a community garden — thanks to a Penn Graduate Community-Engaged Research Summer Fellowship.

Zulkiewicz credits several courses outside of health communication with expanding her research skills. Professor Sandra González-Bailón's class “Meaningful Measures in a Data-Driven World” helped her learn to think creatively about data sources beyond surveys: “That really informed my dissertation — I used an existing panel data set and looked at news coverage,” she says. Professor Joe Turow's "Advertising in the Digital Age" class made her consider how health campaign messages compete with paid advertising.

The Power of Healthcare Providers

Returning to her dissertation, Zulkiewicz says all hope is not lost when it comes to vaccine hesitancy.

“One of the other consistent findings across all of my dissertation research was that even though this information about COVID-19 vaccines decreased trust in public health agencies and organizations, it didn't decrease trust in physicians,” she says. “Healthcare workers are well-positioned to address vaccine uptake because patients have a trusted interpersonal relationship with them. And so I think that if we want to address vaccine hesitancy, we really have to empower healthcare providers to communicate about the importance and necessity of vaccines.”

What’s Next

Zulkiewicz says her time at Annenberg can be summed up in two words: opportunity and connection. Through research projects, peer conversations, conference presentations, and mentorship from professors and alumni, she has become a better researcher than when she arrived at Penn.

“The Annenberg community is so open and so generous,” she says. “My mentor Brian [Southwell] even attended my dissertation defense virtually.”

Soon, Zulkiewicz will join Healogix, a market research firm for pharmaceutical and biotech clients, as a senior associate. As part of this work, she will be conducting research on how and why patients and providers engage in various health behaviors. “It’s important to me to do rigorous research that has real impact on people’s health,” she says.