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Asha Nwaki always believed COVID-19 was real.

The 18-year-old's father described the devastation he witnessed from the frontline as a nurse. Yet Nwaki just wasn't convinced that she needed to be vaccinated against the virus. How bad could an infection be, she wondered, if the hardest-hit patients were older, often sicker adults.

"It's not going to touch me," she thought. Not even the threat of the Delta variant prompted Nwaki to consider vaccination.

If she did become sick, Nwaki imagined making a full recovery after a miserable week in bed. She felt that couldn't be worse than the vaccine's side effects, which can include fever, chills, a headache, and in rare cases heart inflammation known as myocarditis.

So instead of getting the shot, she mostly stayed at home with her mom. She masked in public and avoided crowds. Nwaki was content to take fewer risks and remain unvaccinated until a few months ago, when she met Dr. Cindy Duke, a fertility expert and virologist.

The two sat down to talk about the vaccine under unusual circumstances: They were filming a public service announcement created by the Ad Council.

With its campaign, the nonprofit agency hoped to reach some of the 30 million people between the ages of 18 and 24, a group with the lowest vaccination rate amongst adults in the U.S. Only 55 percent are fully protected against COVID-19. But instead of lecturing unvaccinated participants, the Ad Council decided to pair them with loved ones, or someone like Duke, a trustworthy expert who wouldn't judge their hesitancy.

The Ad Council's research, which included focus groups, led to a clear conclusion. What young unvaccinated people wanted was an open, empathetic conversation about their concerns. Importantly, family and friends motivated them most to reconsider their position. This might surprise those who assume that testimonies from social media influencers or celebrity endorsements (Ariana Grande, anyone?) have more sway over young adults. But it turns out their impact is limited. What really matters is one-on-one interactions, including with friends, family, and romantic partners, an insight that could lead some of the unvaccinated 18- and 24-year-olds to finally get their shot. A few of the PSA participants have since indicated to the Ad Council that they plan to get vaccinated.

During the pandemic, Nwaki spent time on social media, seeing both news reports about vaccine safety as well as positive and negative commentary from Instagram and Twitter users. One of her favorite Instagram accounts, The Shade Room, helped shape her opinion. With 25 million followers, the pop culture-focused account has posted content related to questioning vaccine mandates, and people frequently share skeptical or disapproving comments related to the vaccine.

"Every single person I saw was like, 'No we're not getting the vaccine,'" says Nwaki. "And I think sometimes you see everybody else's opinion toward something, and you think, well, everybody else is not going to get it, everybody else is on the fence, so I'm on the fence too. We're just going to all be on the fence, and we're just not going to get it."

But Duke gently persuaded Nwaki in ways she didn't expect during their hour-long chat.

The one-minute clip of that discussion features Duke telling Nwaki that contracting COVID-19 while pregnant significantly increases the chance of miscarriage. Nwaki, a recent high school graduate has no plans to become a parent soon, but knows well her mom's struggles to bring her into the world. The knowledge that a COVID infection could end a pregnancy was news to Nwaki. The vaccine itself doesn't negatively affect fertility, though persistent and widespread misinformation insists there's a connection.

It also mattered to Nwaki, who is Black, that she was talking to a Black woman and physician. Nwaki, who hadn't spoken to a doctor about her reservations, felt she could inherently trust Duke, who is vaccinated. They compared experiences as Black women who care deeply for their mothers. Duke urged Nwaki to consider getting the vaccine to protect her own 55-year-old mom.

"That hit my heart, what she said about that," says Nwaki. "If something happened to her because I decided to be irresponsible and not get the vaccine, I would be crushed, completely. That would break my heart. I would never want to put her in jeopardy."

Heidi Arthur, chief campaign development officer of the Ad Council, said that the agency hoped to capture people connecting on a deep emotional level. A longer PSA features intense conversations between pairs of unvaccinated and vaccinated people, including two best friends.

"If you was to die, man, that would literally kill me," says the vaccinated friend with tears in his eyes.

"If it made you feel that way, bro, I would probably do it," the friend responds.

The Ad Council wants the average person who fears for an unvaccinated loved one's life to try similar conversational tactics. The point isn't to start a debate that ends with shouting, but to express care and compassion to a friend, spouse, or family member while listening to their concerns. A conversation guide produced by the Ad Council includes tips like leading with empathy and patience while avoiding belittling and overpromising that the vaccine, by itself, can make everything "normal" again.

Arthur acknowledges that the approach has its limits. It's really for the wait-and-see crowd rather than people who've rejected the vaccine outright. She also says it's important for the unvaccinated to recognize how hard their reluctance might be on their loved ones.

"The person who's hesitant has to understand the frustration on the other side too, particularly for those who've been on the frontline for well over a year, seeing the devastation and seeing the impact for those who've not been vaccinated," says Arthur.

Even that brief admission could help a vaccinated person, weary from the pandemic and heartbroken that someone they love remains vulnerable to COVID-19, summon the empathy to have one or several conversations about that fact. At the same time, Arthur notes that it's helpful for someone who's pushing a loved one to get their shot to understand how that could take a toll on the other person.

In general, trusted figures and peer-to-peer interactions play a critical role in persuading the vaccine hesitant. A program in Fresno, California, trained Latino teens to become "promotoritos,"or junior community health workers. After 80 hours of training, they become paid interns of community-based organizations and answer questions about COVID-19, correct misinformation, and encourage neighbors and relatives to get vaccinated.

To counter skepticism of the vaccine based on fears of medical racism, the Ad Council produced a separate PSA earlier this year featuring descendants of the men involved in the U.S. Public Health Service Syphilis Study at Tuskegee who, without their consent, were enrolled in a study that withheld treatment for syphilis. In the five-minute spot, relatives of those Black men explain how that injustice led to new ethical practices to ensure the safety of studies and medical interventions, like the COVID-19 vaccine.

It's credible voices like these that Arthur believes can meaningfully shift people's opinions.

Nwaki says that history of medical racism influenced her initial decision about the vaccine.

"The system, a lot of the times, isn't for you," she says. "We were just used as test subjects. For us, it's like OK, we're going to wait until everybody else gets it. We're going to see what effects everybody else is going to get, and then we'll choose what it is that we want to do. We're not going to be the first in line this time."

In September, Nwaki finally made her choice and got vaccinated. The decision led to an immediate reward: The ability to attend an upcoming BTS concert that requires COVID vaccination or a negative COVID test.

"I think it's really important to have an open conversation about your hesitancy," says Nwaki. "People feel like we can't talk about this, we can't say anything. No, you need to talk, you need to speak. If we're not having a conversation, it's not going to benefit anyone."

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