By Ridhi Arun & Claudia Sosa Lazo

On mornings when public transportation is crowded, we’re reminded of those early moments of the COVID-19 pandemic when being close to other humans was daunting; when we wiped down groceries for fear of an invisible virus festering in a tomato; when intimacy was interrupted by a 10-foot valley; when reported case numbers made clear that some of us were at greater risk than others—showing us that even a virus could discriminate.

Uncertainty was the mantra of the moment; we knew so little. As epidemiologists, scientists, and public health officials scrambled to understand what we were working against, an uphill battle to effectively inform an already skeptical public loomed large.

Three months before the FDA granted use of the first vaccine, IDEO.org partnered with the National Resource Center for Refugees, Immigrants, and Migrants (NRC-RIM) and the Centers for Disease Control and Prevention (CDC) to develop community-driven solutions to build vaccine confidence and increase uptake among Refugee, Immigrant, and Migrant (RIM) communities. Collaborating with over 100 RIM leaders and 25 community-based organizations, we co-designed six adaptable communications and service toolkits that spoke to the unique needs of each community in their language. The open-source availability and adaptability of the materials saved organizations time, labor, and funds in creating tailored assets from scratch.

Reflecting on these two years, we realize that this work wasn’t just about designing a pandemic response—it was about building health communication and service frameworks that met people where they are in their health journey, no matter where that might be. While the pandemic plunged the world into unfamiliar waters, many communities deal with similar challenges with well-researched health issues, lacking thoughtful, culturally relevant health communications to inform their decision-making.

So, what, if anything, have we learned since March 2020?

1. Customize First, Scale Second

Designing for customization and scale shouldn’t be competing goals. When building the “Vaccination Is” campaign toolkit, we found that the Congolese community in Dallas had vastly different concerns than the Congolese community in Boise, Idaho. The Ukrainian community in Seattle required specific messaging strategies unrelated to those of the many Latinx communities in Maryland. Naturally, no single set of colors and visuals spoke to a clear majority, so how could a single campaign lend itself to scaling across diverse communities?

Our solution was pretty simple: create easily adaptable and accessible assets nearly anyone could customize for their community needs. We bet that if we built a campaign with strong bones, accompanied by step-by-step guides and best practices for adaptation, our campaign would lend itself to scale. By focusing on concise key messages rather than long-form copy, relying on user-friendly tools (yes, google slides) much of the material was straightforward to adapt. Scaling here meant democratizing design by providing user-friendly tools and creating the conditions so almost anyone could shape these materials to speak to the fears, aspirations, and realities their communities held.

Diana Haj Ahmad, our senior communications design lead who led several projects in this program, said it best:

“I want to hand over something that continues to give and give for a long time, not something that expires and ends up in a digital dump. I want to co-create something functional, sustainable, and useful, with a life beyond the close of a project, program, or contract. Then, if a design does reach its expiration, it’s because a need has been resolved, and not because the deliverable is outdated and no longer relevant.”

2. Elevate Existing Wisdom

A perennial lesson: don’t reinvent the wheel; trust that people hold the wisdom to design solutions for their own needs. The success of the Vaccine Confidence program is largely owed to the insights that our community participants and co-designers brought to the table from their pre-existing work and deep relationships with communities.

For example, early in our process, co-designers highlighted that promoting COVID-19 vaccinations for the Ukrainian community in Seattle required balancing encouragement with personal choice. Community leaders shared childhood stories of enforced vaccination and the collective trauma that ensued. As one leader said, “We just want them to consider the vaccine again and make a decision for themselves”—a key insight that drove our messaging approach.

In healthcare, those with degrees and accolades are often seen as the ultimate authorities, while those without such traditional credentials are not given the same platform to express their opinions. Rarely is there an opportunity for individuals and communities receiving information to share their knowledge and help shape messaging and strategies to ensure their needs are met. By bringing in co-designers and deeply engaging with community members, we hoped to flip this script. In this space, our role as designers was to equip communities to confidently articulate their ideas and provide them with the right tools to explore without constraint. Then, we brought the magic of turning their ideas into tangible solutions.

3. No Game in Shame: Acknowledge Fear and Doubt

There is no winning formula for changing someone’s mind, especially around a highly sensitive and polarized topic. But if there’s one thing we’ve learned, it’s that acknowledging someone’s doubts is a critical first step: it establishes trust, makes people feel heard, and creates the conditions for a two-way conversation.

When developing Honest Conversations with Canal Alliance, a service campaign created to foster community dialogue about the vaccine, we opted to highlight the stories of everyday people, especially skeptics, to demystify and humanize the vaccination experience. We found that this approach was considerably more effective than deluging a hesitant audience with facts and statistics.

To spur conversation, our team designed fill-in-the-blank templates for community members to share their personal vaccination experiences. The templates included a section for users to describe their initial fears and guided them in illustrating how their thoughts evolved over time. These personal narratives were then shared at local community events, creating a powerful ripple effect by encouraging others to process and work through their own doubts. Rather than approaching hesitant individuals from a place of shame, inclusive and empathetic dialogue allowed for understanding and ultimately, higher levels of acceptance.

Looking Ahead

Horizontal collaboration with our community co-designers unlocked the most powerful insights and learnings critical to this program’s success. As of February 2024, the materials from the Vaccination Is campaign had been downloaded over 9,000 times by users across the country in all 11 available languages. And in a community fair in Marin, California in September 2022, Canal Alliance used the Honest Conversations toolkit to vaccinate over 100 people while encouraging over 50 passerby to share their vaccination stories.

As we continue to design a future grounded in the health and wellness of all people, we remain committed to prioritizing trust, empathy, and tailored approaches in our health communication frameworks. To meet every person at any stage of their health journey is to honor their dignity and recognize the preciousness of their life.

Finally, we would like to conclude this reflection with an expression of deep gratitude to all the community co-designers whose voices and imprints are threaded deeply throughout this work, and to our partners at NRC-RIM and the CDC who made the work possible.

Ridhi Arun is a Design Research Lead who has worked alongside refugee, immigrant, asylum-seeking, and migrant communities throughout her career. She holds an MS in Global Health Sciences from the University of California, San Francisco.

Claudia Sosa Lazo is a Senior Business Design Lead with a background in product management. She holds an MBA from the Yale School of Management.