Amelia Burke-Garcia

Q: All right, so the recording is going. Today is March 14, 2023. This is Heather [E.] Rodriguez for the COVID-19 Oral History and Memory Archive Project for the CDC [Centers for Disease Control and Prevention] Museum. I’m in Atlanta, Georgia, and I’m talking to Dr. Amelia Burke-Garcia. We’re recording through Zoom. Dr. Burke-Garcia, welcome to the project.

BURKE-GARCIA: Thanks, Heather, thank you so much for having me. This is wonderful to be here, and I’m really thrilled to have this conversation with you this morning.

Q: Great, we’re excited to have you as well. Do I have permission to interview you and record this—and to record session?

BURKE-GARCIA: Yes.

Q: Oh, okay, so let’s talk a little bit about your schooling and education, so where did you go to college at?

BURKE-GARCIA: So I did my undergrad degree at McGill University in Montréal, in Québec, in Canada. I studied international development studies and humanistic studies. I did a joint honors double degree.

Q: Tell me a little bit more about more your background because you do have a doctorate and everything, so did you get your master’s degree or did you immediately go to doctorate or—?

BURKE-GARCIA: Oh, yes, so following my undergrad, I actually moved from Montreal to the DC [District of Columbia] area, and I actually started working in an international development organization focused on global public health. And while I was working, I actually decided to go back and get my master’s degree. At the time, I was really passionate about public health and health prevention, and as I was working, I got more exposed to the role of communication in the world of health and public health and was really passionate about this idea of the communication side of health, so essentially health communication.

But in particular, I was young in my career, and social and digital media were just starting to emerge. We didn’t have Facebook [Meta] or YouTube or TikTok of course yet, but website, content, e-newsletter content, some media audio or video content was, you know, becoming more popular in terms of means communicating with people. Certainly mobile devices were emerging, not iPhones yet specifically, but I remember moving to DC and getting my first cellphone. So it was at this time where technology was starting to emerge, different types of technologies and different types of uses of technologies for communication purposes were stating to be seen. There were really interesting start-ups that you saw at least as I was meeting people in my young—in my early career. Different people were doing different types of things and so I really was fascinated about this intersection of health and communication but with a particular focus on technology and the role of technology in health communication.

So I found a program at Georgetown. It's a graduate program where I went and did my master’s, and it was called—it was focused on communication, culture, and technology, and I really loved that intersection of those three items as it relates to what I was doing early in my career. And while I was there, I was even more heavily exposed to people who were just doing really interesting work. I met people who were doing the first phases of social advertising for various magazines or journals in DC or that were originally based in DC. I was exposed to people who were using social and digital media to advance different types of advocacy programs. I met people who were working for the—washingtonpost.com and some of the early news websites. And that really opened my mind to a wide variety of possibilities as it relates to digital communication, and so I really decided at that time where I want to focus and what I want to learn to do really well was social and digital media but for health and for public health and for prevention. And so I found, at the time, what—the only position that I could find focused on what was called at the time e-marketing, and it was with a nonprofit organization in DC called the Academy for Educational Development.

While I was there, I was still going to school, I was finishing my master’s degree, but I really got to move from global to domestic health and work on a wide variety at NIH, National Institutes of Health, and CDC or Centers for Disease Control and Prevention projects and really bring some of that knowledge and early thinking around social and digital communication to public health prevention programs. And so some of the programs I worked on in the—those early days included NIH’s We Can! [Ways to Enhance Children's Activity & Nutrition] program, which was focused on youth physical activity and nutrition. I got to work on a workplace wellness initiative out of CDC. I worked a little bit on the CDC’s National Influenza Vaccination campaign as well as several other different types of initiatives. But the idea was really coming up with creative strategies to reach and engage people using these new channels of communication.

And one example, and again just to show how early we were at that time in our evolution in terms of social and digital media compared to as you think about things and how they are today, we built probably the first Myspace page in support of a national federal public health initiative. So we had a Myspace page in support of the We Can! program on, and really, that was a place where we could share content, connect with people, connect with partners. Not a lot of people were doing this yet, so it was a small—smaller undertaking, but it really was almost a proof of concept of how can we communicate with people outside of, at the time, what were considered traditional communication channels, so print, radio, television, et cetera. So that was really an experiment, and we actually saw, at the time, some really interesting comments from people. We were able to generate a community of people in Myspace, and then as we were doing that, you started to see Facebook open up to the public, Twitter started to emerge. There were a few other social networks like YouTube and others that began to really come on the scene and gain a following, and so we were able to kind of pivot. But those early days, the platform that was available to us for testing and learning was Myspace, and that was one of the earlier social media initiatives that I ran.

So while I was an AED [Academy for Educational Development], I finished my master’s degree and then I went—I was trying to figure out what do I do next, do I stay where I was working. What I really realized at the time was as much as I was learning a lot working on public sector programs, the money and the innovation was happening in the private sector, and so I moved to New York for about two years, and I worked for the largest independent media agency. So most media agencies are owned by bigger conglomerate companies and—but I worked for one called Horizon Media, and they again were not owned by anyone, they’re an independent media agency, they still are. I got to come in as the social media group supervisor and really dig my teeth into a number of brand campaigns that were using social media in those early days as a way of communicating, reaching, engaging with people, promoting products and different brand campaigns that were going on. And so, at the time, I got to work with brands like Cadbury confections so that suite of products that included Stride gum, Trident gum, Sour Patch Kids, Swedish Fish.

I also got to work with A&E television and do some support to some of their programming initiatives. I got to work with GEICO insurance, which was a really amazing experience because we ran with GEICO one of the first brand awareness campaigns that GEICO had ever done. And that was particularly important because GEICO historically and I think even still today has been a direct response brand, right? Their call to action, their advertising has always driven to call this number, go to this website, but the intention of—with the intention of getting people to sign up for insurance.

And we ran with them as a social media brand campaign that was just about awareness. And what we did is we worked with YouTube creators, some of the biggest YouTube creators at the time, and we took their videos. We worked with the creators to recreate them featuring iconic GEICO characters like the Gecko. And so we wove in those characters into those videos and then re-released them again without necessarily a call to action to call a number or visit a website to get insurance, just to engage with people and raise the brand—the awareness of the brand amongst consumers. So that was one of the really interesting projects I got to work there. But overall I think what I learned was how much was happening in this space whether it was we were working with—on social media ads when we were—or whether we were talking about search campaigns, paid search campaigns, or whether we were talking about working with the early, early, early days of what we now call social media influencers. I got to work on those kinds of projects and with other people who were doing this kind of work and just really learn the full breadth and scope of this space that we now call digital media.

So that was an incredible experience, and I have really, really loved working with the people that I worked with and having those experiences, but I really, really missed the public health side. So after being in New York for two years, I came back to DC and I went back to the Academy for Educational Development, and I went in as their director of digital media. And I had the opportunity to work on a variety of campaigns, many of which were focused on vaccination and immunization communication. So I worked on their—the CDC’s National Influenza Vaccination campaign, CDC’s Lifespan Vaccination campaigns—it was a suite of campaigns—and led digital for those initiatives.

And so from there, I ended up going to Westat, which is a research organization also in the DC area, and while I was at Westat, I decided to go back and get my PhD [doctor of philosophy]. I went to George Mason University for my PhD, and I was in their communication program with a focus on health communication in particular and really just loved the experience and loved the people that I got to work with and collaborate with there. And the professors were incredible, and it was just such an amazing program. And really just, again, every time I’ve gone back to school, I feel like my mind and my brain have expanded and shifted in different ways to accommodate all the new learning and exposure that you get through that process, and it was just incredible. I finished that degree in 2017 and continued to work through that time, and then in 2019, ended up at NORC [National Opinion Research Center] at the University of Chicago, which is where I'm currently at.

Q: Awesome, so I have a couple of questions. So can you tell me a little bit more, it’s just—it’s really interesting because we’d never really hear about these really early brushes of CDC breaking into the social media or really first using really early forms of social media for vaccination campaign. Can you tell me a little more about the National Influenza Campaign before you went to Horizon Media and then afterwards too and then about the Lifespan Vaccination campaign? As much as you can remember, what was CDC’s thing—what did they use, just give me a big scope of the project if you can?

BURKE-GARCIA: Sure, so, of course, for each of the immunization efforts, they have their own priority audiences. For flu, all Americans are recommended to get the flu vaccine, but of course, there are subgroups like pregnant women or older adults who may be at higher risk for severe illness or complications if they get the flu. So we had a general audience focus, but of course, we had a number of audiences that we highlighted as being particularly at risk and therefore should—who should prioritize the flu vaccine.

Q: And what year was this?

BURKE-GARCIA: So when I came back from New York this—that would have been 2010.

Q: Okay, so this is after the universal recommendation for influenza?

BURKE-GARCIA: Yes.

Q: Okay, got you.

BURKE-GARCIA: Exactly.

Q: Yes, so that makes sense, everyone should get it, but they do have these priority action, yes. Continue, just tell me a little bit more about it? Sorry to interrupt.

BURKE-GARCIA: No, no it’s totally fine. And then I think for the Lifespan campaigns for the childhood vaccination campaigns, campaign focused, of course, on parents of young children. The adult immunization campaign, of course, was focused on adult immunizations and the immunizations that adults still need to get as they get older. All of them had different types of efforts and activities that they were doing. The flu campaign was probably the place where we did some really interesting activities and then for the childhood immunization campaign, we also did several really interesting activities that I think pushed the boundaries of federal public health in the social and digital space. And I will say I think—

Q: Can you elaborate?

BURKE-GARCIA: Oh, yes—

Q: Yes, I’m sorry—

BURKE-GARCIA: Give me a second—no, it’s totally fine. I was going to just pause and reflect on the fact that I think that public health in general and government and in particular federal public health agency is—sometimes get a bad rap [reputation] for not being innovative, for not being forward thinking, for not being able to move quickly. And certainly, there are elements of different initiatives or programs where those things may be true. I have to say in the work that I have spearheaded over the years and in particular with relation to these campaigns, I think that my clients and the work that we’ve done together have been tremendously innovative and have really pushed the boundaries of what is possible to do in order to engage people around these very critical health topics in new and interesting and innovative ways that recognize how people are starting to engage with one another and with content in emerging environments.

So to your question, I'm now having sort of—I’ll step down off my soapbox there for a second. We ran a campaign with an early group of Twitter influencers, Twitter Moms—called Twitter Moms, and I think eventually, they became known as Social Media Moms or something like that. But we did like a tweet-a-thon, what was we called a tweet-a-thon back in the day where we had a number of moms who participated to help get the word out about the flu campaign and the importance of influenza vaccination. And that was probably one of the first places where we worked with people in social media who had a following, who had a voice, and we encouraged them with some key messaging to share CDC’s recommendations in their own voices.

Again when I talk about innovation and people who have worked in this space, there's often a lot of intention to make sure that the evidence-based messages in health are communicated correctly and accurately, and that makes sense. We do not want to have misinformation out there, right? We don’t want to have inaccurate information put out into the public space and so a lot of times, there was concern around how are people going to interpret and share these messages. What we found is that they really—these moms in these early days of Twitter and social media really, really embraced the content and shared it accurately. And if anything, we did see some traction with people who were not necessarily in support of vaccination.

Again to the credit of my clients, we—nobody freaked out. We had a plan, an escalation plan in place, we had a response policy in place before went live, and we were able to ride out some of the negative commentary and really produce a lot of positive messaging that supported the campaign’s aims.

Similarly for childhood vaccination, we actually worked—this is later now, but we did a—we had a number of social media influencers cohost a Twitter chat in support of childhood vaccination. The day before that, we got wind of—again social media, at that time, had grown a lot more, and there were more people engaged, there were lots more voices at the table. And we had a lot of people who were—who did not believe in vaccination, who were apparently going to—who got wind of the chat and who were planning to come to the chat to disrupt the conversation. And what we found is that because we worked with a set of social media influencers who were cohosting the chat, they were empowered to—bring to the table their followings and produce what ended up being quite a lively chat. There was a lot of back and forth and discussion, but when you looked at the end of the chat at the number of messages that supported vaccination versus those that did not support vaccination, the former far outweighed the latter, and it was deemed, yes, a very exciting chat and one that we had to be prepared for and monitor, but certainly, it was one that we felt was very successful.

So it just goes to show that these tactics, and in those early days, so much of this was unknown, these were really again places where we were conducting these as pilot tests. Looking at these opportunities as proving grounds for things that worked well and things that didn't work well, and that would eventually lay the foundation for processes and policies that people would use down the road. Now that doesn’t mean that social media doesn’t change. We’re seeing a lot of change in this environment right now with [Elon R.] Musk taking over Twitter last year and some of the changes we’re seeing around TikTok access. But all of that just goes to show that some of the tried-and-true methodologies and approaches that we used in those early days still work today. We just need to be very cognizant of how the environment is changing and be adapting as we see what works and what doesn't work anymore.

Q: Yes, I appreciate you talking a little bit about the misinformation that can be so prevalent on social media, so, and how you guys planned against that or had a plan to combat these misinformations. So it’s interesting to hear about the early versions, which we know obviously expand a lot during the pandemic.

BURKE-GARCIA: Yes, and just on that, I think it's interesting, right, because I don't think at the time we necessarily even called it misinformation. Or at least, that was not a concept that was at the top of our minds more broadly as a country and as a group of people. But I certainly think that no matter what you do, you treat social media with the same planning and rigor that you would any other initiative that you’d plan for. If you were doing an event or a conference or some kind of media interview, you would be prepared. You’d be prepared for—with your talking points, you’d be prepared for questions that could come up that are hard ones to answer, and you do—and you had to take the same approach, right? You had to have your content planned, you had to have your partnerships planned. You had to have your communication escalation policies in place and have a—everyone who was at the table who was participating really needed to buy into the approach because inevitably, something was going to go amiss, right? Something was going to go wrong and it’s only a matter of how wrong it goes, right? So—

Q: Yes.

BURKE-GARCIA: —if you are all in this together, and there’s an ability to have a common understanding of, okay, how are we going to address a problem that arises, then you don't freak out. And you don't make a mistake in the heat of the moment because you can be calmer and take a more measured approach to how you react to something when it happens. In that first Twitter Moms chat, we saw some of the negative tweets happening. One of the things we looked at—and again, this certainly was a little bit easier to do in those early days, but I think the approach still—still counts, is that how big were the followings of those people, how active were they, what were the—what was the other content that they were posting about? I remember one person posted something, and within the same minute of posting something negative about our Twitter Moms tweet-a-thon, that was on to tweeting something negative about some car brand or some other kind of private-sector brand and so you got a sense for the sensational content that this person wanted to put out there. And, yes, it doesn’t mean that it’s not impactful, it’s not—it doesn’t mean that you can just ignore it, but just be aware of what's going on and monitor in terms of how big is it becoming, all of those things. You need to take all of those things into consideration.

Q: Yes, oh, great. Okay, so that brings us up to 2017. So you’re at NORC, can you tell us a little bit more about NORC? Well, first of all, what NORC stands for and then more about like what are they do—more about the organization itself?

BURKE-GARCIA: I actually came to NORC in 2019, and to answer your question, NORC stands for National Opinion Research Center, but we go by NORC at the University of Chicago. We are an independent, nonprofit, nonpartisan research organization affiliated with The University of Chicago. More than about half of our board is comprised of faculty and staff at the university. But we pursue our own business and projects and collaborate with The University Chicago on a variety of things, but also pursue our own things independently. I was drawn to NORC because it has such a wide variety of work that it does. So we do work in, of course, health, that’s where I sit, I sit in the public health department. But we also have work in education, we have work in economics, we have work in social justice, we do work in transportation, environment.

So there are just a lot of very talented people in this organization doing a lot of really interesting work across a variety of topics. And I loved the mix of academic rigor with what I would consider business prowess. So this idea that we can pursue different types of work, both with federal agencies as well as state and local, but also foundations, associations, private companies. There’s just a big commitment internally at the organization to innovative methods, looking forward to the future of our field and how can NORC help build out and support what that future looks like.

Q: Yes, so tell me a little bit about what you were working on pre-pandemic? So when you get there, it’s 2019, I don't know which—were you there really early in 2019, so you had an entire year or did you get there [crosstalk]—?

BURKE-GARCIA: Yes, no. That’s such a great question. So I arrived in June of 2019, and it was about midway through the year, and of course at the time, none of us knew what was about to happen. And so when I joined, I was working on a couple different things. One of NORC’s cornerstone projects is called the General Social Survey, and it’s this amazing survey that is supported through the National Science Foundation. It’s a national survey of Americans, and it's one of the few surveys in the United States [of America] that really gives a look at a slice of American life. So it's one of the few places where we’ve tracked perceptions around marijuana or gun ownership or gay marriage for the last fifty years. And so those really interesting topics where Americans’ perception of that have shifted so wildly over the last fifty years. The General Social Survey is one of the few places where you can look at those data and see those trends over time and really understanding—understand how American culture has shifted during this time.

I started to do a little bit of work with them early in my—in the first couple of months before the pandemic hit. I also was starting to work on some of my own research. Again, my dissertation research was on social media influencers and health behavior change. And I had an early, small pilot project with a partner of mine, Dr. Amy [E.] Leader at Thomas Jefferson University, and we were collaborating to explore the perceptions around HPV [human papillomavirus] vaccination among social media influencers. And so that was a big focus of mine in those early months of my tenure at NORC. And then as we rolled into 2020, things started to change.

Q: Yes, so all right. So, yes, so now, we’re at the beginning of the pandemic. Tell me about when did you first hear about the pandemic? When did you first year about COVID-19, and what was your impression of what was going on?

BURKE-GARCIA: Yes, it's really interesting. So I think you know this, but for anyone listening, I actually have a book coming out in April called Communicating Through a Pandemic: A Chronicle of Experiences, Lessons Learned and a Vision for the Future. And we can talk about that later if you want, but in the beginning part of that book, I document my earliest memories of COVID and COVID-19. And I remember it was the end of 2019, so before anything had happened right, so before we had called—before we called it a pandemic, before we went into stay-at-home measures. And it was early one morning, and I was sitting on my couch at home, and I was reading the news on my phone.

And there were these news stories of a new virus that had emerged in China and how it was making people sick. The general sentiment was not to worry, it’s not a big deal here in the US and to date, no cases had been found. And I remember thinking in that moment, I wasn't worried, it didn’t make me worried, I had no idea what was going to happen in 2020, but I definitely thought, “Of course, it's here,” I was like, “how could it not be here?” And that’s purely from the fact that people—we travel all the time now from all over the world and so if something was in China, there was a very good chance it was already here. That is my earliest memory of COVID and my thought process related COVID. Again I—

Q: And was it—?

BURKE-GARCIA: —I had no idea of what was to come but that was—that's what I was thinking about at the end of 2019.

Q: Of course, and was it just like gut instinct being like of course, it’s—or relying a little bit about what you've learned from—what you know about public health and everything and how disease is spread?

BURKE-GARCIA: Again I just figured the way that we traveled nowadays and how many people travel internationally every day, I just could not imagine that we were not going to have cases in the United States, I just—I could not believe that. The message to us at the time as there are no cases in the US. I just figured they had to be here, we just haven’t found them yet.

Q: Got you. Okay, so that’s where you first heard about it. So now, there’s a lot that’s really happening in the first—just in January alone. So with the first case coming, the first I guess recorded case, the first reported case in the CDC, so what’s your thoughts on that, what’s happening at NORC and everything? Take me into what is going on at this point in your life?

BURKE-GARCIA: As we rolled into 2020, we were getting into the winter months. I was still traveling, I was definitely traveling in those early winter months of 2020, and I really don't even think that COVID was on my radar. I mean it certainly was occurring perhaps more in the media, but I—definitely, it didn't stop me from traveling yet, I don’t think it really stopped anyone from traveling at the time. Life was just going on, right? So if anything, I was worried about travel in the winter and getting stuck somewhere because of a storm or getting a cold but not specifically worried about getting COVID. I think for me, the early part of 2020 was business as usual and then that all started to very quickly change as we rolled into March. And as things started to very quickly get bad and more cases were showing up and people were getting really sick, we started to go into stay-at-home measures.

Organizationally, we moved people to remote work, and I think there were some adjustments there. Certainly, NORC, like many other companies, have remote staff but moving an entire organization to remote operations took some shifting around and then it was adapting to life at home. Another story I tell in the—in my book is about when all of this started to happen, I looked at my husband, and I was like, “Okay, we need to go to the grocery store to stock up on some things.” We went to the grocery store and as I’m sure you may recall or others listening may recall, it was nuts, it was nuts. The shelves were empty, there was no toilet paper as we would experience for many, many more months. And I remember sitting or standing in the aisle with my husband, and we were like, “Okay, how many cans of beans do we get, how many boxes of pasta do we get, how many cans of beans and boxes of pasta do you need to get through this time?”

We had no idea. We were so naïve as to what would come. So what did we buy? We bought probably four cans of kidney beans, four cans of black beans, and a couple of boxes of pasta, and we went home. And that was not enough in any respect, but it also was saying like we don't want to buy everything off the shelves either, so we’re going to get what we need for at least the shorter term, and we’ll figure the rest out as we move forward. But it was just so wild to be in a situation where you were having to ask yourself some of those questions and not really knowing what the right answers were.

Q: Yes. So you told me in your answer that things started really changing, noticed that shift. What did you notice? Can you remember any kind of specific instances when things started to shift in March that just really stick out to you?

BURKE-GARCIA: I think that some of those just experiences going to the grocery stores, no longer driving to work, waking up and working from home, figuring out new routines, right? So you might have had a routine early on before the pandemic hit, and you would go to the gym and then go to the office or maybe you go to work and then you go to the gym, you go out to dinner with friends, you—whatever the things are that you do, that you spend your time doing, all of that had to be rethought. Some of those early days really meant, okay, how do I operate in this new environment and how am I going to spend my time? And to some extent, I think people thought, Oh, this is going to be a week or two and then we’ll get back to normal, and as we all know now that didn’t happen.

And so while a week or two is perhaps like a mini vacation, and you can give up some of your regular activities or schedule—scheduling that you might normally do. I think after a week or two, people were starting to say, “Okay, we definitely have to figure out something else because we need to—we can’t go stir crazy, we can’t work twenty-four hours a day. We have to have a break, and we have to figure out how to get that reprieve without necessarily leaving the house or hanging out with other people or doing certain activities that might have been the activities we used to do to get that reprieve or get that break in our life. And so I think just some of that basic functioning was really—stands out in my mind from those early days.

And then, of course, for me personally, I think it wasn't too far after March when I started working on what would become known as the How Right Now campaign, and I know we’ll get into that in a little bit. But that really took up a lot of time and space in my life, and so that certainly was something that was a big piece of those days in 2020 as we were at home. Of course, that’s something that stands out to me quite a bit.

Q: Yes, I’m actually going to pause the recording really quick.

[INTERRUPTION]

Q: Okay, so tell me a little bit more about what was going on. You mentioned the How Right Now campaign and NORC going completely virtual, moving the entire organization. So tell me a little bit more about how NORC transitioned into being completely virtual and then the beginnings of the How Right Now campaign?

BURKE-GARCIA: Sure yes, so again, I was not part of these discussions, but from what I have heard and been told, early on in 2020 before COVID was declared a pandemic, folks at CDC were really really looking at what was happening and were together brainstorming what are all of the possible implications of this.

One of the things they identified as a possible negative ramification of this pandemic was the impact on people's mental health. It was really identified early on that some kind of supportive communications effort was going to be needed to be able to provide people with the tools and the tips and the messages that would help them through what was to come. I think even back then, we had no idea exactly how long we would be in stay-at-home measures, how long the pandemic would continue to rage on. But even in those early days, even thinking that this would be something that would be with us maybe perhaps for a shorter amount of time, I think that there was a very clear recognition that the pandemic would have negative impacts on people's mental health and that we needed to do something to help support people.

And so that's really where the idea for what eventually became known as How Right Now originated. Again, I just speak to the foresight and the thoughtfulness with which I think our public health service engages in their work. Because when you're looking at something like a virus, like COVID, that it can—there’s—there is a natural tendency to, of course, prioritize the physical health of people and how do we address those urgent issues. The mental health impacts of the pandemic were profound, and I think that early recognition just speaks volumes to how our public health service is aware of the multifaceted impacts of pandemics and the need for a multifaceted response.

When I say what would become known as How Right Now, it’s—it is again a testament to the belief that something to support people's mental health should be driven by what the people tell us they need or will need. And so it was never necessarily dictated or clearly stated, oh, this needs to be a communication campaign, this needs to be something called How Right Now. Those are elements that all emerged from the research that was conducted very rapidly early in the process of building How Right Now. It was a real commitment to making sure that whatever we built, whatever we stood up was informed by research, was audience centered, and really was reflected—reflective of the needs of the populations that we sought to serve especially in those early days.

Q: Yes, so tell me a little bit about why is it CDC and not SAMHSA [Substance Abuse and Mental Health Services Administration] that’s undertaking this? Do you know why or was that a part of the discussion or anything like that, so why this agency rather than SAMHSA because then—?

BURKE-GARCIA: So, I honestly can’t speak to that. SAMHSA was a very good partner to How Right Now, but this work was initiated out of CDC under their response efforts.

Q: Okay, got you, so, okay, understood. So this is the what are the early conversations. You alluded to it a little bit about how there is this need for people to—that was social distancing measures, that the economic crisis, that it’s going to really impact people’s mental health. Can you tell me a little bit more about what are these early conversations that eventually—how did the How Right Now campaign get started, so?

BURKE-GARCIA: So in May of 2020, the CDC Foundation in partnership with CDC approached NORC to help lead the development of what would eventually become How Right Now, and both of the—of our clients, CDC Foundation and CDC were just incredible partners to us. NORC led this project as the prime contractor, but we had two wonderful partners that collaborated with us, Burness Communications, [Inc.] and TMN [The Media Network] Corp. Burness did our creative and led a lot of our partnership work, and TMN did a lot of our translation or what I like to refer to as transcreation, so not just language, word-for-word translation but really cultural adaptation of our messaging and products for Spanish language. This was a large team, and we came together to do a large job very, very quickly.

But in those early days of the formative research process, we wanted to collect as much data because we had to move so quickly, and we wanted to make sure that we weren’t misinterpreting something or missing a—missing something in our research because we didn't collect data from as many sources. We wanted to answer a lot of different types of research questions like, yes, what were people experiencing but also what did they need to cope, and how could we support those needs, what can we develop in order to help people in this moment, and then who were the trusted voices through which the communities we sought to serve wanted to receive those messages and products and tips and tools. So we had to put together a pretty big plan pretty quickly.

And so we conducted survey research through NORC’s AmeriSpeak platform. We did online focus groups, we did partner listening sessions so that—these were groups that—informal conversations we held that our partner organization, national organizational partners helped convene. We had partner in-depth interviews, so we talked with organizational partners who were on the ground with communities, hearing from them what their struggles were, what their needs were in those moments. We did social data or social listening, so we collected social media data, public conversations about what people were sharing online about what they were going through, what they were experiencing and then we also did an environmental scan and a literature review. And so across all of these data sources, we really distilled out the key needs and experiences and what people wanted to see, what they needed to have in order to be resilient.

And what we found was that people were really struggling, not surprisingly, and as you just mentioned, these struggles were really emerging from the inability to gather with loved ones, to see people that they care about. They emerged from worries over their financial future, disruption to health care, disruption to, you know, worries about ability to put food on the table, the ability to pay this month's rent or mortgage. So all of those stressors were really coming out in the early days of the pandemic as people were being asked to stay home, as businesses were shutting their doors and public places were limiting how people could gather together.

And so we really wanted to capture those experiences and those voices, and people wanted to be heard. They wanted to know that how they were feeling was okay, it was normal, that it was okay not to be okay. I know that’s a statement that is used a lot now, but in those early days, it was really meaningful to people to say like, “This is okay, what you’re going through, it’s totally normal, a lot of other people are experiencing these things.” But there also was this incredible commitment to and a recognition of the need to be resilient and the need to cope and the need take steps forward. People recognize that this is very hard and there’s a—there are a lot of emotions going on right now, people feeling lonely, people feeling scared, people feeling angry. But that they wanted to take steps to be resilient, to cope through this time, to take care of themselves and their loved ones. And so we recognized this need to acknowledge people's experiences and then give them the tools and the tips that would help them cope. What people didn't want to hear was fluffy content, so not anything that was overly superficial or not meaningful or actionable. They wanted really kind of day-to-day tips, tools, steps that they could take, things that they could do, low-barrier, low-cost-to-entry things that they could do to protect their mental health and the mental health of their family and their friends. And so that's really where the idea for this campaign came about out.

The brand name, How Right Now came—we did do brand name testing using a couple of versions. The feedback we got from testing was that How Right Now really resonated with people because it allowed for this nimbleness to be ever present in the campaign, this idea of how do I cope right now in this moment today. So not just trying to fix problems for people for the long term necessarily but also—but really try to say what are the things we can do today and quite frankly as the pandemic rolled out, and we needed to be nimble and responsive as new waves of the virus emerged, as new challenges emerged for people, how do I—how can people cope right now? And so that’s where the name came from, and at its core, How Right Now is a platform for resources, and those resources have been organized by emotion. So you can get information that's tailored to how you’re feeling, and if you don't know exactly how you're feeling, you can click on and look at all the resources. Each of the emotions has an emotion one pager that really articulates what that emotion is all about. And in order to help people understand not just here are the—here are some useful tools for you, but let's break it down, let’s actually talk a little bit about what you're feeling. All of our resources, all of our messaging, all of our content was vetted by a panel of clinical psychologists that worked with us in those early days. We really wanted to make sure that we were giving people evidence-based information that they could trust. That’s the platform that is How Right Now.

And then surrounding How Right Now are a series of messages, products, animated GIFs [graphics interchange format], things that can be shared in social media or in newsletters or in other environments that help share those messages out, that again ring true to the core of the campaign, acknowledging what somebody is going through but also giving them actionable steps they can take right now in their lives to help their mental health. Those promotional or dissemination pieces helped amplify the How Right Now website as the core platform.

One other thing I think is really important to note is we were very aware of the connection between mental health challenges in the pandemic and disruption to basic needs and basic services. So one of the things we didn't want to do is come across as almost tone-deaf to why people were struggling. And quite frankly if people were struggling and just needed some help, How Right Now is there for them too. But we also wanted to provide resources that helped address some of those underlying stressors, and so we created a series of—and we provide on the website links to job bank resources, food bank resources, other types of helpful crisis lines or support lines. So that people can actually get help to address the stressors that are giving them the mental health challenges that they’re actually experiencing. So we wanted to both support their mental health but also acknowledge and support some of those more basic needs that people had been—had in those early days.

Q: Got you. So you did a great job of explaining the reason for the project and the listening sessions and the formative research that goes into. Let’s talk about the products that were created, which you’ve touched on a bit. So can you talk to me more about why was—because it’s a web-based platform, that people can scroll through and to pick up the—why was that chosen as the way—or how was that developed as the way to get these resources out to people? Why was that chosen as the best way to go forward?

BURKE-GARCIA: Yes, it’s interesting, right? Because one of the criticisms or perhaps questions we get about How Right Now is how heavily digitally focused it is, and my response is twofold. One, that at the time, people couldn’t get together, they couldn’t gather. So you might recall some conferences were just canceled outright, but there were lots of conferences that moved to virtual platforms. There were organizations that were hosting virtual town halls or events to communicate with different communities about what was going on, but these were all done virtually, people were not gathering in-person.

And so How Right Now really had to be able to operate in an environment where almost all communication and interaction was happening either via phone, via a laptop, computer, any kind of virtual distance environment. That said, we recognized that we weren’t always going to be in this environment, and that as the pandemic shifted and it’s—especially as vaccines rolled out and people could start to go back out and see people again and socially distance, get together but do social distancing get-togethers. And we did want to make sure that How Right Now could shift into and be available and supportive in in-person environments as well. All of the materials can be printed and have an applicability for in-person use.

So we created a little bumper video that could run in between sessions during a Zoom town hall, right? If you had a break, you could have this bumper video loop, and it would promote High Right Now and its resources. As people were maybe taking a bathroom break or getting a glass of water, but some people may have just been sitting waiting for the next session to begin, so that same bumper that worked well as an interstitial element during virtual events could be played at in-person. So all of the pieces I think worked well for the remote environment we found ourselves in as well as could be then repurposed for in-person as we shifted and can start to gather again.

The other thing I’ll just say is that the reason that we curated a list of evidence-based materials is because what we knew early on was that there were already—there was already a wealth of information and evidence-based information out there, and we didn't want How Right Now to just recreate the wheel. We didn't want How Right Now to create something that already existed, that was vetted, that was created by a trusted partner. What we really wanted to do was curate those great resources and amplify them and then use How Right Now to fill in any gaps. And so that's really where the idea of curating a website full of these trusted resources and then letting How Right Now develop pieces of content. For instance, we have a series of materials focused on how to have emotional conversations, how do you—how can you be a more compassionate listener, and how can you actually start a conversation with somebody you love about their mental health. Those are not easy conversations to have, and so we recognized that. It was something we actually heard in our research, so we created a conversation guide and a compassionate listener—listening GIF that provides phrases to use in lieu of other phrases that are a little bit more supportive and a little bit more compassionate when it comes to people sharing with you their stories about their mental health. And so those were places where we wanted to make sure that we—How Right Now could add value to what already existed in the mental health resource space.

Q: So health equity is basically a big scene of the pandemic and now in public health in general, and we know that the burden for mental health fell more harshly upon communities of color and people who were lower income. So how did How Right now—did it seek to—have like a healthy-equity-focused lens when it was being created? And if so, tell me a little bit more about that and how these resources would have helped out people in the—in lower socioeconomic or people or communities of color so—?

BURKE-GARCIA: I’m going to start broad and then I’ll go to How Right Now, but I think that in two main ways, the pandemic has shined a light on inequities in the pandemic, and these inequities have existed, right? These are not new, they’re not brought on by the pandemic, they were certainly exacerbated by the pandemic, but these are things that have always existed. And I think those two areas are stigma around mental health and systemic inequities, and I’ll tackle each of those in turn. So in terms of stigma, I think that more than ever before, we talk about mental health more, we are more aware of mental health and people's mental health challenges. And I think that, at least I hope that, there’s more compassion for people who are struggling with their mental health than I think ever before. And I think that that comes from the fact that there were people in this pandemic who may have never experienced challenges with their mental health, who for the first time, they did due to the various things we’ve talked about, right, the financial insecurity, the social distancing, the loneliness, the anger or the worry that people were feeling. I think that the fact that people broadly experienced these challenges universally really meant that people understood what it meant to go through and struggle mentally in terms of what they were going through in the pandemic.

That said, I think the other area has to do with systemic inequities and what—and that has to do with whether it's racial, gender-related, or socioeconomic. I think we really saw how the systems in our country don’t support people the same, and therefore when something like a pandemic happens, those who are already struggling, struggle more, and therefore, they carried a greater burden. Whether that's the people who tend to work in jobs that are essential, they are more often people of color, they are more often women, they are people who are, of course, as an industry, make lower wages, have less access to or not consistent access to healthcare coverage. And all of those things contribute to the unfair burden of morbidity and mortality as well as mental health impacts on those communities.

I think that How Right Now really tried to prioritize communities that were struggling from its inception, and in particular, what’s notable in its approach is that How Right Now had four priority audience groups. Of course, How Right Now can support anyone's mental health; however, there were four priority groups that we did want to make sure were prioritized in the campaign and had—and that we did research with and had developed resources for. Those were people ages sixty-five and older and their caregivers, people who are living with preexisting physical and mental health conditions, people who are experiencing economic distress, and people who are experiencing violence. Except really for the group, the sixty-five and older group, those groups are not demographic groups, they are psychographic groups. And what I loved about that idea of focusing on audience groups that were cross-cutting is that it allowed you to get a really interesting mix of perspectives and create resources for people's experiences and thereby addressing those inequities regardless of where you were or who you were, and, therefore, it felt like it aimed to be inclusive of—for people who are struggling at any moment in—during the course of the campaign. I think as the campaign has rolled out and over the course of the pandemic as more data has become available about the disproportionate effects in terms of mental health and morbidity and mortality on African American/Black, Hispanic/Latino, and American Indian or Alaska Native communities, the campaign has pivoted to do new research specific with—specifically with those communities and develop some additional tailored resources for them. And so I think the campaign set out to be as supportive to people who are struggling as possible and then adapted as the campaign evolved to be able to address needs as they were emerging and as we saw things shift.

Q: Got you, so let’s talk a little bit about these materials gathered for all of the targeted groups. So tell me about like did they differ and what went into the kind of—? So if someone had never seen this kind of thing, tell me a little bit about what they would experience in each of these?

BURKE-GARCIA: Sure, yes. So a few moments ago, we talked a little bit about how we tested the campaign name. One of the things we also tested during that process was the color palette for the campaign.

Originally, our color palette was dark. Yes, I think it was black or very dark brown, and I think there were some oranges or some red colors in there, accent colors, and what we heard in our testing was that people didn’t like those colors. They actually wanted a brighter palette, a more hopeful palette. And so what you see when you see How Right Now—when you see a How Right Now resource, it’s a very consistent color palette that is made up of bright blues, bright greens, bright yellows, and oranges, but they all are woven throughout all of the website and then all of pieces of content that get disseminated.

You also will see different types of messages. So for people experiencing violence or for people experiencing economic distress, we addressed those experiences in our—in the copy that’s developed. For people who maybe are living with existing mental health challenges, we use tested tools for reducing anxiety, right. There’s one called the grounding effect, and so we use that, we repurposed that into an animated GIF. As the campaign continued and we created new materials for American Indian or Alaska Native communities, we leveraged the medicine wheel in one of our images. And then through our testing of those, we made sure to incorporate elements of life activities that were really reflective of those communities. So I think that when you see the content, it has a particular look and feel to it, bright and hopeful, and then each of our messages can speak to certain communities in very specific ways.

Q: Yes. Can you tell me a little bit more about the collaborating with these communities to create the content?

BURKE-GARCIA: Yes, so what is amazing about How Right Now and I think a really—another strength of the campaign was that it was never a mass media campaign. The campaign never had a large media buy budget. It was always partnership based, so partners were part of our formative research. They were reconvened partner meetings, brown bags throughout the first year of the campaign to bring the partners into the campaign, to share with them what we were working on, but also to hear from them what their communities were experiencing as the pandemic rolled out. They were part of all of our activations. We had a number of different activations to really amplify the campaign at key moments. So just as an example in October on 10/15, so October fifteenth, we ran an activation focused on taking ten to fifteen minutes be do something for your mental health, and our partners were key to that. They were part of helping to share out those messages, encourage people to take those—that time for themselves and share back what they were doing to protect their mental health. Likewise, as we moved on in that fall of 2020, we—and we got closer to the holidays, it was really our partners who came back to us and said, “This is going to be tough for people. This may be the first holiday without somebody that has passed or they can’t be together with family because of social distancing. It may be a hard holiday because of finances, may be because they’re somebody—a family is not in their home.” So we really heard from them forecasting what was to come, and that allowed this—the campaign to develop resources that then could be shared out during the holiday season that acknowledged how hard it was going to be, and again, provided messaging and resources that could help people during that time.

I think our partners, and there were many of them and—but we—just to name a few here. We worked with Mental Health America, we worked with the National Association of Mental Illness. We worked with the National Latino Behavioral Health Association. We worked with so many great partners, and they all just were fabulous in terms of their commitment to ensuring that How Right Now continued to serve the communities it wanted to and supported them in the right ways and with the right messages and with the right tools for where those communities were in those moments. And so I just can't say enough, they were the heartbeat of the campaign and were really instrumental to making it what it was, and we couldn’t have done it without them.

Q: Yes, so this is all happening. So you mentioned that all of this is in a really short timescale, and so, and to develop something so big and so thoroughly researched, it seems like it really did come out in a very time. So tell me more about the pace of the research and just how—what was that like for everyone working on the project or for—like just for you working on the project? Excuse me, not—?

BURKE-GARCIA: Yes, well—I think I can easily speak for members of the team. It was intense, it was the early days of starting up and getting that campaign launched. It launched on August fifth officially, so by getting it launched by August fifth, we’re—and there’s just really no other way to state it except that they were just insane. They were long days and nights, people working around the clock to get the work done, just constantly being available for meetings or conducting the research, analyzing the data, figuring out, working together with all of our partners to figure out what the right—what the needs were and what the right solutions to those needs were. We worked very closely as a team. We held daily stand-ups, so every day and actually for quite a while, every evening, we had check-in meetings because there was so much going on that we had to meet regularly, and those daily stand-ups were just the large team. Then smaller groups within the team met regularly throughout the day depending on whatever their area was that they were working on. Also notably, our clients were actively involved. They were in every meeting that we were holding, they were giving us tons of feedback and insight. They were just incredible, incredible partners, the CDC Foundation and the CDC on this effort.

And then in addition, we used all different types of different technologies. I think at the time, we were using Link or something like that or Skype, but whether we were calling or texting or IM-ing [instant messaging] or emailing or meeting over Zoom, whatever it was, there were so many touch points within the team that allowed us to ask questions, resolve differences, and move it forward in a timely manner. And then finally, I think the other really powerful part of this was we didn’t divide the team between research and comm [communication] specifically, right. Sure, there were researchers and then there were creatives, but the creatives were part of the research process. So they heard from the research team as we were going through that process what we were learning. They were in the discussions with us about what our preliminary findings and what we were seeing, and they were able to iterate on messaging and creative ideas as we were doing the research so that things were happening iteratively as opposed to sequentially.

And so we were able to—by being a team together where it wasn’t sort of like, oh, the research team does this and then creative team takes the research, it goes and creates the messages and the products. Everyone worked together, and I think that that really created a stronger team, a stronger product, in the end, a stronger campaign. And something that really was just so tied together based on what we learned and then how do you take that and turn it into actionable communication messages and products. It just was seamless, and everyone was so committed to the mission, and I think that that—those were qualities that really resulted in How Right Now becoming what it became.

Q: Yes, do you mind if we talk about your personal life?

BURKE-GARCIA: Sure.

Q: Great, so during all of this going on, I mean you’re still a person living throughout the pandemic, so tell me more about what is happening also just as a person living throughout the pandemic during this time?

BURKE-GARCIA: Yes, and I think I addressed this a little bit earlier on. The first couple weeks feel like you’re—oh, we have to go home, we don’t really know what this is all about, we’re adjusting to teleworking full time. For the moment, you’re like, oh, okay, we can—we’ll get through this, this—not much is changing, right? My husband and I don't have children, so we didn't have the extra challenge of us both teleworking and having our kids transition to at-home school, so, for us, it was a little bit I think easier of a transition. We both also had teleworked at least part time in our careers prior to this so that wasn’t a complete shift for us either. We had our dog Bear throughout the pandemic, and I always—and Bear passed away actually in 2021. But I always think that Bear was our gift in the pandemic because especially for me who was working all the time, Bear was always the reminder of, oh, you have to get up and you have to—I have to go to the bathroom, I have to go for a walk, I have to go out. He was always a blessing that way of giving me the break that I didn't feel like I could take, but that I knew I really needed. And then I think as the pandemic rolled on, it became a challenge, right? We couldn’t do a lot of the things that we normally would do.

I’m a big fan of hot yoga, and I couldn’t go to hot yoga classes anymore. So for me, I’m in this immense period of intense work and the thing that has traditionally in my life given me that break, that mental break, that physical break, it has allowed me to go and just destress, that was taken away. And so finding other ways to be physically active and to have those—have that mental break and have that physical break from the work was a challenge.

Also, it was just me and my husband for many, many months, and we didn’t see friends, and we did not see family for a long time. And so just even thinking about how do we change up our routine, how do we not just Netflix and chill every single day, every single night? Trying to find new games to play, or new puzzles to do, or deciding that some nights we’ll not—we won’t turn the television on so that we just don't zone out completely. We really did try to find new activities that we could do together, but that would be new and different and would help make that monotony of everyday feeling like it was just this hamster wheel of work, television, sleep, work, television, sleep—would help change that up.

Q: Got you. So the How Right Now website launches in August, like you said of August 2020, so tell me more about—you said it—well, that’s not like a big media marketing kind of thing, but does it have any promotional kind of thing? What was the process like to just get the word out? You’ve talked on this a little bit, but can you be a little bit more detailed, so?

BURKE-GARCIA: Yes, sure. So I talked a little bit about how great our partners were, and they were really core to our dissemination approach. But we also did work with social media influencers, we worked with celebrities, and we did do some small digital and radio ad buys over the holiday season in 2020 into 2021. We had some great support from a wide variety of social media influencers. The influencers ranged from all over the country, all different age groups, all different racial ethnic groups, and then we had wonderful support, which was pro bono hundred percent, from celebrities. So Melissa Joan Hart, [James] Lance Bass, several NFL [National Football League] players all lent their voices to support the campaign either through some video content that they produced or some social media posts.

We actually had an amazing PSA [public service announcement] done by the actor Omari [L.] Hardwick, and he talked a lot about the value of conversation and talking when you’re struggling as part of our coping conversations content. If you have not seen that video, it is a beautiful video, you should watch all of the PSAs, but his is particularly wonderful. We also had actors like Danny Trejo who posted in their social media and helped promote the campaign, and then we also had high-profile celebrities like [Kristen] Kris [M.] Jenner post as well. So we were able to engage people at all different levels who reach all different types of communities by—with—by working with these celebrities who I think really understood what people—the hurt that people were feeling in those times and were willing to support at no cost the messaging for How Right Now.

And then our ad buys, we did in social and digital media and in radio in English and Spanish, and that’s an important point that really should not be lost. We’ve talked a lot about how How Right Now is How Right Now. But How Right Now is officially How Right Now/Qué Hacer Ahora, which is the full Spanish language, sister campaign to How Right Now. And all of the research and all of the content for How Right Now was done fully in English and fully in Spanish. As we looked at our data through the fall of 2020, and we saw that our Spanish-language website traffic was actually not as high as our English language website traffic, we wanted to make sure that we were getting into Spanish-speaking communities using the right tools. And so radio, of course, is one that works very well and so that's why we decided to spend a little bit of money to do some radio ad buys.

Q: You mentioned site traffic. So once the sites are launched, how—what does the site traffic look like on both the English and Spanish side?

BURKE-GARCIA: So I think what’s perhaps more important than the actual traffic number was that in our evaluation, we looked at a variety of data sources to just assess how the campaign was performing. It included the website traffic, but it also included our ad buy metrics, our partner activity metrics. We worked with our partners to collect data from them on the activities that they were doing, and we looked at a lot of the data on an ongoing basis. We did ongoing environmental scanning and literature review over the course of the year 2020 to 2021 in order to make sure that we were both aware of what was working, adjust where something might not have been working, and also staying abreast, like I mentioned previously, on what was coming down the pike, what were people experiencing or what were we hearing that people were experiencing or perhaps going to experience as different phases of the pandemic were rolling out. And I think that helped us be nimble and responsive throughout the year, and by doing that, we saw overall increases in our website traffic. So by listening, by listening to what people were telling us, adjusting our campaign approach, we actually continued to increase our visibility of our dissemination activities and our traffic to the website over time, and that’s what we found.

We did our year-one evaluation and it—we finished it up and presented it the summer of 2021, and those were some of the findings. We also, as part of that, conducted another survey using NORC’s AmeriSpeak panel, and we really found that the campaign, by being nimble and responsive, increased its overall reach over time. We were able to show through our surveys and through our survey data that exposure to How Right Now messages had a positive impact on coping and resilience, and that in particular, we saw positive effects, campaign effects for communities that were struggling the most. So those who self-reported the highest levels of stress and discord in the family, those were the same communities that were reporting the positive impacts after campaign exposure. And those communities were people experiencing economic distress, people experiencing violence and communities of color.

I think that it’s profound when you think about developing the campaign as quickly as we did, standing up a national campaign that was not a mass media campaign but was through a—was a with and through trusted voices, partnership campaign. And then to be ongoing—to be iteratively collecting data and assessing performance so that you could adjust your strategies while you’re in market, allowed us to actually do our jobs better and have—and then be able to show positive impacts in terms of coping and resilience amongst those that were suffering the most. As a health communicator, as somebody who’s been doing this for twenty years, this is the high point. This is the high point of working in this field, of doing this this kind of work, and of being able to develop communication products that work. It has just been an immense honor, and I am—I was so excited these results.

Q: Yes. So I’m going to backtrack just a little bit. Because you mentioned about the Spanish language one, Qué Hacer Aror—Ahora—excuse me, really messed that up. Because you mentioned that it was almost like a totally different website, that it was not just a mere language translation, but it was culturally relevant as well, so tell me about the development of the Spanish side of the How Right Now campaign and the—what went into that a little bit more?

BURKE-GARCIA: Yes, I mean it followed the same process that the English website and English version of the campaign followed. If anything, that was why it worked so well is that we created them together. So, again, as I mentioned, all of the formative research was done in English and Spanish and because of that, we had lots of data and lots of information about what people needed both for English speakers and Spanish speakers. And so as we were creating content for the English version, our partner, TMN Corp, they were helping to transcreate that for the Spanish sister campaign. And I think that, again, it was the same process of working together, of not drawing a line between research and communication/creatives, of building these two versions of the campaign simultaneously, not as an afterthought. And so I think that that allowed us to give the same level of rigor to the development of both of them and the same level of attention and detail to both of them. And so, again, we weren't doing Qué Hacer Ahora as an afterthought or as an, okay, now everything’s in English done, let’s just go translate it. it was really that we built the two simultaneously.

Q: Thank you, so—all right. So now, the project’s launched, you did a year-one review. Tell me a little bit more about what was the work done after the thing was launched past that year-one review?

BURKE-GARCIA: So after we completed the year-one evaluation, the—so actually strike that. Before we get to what happened after the year-one evaluation, I want to just take one quick step back and acknowledge that one of the very exciting—one of the other very exciting things about How Right Now is that in the early part of 2021, it moved at—over from living under the CDC response to being a program at CDC. So it now is a campaign out of the Division of—for Population Health at CDC. What is exciting about that is that I think the aim of a response is to be immediate and urgent and swift because of the urgency and to be able to be there to support people during an emergency. And then when that emergency is no longer there, those products or pieces are maybe not needed as much anymore.

I think COVID is an interesting pandemic because I don't know that many people could have anticipated that it would last as long as it did, not specifically the virus but that the pandemic and that the associated mitigation efforts would have lasted as long as they did, and therefore that the response needs would also have lasted as long as they did. That said, How Right Now could have always gone up, supported people, and then perhaps gone away if the pandemic had gone in a different direction and it was no longer needed. But COVID continued and the pandemic continued, and the needs, the mental health needs continued. And so the idea that we could build something that was based in evidence, based in research, and done so well, and then it could be decided that it would move from the response to live on as a program at CDC is just incredible. Because it just goes to show that you create something that is again audience centered, based in data, based in research.

You built it with input from the communities that you're seeking to serve, and you’ve shown that this project and this campaign is actually effective. All of those things allow for this to—for the case to be made that it should live on. And for CDC to say we want to see this continue on is just a—is like the cherry on top of all the other great aspects of working on this campaign. It’s so wonderful to see all of that effort continue on and continue to have support behind it at CDC.

And so what happened after year one is while things were moving over to CDC and some things were being transitioned, we ended up coming—reassessing what the campaign needed to focus on, moving forward. So that's really when we ended up conducting some new work with a focus on disruptions to social determinants of health and doing some new research with racial and ethnic communities such as African American/Black, Hispanic/Latino, and American Indian or Alaska Native communities, creating some new products and then leveraging some partners and doing some dissemination of those products. And then now where we are is we are starting to explore the mental health impacts of the pandemic as well as the broader environment for teachers and school staff, So that is a new phase that we are in, and we just completed our formative work for that part of that phase, and we’ll be developing some new messages that will be—you'll probably start to see those hopefully come out this summer.

Q: Got you, yes, and so you mentioned a little bit about how the campaign could shift to have more targeted messages if forecasting showed that people like—but that there was a need, so like during the holiday season of 2020. Were there any other instances where this was done like the shifting or targeting?

BURKE-GARCIA: Oh well, I think it really happened throughout the—throughout that first year between August—launch in August and the end of the campaign. We went through October and did our 10/15 activation. We did the holiday season push. As we rolled into 2021, we looked towards mental health awareness month in May and then we were starting to wind down and work on our evaluation as that phase was coming to a conclusion. But it was a real effort to look at those data monthly, if not every other month, to make some of those strategic assessments and adjustments at key times. We also wanted to make sure that we kept the website resources list up to date. So we did look at new resources that we may have unearthed through our lit [literature] review and e-scan process to be able to add those to the website and keep those—that list updated and refreshed. And then we also wanted to make sure that we were just aware of what was going on in terms of social media’s pickup of the campaign.

In addition to some of the other things, we were monitoring social data, and one of the things we started to find was that people were taking the How Right Now message, the How Right Now name, but they were turning it into their own creative that was then being used on their social channels. So it wasn't specifically—I talked earlier about the look and feel of the campaign, the bright colors and all of that, but this was people taking the campaign messages and turning it into collateral that was related to their brand and their communities. And in some ways, you might ask, well, oh no, that sounds like it’s a terrible thing, right?

You don’t want your brand to be taken up and repurposed in a different font or color palette or whatever, but at the—it really wasn’t. We did collect examples of what we saw happening, and we did share it back with CDC Foundation and CDC because we wanted them to be aware, and we wanted to have the conversation about what was going on. But at the end of the day, it was considered a success that people were taking these messages and then using them in ways that spoke to their own audiences. It was not seen as, oh, the brand is being turned into something it isn’t, or—it was really seen as we want this to be community driven, and we wanted people to take these resources and use them in ways that were helpful, and that’s what we saw happening.

Q: Yes, got you. So tell me a little bit about—because it sounds like once the How Right Now campaign is launched and everything, it’s still a really intensive project. Were you working on other things professionally or is it just—or was there a time when once—maybe after year one or once it transitions to CDC to where you’re a little bit more free to work on other projects?

BURKE-GARCIA: Yes, so I think that the nature of contracting is that we work on all sorts of things all at once. I have a lot of interests, so of course, this was focused on mental health and coping and resilience and that’s an area that I was—have been extremely passionate about. As we talked about early on, I’m a—one of my passion areas is immunization communication, and so as I had noted in 2019, I had started some work focused on social media influencers and vaccine communication, and that work did continue. So I run, uh, with my partner at Thomas Jefferson University, Dr. Leader, a number of studies focused on exploring social media influencers and their role in vaccine communication and so those studies were continuing at the same time. Yes, so I think the benefit of investing the time in those projects while How Right Now was going on, I see the fruits of that now with some of the projects that I've got going on and some of the new work that has come in since—as How Right Now did taper down in terms of level of effort after year one. So, yes, I did lots of different things, but How Right Now was my primary focus and did take up the majority of my time.

Q: Tell me a little bit more about the vaccine research that you did because you mentioned we talked about earlier about misinformation that existed or way previously that’s—that was on the internet. So tell me a little bit more about this immunization communication work that you’re doing. Are you looking at COVID-19 vaccines or is it just other vaccines in general like childhood vaccines or what have you—what’s your thoughts on—?

BURKE-GARCIA: Yes, so I actually have a couple of studies right now in various stages. They’re focused on different vaccines. So one study I have is looking at social media influencers and the COVID vaccine. This is one that started up in I think 2021. And what we’re doing there, it’s an intervention study, and we recruited a sample of influencers that were either African American or Hispanic Latino, and we interviewed them about their willingness to write about the COVID vaccine. Their messaging approaches, their concerns, really to understand their process, and then we had them write a post, and then each of them recruited a sample of their followers. And in the pre-post survey where they were exposed to their influencer’s message about the COVID vaccine, they—we evaluated. The followers had a set of questions and then were exposed to the message and had another set of questions, and we assessed changes in their responses based on exposure to the message.

That study is actually close to being wrapped up, and what’s very exciting is that we found that after exposure to their influencer’s message, there were statistically significant increases in knowledge about the COVID vaccine, awareness that COVID—the COVID-19 pandemic is serious and intention to get vaccinated amongst their followers. In addition to that, we have another study that's running simultaneously that’s very similarly designed, but it’s focused on the HPV vaccination. The study is—the data collection process is complete, and we’re right now in our analysis phase, so I don't have the results for you for—on that one, but it’s a similar design.

And then right now, we have a new study that's just getting started focused on eighteen- to twenty-six-year-olds, non-college. So eighteen- to twenty-six-year-olds who are not in necessarily a place like a university or a college setting where they would have access to a health clinic. We want to understand where they get their health information and their perceptions of the HPV vaccination. In addition to that, we are also interviewing a series of TikTok influencers about their willingness to talk about health issues and the HPV vaccine on their TikTok handle. So we’re going to learn a little bit about, in that one, this harder-to-reach age group, and we’re going to learn a little bit about emerging influencers on TikTok and their roles in health communication.

Q: Got you. So that brings us up a little bit to the present, correct?

BURKE-GARCIA: Yes, I think so, we’ve talked about a lot.

Q: Of course. So tell me a little bit about your thoughts about the COVID-19 pandemic and where—because you’re really connected to the public health and public health’s messaging in particular especially on social media. So tell me about what are your thoughts about the pandemic in general about where things are going? It’s still ongoing even today even though it definitely feels like a different stage than the earlier years. Yes, just tell me about it.

BURKE-GARCIA: Yes, as I reflect back on this time, there are a couple of things that I think about. The first is that this is—the pandemic has been both a terrible experience, but there have been silver linings that have resulted from it.

So, of course, there are in she—the sickness and the death and the mental health challenges and the loneliness and the fear and worry that people have felt. Those are all terrible experience that we’ve gone through. But in other ways, I think we have some new appreciation, or at least I hope we have some new appreciation for some of those things that we missed during that time. So whether that's being with family and friends again, whether that's realizing how lucky we are to do the activities that we once maybe took for granted. There are days when I don’t want to go to yoga, but I make myself to go to yoga because there was a period when I couldn’t go to yoga. I think that the awareness of people's mental health challenges, I think the awareness of the systemic inequities that have come to light in a pandemic while those experiences are not—they’re not positive, I am hopeful that the more we talk about these things and the more that we are aware of these things, that more can be done to address them.

I really believe that we shouldn’t forget, I think we shouldn’t forget what we’ve been through and what we’ve learned that other people have been through for generations before the pandemic just because we can go to restaurants again and just because we don’t have to wear our masks on planes anymore or whatever it is. Whatever the thing is that you get to do now again, I really hope we don't lose the memories of this time. Because I think that we are at a point, at a pivotal point where there is an opportunity to make some big strides, and it will be unfortunate if we don't make the effort to actually make those changes and to make them for real, not to make them because they’re in the media right now or they’re getting a lot of attention, but really because we care as a community, as a global community and as a nation about all of our people right, about all of our people.

We are deeply connected to one another even though we are all living our own lives, and I just really hope that we recognize that. And while it doesn't feel like that in our communities right now necessarily in our nation, we feel very divided, I think that we need to work towards that. We need to work towards an understanding that having compassion for one another, caring about the health and safety and well-being of our fellow person is paramount. Because their lack of success or their inability to thrive impacts us even if it's not in our day-to-day. We may not feel it when we go to the grocery store or something, but if somebody else is not doing well, we are all—we’re all not doing well. And I don’t think that we could be a nation and move forward successfully if we’re not trying to raise everyone up.

And then I would also acknowledge that one of my other my hopes is that we recognize the importance of public health infrastructure and just how much work our public health workforce does. Those people who have toiled under the response, who have given up their time with their families, who have given up their own physical and mental health, at times I'm sure, during the pandemic for the sake of others. And that we really recognize the need and the importance of this workforce and that we make some strides to fund it better, train people better, include more diverse voices at the table to ensure that our public health policy as we move forward is inclusive and supports all of those things I just mentioned about making sure that everyone can thrive, not just some of us.

Q: Great, thank you. So is there anything else that you want to share with us today that you didn’t touch on?

BURKE-GARCIA: I don’t think so. I just want to thank you again so much for having me and for letting me share a little bit about my work and my experiences. And just a big thank you to my NORC colleagues, my Burness and TMN colleagues for How Right Now—our collaborations on How Right Now. To the CDC Foundation and to CDC for all of the work we've done together over the past couple years but also just all of their efforts to make this world a better place and a healthier place.

Q: Well, thank you so much, Dr. Burke-Garcia.

BURKE-GARCIA: Thank you, Heather—

Q: Of course.

BURKE-GARCIA: —it’s been a pleasure.

Q: Yes.

[END OF INTERVIEW]

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