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What Can We Learn From the WNBA's Vaccination Success?

A player-led process helped the league become the first in North American sports to reach the 99% milestone.

Last winter WNBA commissioner Cathy Engelbert sat down to speak with the executive director of the players union, Terri Jackson. The COVID-19 vaccines would roll out to the general public by that spring, and, with the league’s season starting in May, both women knew that achieving a high vaccination rate among players would be a priority.

Engelbert asked Jackson what she thought the league could do to make that happen. Jackson had an answer ready: nothing.

She knew that any vaccination effort would require a strong focus on player education and on streamlining basic logistics. But the most important ingredient, by far, would be trust. And for players who might already be skeptical about getting the shot, it would be much easier to build that trust if the conversation started as one among teammates, not as a meeting with an employer.

“What I said to Cathy was, ‘You’ve got to let me do this,’ ” Jackson recalls. “We, PA staff, we knew we had to do this. We knew that it had to come purely from the players association, because we are the players, we report to them, and they trust us, period, the end.”

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She explained to Engelbert the rough contours of what she was planning: One-on-one outreach to players to gauge their concerns would form the basis of panels with health care professionals on Zoom, where the focus would be on creating an open, shame-free space for everyone to ask questions.

The league agreed to give the union the space to launch that effort without trying to duplicate it. And it worked.

In June, the WNBA became the first major North American sports league to announce that it had reached near-total vaccination among its players, 99%. (In large leagues, a perfect 100% is a long shot without something like a mandate.) Other leagues have approached the WNBA's milestone in recent months. But none have been able to announce that they have made it all the way there yet—which has made for some occasional bumpy moments. In MLB, a handful of teams remain below the league’s desired vaccination level of 85%, even as outbreaks have affected the playoff outlook for some clubs below that standard. The NFL, which announced a vaccination rate of 93% at the end of August, expressed interest in proposing a vaccine mandate for players earlier this summer.

Other leagues have crossed the 90% threshold, with some nearing even 95%, far above the national vaccination rate of about 55%. The NHL says it hopes to be at 98% when its season starts in October. But the WNBA remains the gold standard. And the league’s path was aided by not only its relative size (MLB has to account for about five times as many players; the NFL, 10 times.) but also its pioneering, player-led approach to outreach.

“I think that was what made players comfortable, to be honest,” says Dream forward Elizabeth Williams, who was one of the player leaders of the vaccination campaign. “If the league were to mandate it and we didn’t feel like we knew enough about it, I don’t think people would have gotten vaccinated. But because as player leadership, we were saying, ‘Hey, here’s an opportunity to ask all these questions and not feel bad about it’—I think that was kind of what made people feel more comfortable, not feeling that extra level of pressure.”

Dream forward Elizabeth Williams helped spearhead the WNBPA's vaccination effort.

Dream forward Elizabeth Williams helped spearhead the WNBPA's vaccination effort.

Williams had followed news about vaccine development closely. The daughter of health care workers—her father is a gastroenterologist and her mother a nurse—she followed updates on the process last fall when she went to play in Turkey after the WNBA regular season ended. But as clinical trials advanced, Williams found that she had questions about just how the vaccine worked, yet with half-truths and hostility flying around the internet, it was getting more difficult to parse all the information that she was seeing.

“For me, it was kind of like, if I want to have these questions answered, I can’t imagine how the rest of the league feels,” she says.

Williams is the secretary for the executive committee of the WNBPA. In October—more than a month before the Pfizer and Moderna vaccines would receive emergency-use authorization from the FDA—she brought an idea to Jackson: We should be getting out in front of this. Misinformation seemed to be ramping up. It was getting more and more complicated to figure out where to seek reliable guidance. If the union wanted to ensure that players would be able to make educated choices about vaccination, they should be putting together an outreach program, and they should not wait to start until the shots were widely available. They should start to work on their plans right away.

But there wasn’t immediately an obvious answer for how to make that happen. Whatever they did needed to be engaging—a fact sheet sent out over email wouldn’t cut it—but it also needed to be something that players could save and come back to with time to process. It needed to be accessible to all players despite the fact that most, like Williams, were playing overseas for the winter, scattered across various time zones. It needed to be informative but still easy to digest. And it needed to address players’ concerns specifically: What exactly did they want to know? Where did their fears or hesitations lie? Who did they want to hear from?

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The WNBPA landed on a layered approach. They would set up a series of panels with researchers and experts—three sessions on Zoom, held at different times so that every player would be able to easily access at least one, no matter what time zone they were in. But first they would canvas the players to learn which concerns to focus on and talk to the invited experts about the kind of environment they wanted to cultivate: open and participatory, with plenty of space for questions, no matter how silly or small they might seem. The sessions would be recorded so that players could rewatch later if they wanted to. Finally, for a league whose players had long focused on community activism and social justice—with causes from voting rights to police brutality—they would make it clear that educating themselves about the vaccine was part of that mission, too.

“If Black Lives Matter is what we’re about, then in the public health space, this is really big for Black and brown communities,” Jackson says of the message sent by the player leadership of the WNBPA, citing the fact that Black Americans have been disproportionately hospitalized with and died from COVID-19. “We better be informed, and we better be ready to show up.”

The process started with team union representatives reaching out to their fellow players in November and December. These one-on-one conversations were not designed to persuade anyone or to apply pressure. They were just loose chats: How are you dealing with the pandemic right now? Is there anything in particular about the vaccine that makes you nervous? What do you want to know more about? Most of the conversations were fruitful. Players felt comfortable being open—they were talking to their teammates, after all, rather than to a stranger or to a person sent from their employer.

The players leading the conversations kept track of concerns that came up consistently and collected them in a spreadsheet. (“We’re spreadsheet people,” Jackson says of the WNBPA. “You name it, we put a spreadsheet together for it.”) Some of the most popular questions were mainstream ones that had been easy to anticipate: Players wanted to know more about what clinical trials were like and how long the vaccines had been tested. Others were more specific: “As a league of women, a lot of questions were about fertility and how it would affect us long-term,” says Williams. “And there were a couple of questions about us as athletes—if the vaccine might affect us differently.”

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The WNBPA used this list of topics to help select which experts to invite. (To address fertility questions, for instance, they sought to add OB-GYNs and other women’s health experts to the panels.) For a league that is majority Black women, they made sure to include female researchers of color. And when Jackson reached out to make those requests, she was open about the sort of environment that they were hoping to have in these January and February Zooms: The players might have a lot of questions, and they were aiming for candid, judgement-free conversation.

Jessica Malaty Rivera, an infectious disease epidemiologist and research fellow at Boston Children’s Hospital, was one of the experts invited to speak. She was heartened by what she saw when she logged on. If the pandemic had given Zoom a reputation for situations where people felt like speaking into a void, to a sea of black screens with no feedback, this was the opposite. The WNBA players had their cameras on. They were nodding their heads when the researchers made important points. The chat was active with questions. And while there was naturally some lingering skepticism, there was “zero antagonism,” says Rivera.

“There was no snark. There was no laughing during the myth-busting. It was all earnest,” she says. “I think that trust is one of those things that we don’t even realize is so valuable until it’s lost, and by maintaining that trust, you keep people’s attention. I felt like because I spoke to them not as a scientist who would make them feel dumb for not knowing these things already, but as a peer, as a fellow woman of color, as a fellow mom, they trusted me. That went a long way.”

That approach resonated with players like Alysha Clark. The Mystics small forward had initially been hesitant about the vaccine: “I was on the fence about it. I’m not going to lie,” she says. “I want to know everything there is to know before I put something in my body, and I didn’t feel comfortable with all the information and misinformation that was out there.” She was playing in France when the union started its vaccine information sessions, and she logged on to one from a bus, listening in as her team made its way to a road game. She didn’t know how she would feel about what she heard. Ultimately, though, there were two key factors that convinced her to eventually get the shot.

One was that the panels felt like “a safe space” for players without league leadership present. “It’s a business at the end of the day. The commissioner … it’s not that we mistrust her, but there’s that thought there,” Clark says. “The fact that the PA helped alleviate that concern and those fears by reaching out to independent medical professionals, that just added another layer of trust, right?” The second was that she had space to ask questions and time to think about it all. She didn’t log off from her first Zoom completely certain that she would get vaccinated. But she did log off feeling like she had been taken seriously and like she had more information than she had previously. After taking a while longer to consider what she had heard, she felt secure in the decision to get the shot.

“Those conversations with those medical professionals are what helped me get over the hump,” she says.

Jackson was excited by the level of player engagement that she saw on the Zooms. There were players who showed up to multiple panels. Several reached out to thank the presenters individually. Some asked for recordings of the sessions to share with vaccine-skeptical family and friends. Lynx forward Natalie Achonwa even kept in touch with Rivera by following her on social media and did a joint Instagram Live with the researcher when she was able to get her shot in April—giving her followers a look at some of the topics that had been discussed on the panel and asking follow-up questions about side effects.

“When we got through the Zooms, and we heard the questions, and then we got the feedback coming from it, I thought, Oh, my goodness, we’re not just going to get a B on this,” Jackson recalls of her initial guess that maybe they could hit a vaccination rate of 80%. “We’re going to get an A.

Jackson had been optimistic about the WNBPA’s vaccination work months earlier when she had asked Engelbert for the space to put it together unimpeded. But this participation surpassed even her highest hopes, and she was especially proud that it had been player-led, with teammates trusting each other and showing up for one another.

The WNBA did not make Engelbert available for an interview but did respond to questions with a statement:

“From day one on the job as Commissioner, we have been leading with a player-first agenda, and we highly value the relationship the league has with the WNBPA and WNBA players,” it read. “Our mutual success depends on a positive and collaborative relationship. And I’m proud of and commend the players for their leadership in getting the vaccine and serving as role models across all of sports and society.”

Mystics forward Alysha Clark was initially hesitant about the COVID vaccine, but was persuaded by the WNBPA's approach.

Mystics forward Alysha Clark was initially hesitant about the COVID vaccine, but was persuaded by the WNBPA's approach.

The WNBPA’s original aim was not such a high vaccination rate. It simply was to encourage players to feel empowered and educated about their choice.

“Initially, that wasn’t even the goal,” Williams says of the 99% milestone. “The goal was just to allow people to make informed decisions. But as more information came out and more players got vaccinated, I think we just kind of moved towards it.”

The players who had not felt comfortable getting the shot by the start of the season gradually changed their minds as they saw their teammates getting the vaccine and encountering minimal side effects. By late June, a little more than a month into the season, 99% of them were fully vaccinated.

It’s tricky to extrapolate lessons from the WNBA to the general population, says Harvard health policy professor Robert Blendon, who has studied vaccine hesitancy and skepticism. But there are some points here that resonate with what has been observed nationally. One is that the outreach started early—it’s much easier to encourage vaccination if people start from a point of uncertainty rather than a place where they have already made up their minds against it. Another is the focus on experts who come from backgrounds similar to the players.

“That’s incredibly important, who they hear it from,” says Blendon. “Because if it’s put together by the management or the teams, they might say, Oh, they have their own interests. There are other factors. They don’t really have my interests in mind.”

The WNBA’s players are encouraged that other leagues’ vaccination rates have been catching up to them. But they don’t consider their work finished: Their next step is sharing what they’ve learned. In August the union announced a partnership with the Black Women’s Health Imperative for the fall called “Take the Shot for the Win,” offering information from their own vaccine education to Black women across the country.

“I think it helps that we’re practicing what we preach,” says Williams. “We went step by step. We started, O.K., let’s ask questions, let’s reach out to people who know more and then let’s move forward. And so being able to share that testimony of what we did—I think that’s what’s really powerful.”

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