Episode 8: Fighting COVID with Art

Because art is a powerful tool for connecting with communities, building stronger relationships between artists and public health programs may be a way to increase people’s confidence about vaccines. On this episode, cartoonist Lalo Alcaraz and Jill Sonke, director of the Center for Art in Medicine at the University of Florida, join us to explore the question, “What role could artists and culture bearers play in discussions of vaccine confidence?”


Talasek: Welcome to The Ongoing Transformation, a podcast from Issues in Science and Technology. Issues is a quarterly journal published by the National Academies of Sciences, Engineering, and Medicine and Arizona State University. I’m J.D. Talasek, the director of Cultural Programs at the National Academy of Sciences. On this episode, we’re in discussion with cartoonist Lalo Alcaraz and Jill Sonke, who is the director of the Center for Arts in Medicine at the University of Florida. We’re coming up on two years since COVID first began altering our lives, and it doesn’t seem to be going away, despite the tools we have to reduce its impact—including a highly effective set of vaccines. The decision to be vaccinated or not to be vaccinated is often rooted in cultural and often very personal reasons, which begs the question that we’re going to address today: What could the role of artists and culture bearers play in discussions of vaccine confidence? And I’m very excited to have this conversation with both of you. Lalo, Jill, thank you so much for joining us today.

Sonke: Thank you, J.D. Happy to be here.

Alcaraz: Thanks for having me.

Talasek: Absolutely. Lalo, let’s start with you. I’d like to ask—it’s kind of an origin/background story: What motivated you to become an artist, a cartoonist? And take that up to how you became involved with discussions around COVID vaccines.

Alcaraz: Just yesterday, I think on Instagram, a user asked me, “I would love to know what your process is?” And I said, “Well, my process is I get pissed off and then I draw.” And that is the origin story, basically, of why I draw cartoons. I grew up on the US-Mexico border in San Diego and Tijuana, and my parents are Mexican immigrants. And I just kind of grew up with a sense of injustice, seeing how my parents were mistreated, how the system mistreated them, and then watching it happen to me too. You go to school and they tell you all this stuff about how great the US is and how everyone’s equal and all that, but I wasn’t buying it because I was getting treated as a second-class Mexican immigrant, even though I was born in the US or whatever.

It just kind of made me reflect and sharpen my sense of irony. I carry that chip on my shoulder to this day, that when I die they’re going to throw me in a hole and I’m still going to be mad. And that’s good, I think, because it’s my gasoline, it’s my fuel, it’s my motivation. So looking at how the inequities in the Latino community, specifically for the project I’m working on now, specifically with the farmworker community in the Central Valley of California.

Talasek: Lalo, you might also describe that in detail for those who aren’t familiar with that project.

Alcaraz: Sure. So the project that I’m working on, the campesinos, the farmworkers of the Central Valley of California. The Central Valley is a place with lots of glaring inequities in work conditions, healthcare, income, you name it. It’s really stark and the community suffers from misinformation on vaccines and healthcare, lack of healthcare, and also results in vaccine hesitancy for many reasons. And so the project that I’m working on is in conjunction with the ASU School of Transborder Studies. I’m the virtual artist-in-residence for that, it’s really nice, and I work with Dr. Gil Lopez, and we have created a series of about 15 editorial cartoons in English and Spanglish. We’ve done a couple in Spanish I believe, and Dr. Lopez has also facilitated other artists to do artwork, culturally resonant artwork, that reaches out to that population of farmworkers and Mexican Americans and Mexican immigrants that reside in the Central Valley. But it’s really been a campaign that’s taken off, so I get to use all my cartoon tools to spread science, which is nice.

Talasek: That’s wonderful because Jill also has a lot of experience and perspective on this integration of art with medicine, even predating this pandemic, as director of the Center for Arts in Medicine. Jill, I wonder if you could tell us a little bit more about your role at the Center for Arts in Medicine, and the conversations that you’ve been a part of recently regarding vaccine confidence.

Sonke: Sure, J.D., thanks. I have, as you mentioned, been director of the Center for Arts in Medicine at the University of Florida since 1996, when we created it. I was working at the time as an artist-in-residence in the hospital. Dance is my primary artistic background. So in my role as director of the center, I oversee academic programs, I also focus quite a bit on research. I run two research labs at UF: one that does an array of prospective studies, mixed method studies, primary data collection and analysis, and another, which is called the EpiArts lab, it’s a National Endowment for the Arts lab. And we do epidemiological studies, in partnership with Dr. Daisy Fancourt at University College London, that associate arts participation with an array of health outcomes at the population level.

I began conversations with the CDC when I was invited to meet with the COVID-19 vaccine task force’s vaccine confidence and demand team in the spring of 2021. And in June, I was appointed as a senior advisor to that team in order to expand the conversation in the United States about how artists and culture bearers can be engaged, and how the arts can be engaged, in vaccine confidence work, just like we’re hearing from Lalo, it’s such a beautiful example. So in that work, I’ve created field guides for guiding both partnerships and health communication programs and campaigns and helped support the effort that just awarded $2.1 million in grants from the CDC Foundation to arts organizations all around the United States.

The reason that I was invited to work with the CDC is because many of the members of the task force at the CDC are public health professionals who have worked in emergency public health situations around the world and recognize that you would never mount a major public health campaign without artists, and without songs, and drama, and film, and all of these art forms. Why would we approach this pandemic without artists when we know how important they are in these moments?

Talasek: Yeah. That reminds me of what happened during the ’80s during the AIDS epidemic, and how it became so evident that the gay community was effective at communicating protocols and safe sex practices within their community that it became sort of a model for understanding that one public service announcement doesn’t fit everyone—that it’s not just an issue of stating information and just assuming that people are going to absorb it; there’s a lot of cultural filters that we go through. Lalo, I’m kind of wondering what you have found to be effective, or even exciting? Maybe even some of the responses from the community that you’ve experienced in this direction.

Alcaraz: Sure. Well, as a political cartoonist, I am used to getting hate mail from everyone, including the community, but overall I think the responses have been very positive. When I do a political cartoon that’s not vaccine related for my regular editorial feed, the whole point of it, to me, is to get the community to—I’m not trying to brainwash anybody, but I want to at least start a discussion, or at least have them understand how to talk about an issue. For instance, immigration, I do a lot of cartoons about immigration, and regular people on the street don’t really know sometimes how to talk about that or think about it. And I hope that I help that conversation or that consciousness come.

I sweeten the conversation with some sugar: some comedy, some satire, some cultural images. I will use images in my regular cartoons to make a point, to get across to Latinos, and everyone else can read them too. And so the response for the vaccine cartoons has been kind of along the lines of the responses we’re all getting from the wide community: some people love it, some people accuse me of being in the pocket of big pharma, other people have called me a sellout. And I’m like, “If I’m a sellout for wanting farmworkers to be healthy, then I’m the world’s biggest sellout.” It’s alright. I’m used to all this battering anyway.

Talasek: I want to make sure that Jill’s part of this conversation too. Because I know one of the discussions that comes around this is we are engaging with artists for a lot of different topics—vaccines being one of them, creating conversation and empathy around climate change—there’s always this sort of issue of engaging with the artist or using the artist. And there’s got to be a sensitivity on our part that this is not—I heard somebody put this perfectly a couple of weeks ago, that the role of the artist is not to communicate but to expand our imagination. Jill, I know that you and I have talked about this before, but I wonder if we could dig a little bit more into that as far as the sensitivities in the ideals of how we engage or use artists in these capacities. What’s the word on that?

Sonke: J.D., I appreciate this line of dialogue so much, and I’ll start by reflecting a bit on Lalo’s comment, which I loved. It’s not about brainwashing. It’s true that something we’ve been really sensitive to in the development of these field guides with the CDC is that we’re not seeking to use artists to persuade people to get vaccinated—though the goal is vaccination—but rather to understand that artists do facilitate dialogue. As people engage in the arts, they engage with characters, storylines, narratives that they relate to personally and culturally. And in doing so they’re able to consider their own lives, their own values, their own decisions.

That’s really important because health communication isn’t, as you said, J.D., about providing factual—I mean, it is about providing factual information, but it isn’t that information that leads us to change our behaviors. We know a lot about what is and isn’t good for us, but we make choices because things are culturally relevant, or they nourish or benefit us in other ways. So it’s really important that we recognize that this isn’t about the arts persuading or brainwashing, but facilitating that dialogue.

And around the notion of using artists, that is language that I feel particularly sensitive to. We often do hear people talk about using the arts or using artists for particular goals. And for me, what’s really important in that, and this reflects, I think, a cultural orientation to the arts in the United States—our arts can be a bit hierarchical and exclusionary, there is a social gradient around the arts, who participates, who doesn’t—and so when we think about partnering with the arts, other sectors will often think, “Well, let’s reach out to artists because if we engage them it’ll be really great for them. It’ll give them great opportunities for exposure. They don’t need to be compensated because this is what they do, artists love doing what they do.”

Talasek: Yes. Artists are supposed to be starving. You can’t be a starving artist if—

Sonke: —If you get paid, right? So there’s an undervaluation of artists in our culture. There’s also an undervaluation of the knowledge and the expertise that artists hold. And in this moment with the pandemic, what artists know about engaging people in dialogue, what artists know about capturing attention, what artists know about translating information in understandable ways, and in culturally relevant and personally relevant ways, has tremendous value. Public health needs these understandings. We see this again playing out more in other countries, but in this country, the public health sector really needs this understanding. And so I advocate very strongly for really equitable cross-sector collaboration in which everyone is compensated equally, all forms of knowledge are valued equally, all forms of communication are valued equally. And I think this is a moment where we have the potential for greater understanding of the value of artists as equal partners in these spaces.

Talasek: I would also add to that just based on my experience of bringing artists into the conversation earlier, in the planning, in the discussion stage, as opposed to, as you were alluding to, Jill, the idea of that it’s an add-on value. It’s something that we decide what we’re going to do and then we ask an artist to illustrate or communicate.

Sonke: Yeah. To make something prettier or more exciting.

Alcaraz: I agree with you 10,000%. And it made me think of one of the cartoons. The themes that kind of popped up in our campaign to reach out to Latinos is through the most obvious way, which is through the family situations and portrayals of the family. And we kind of discovered this character, Tío Rigo, Uncle Rigo, who kind of—sometimes cartoon characters will tell you what they want to do. If you’ve been a cartoonist long enough, I know it sounds crazy, but the characters start having a life of their own. Tío Rigo ends up being that conservative uncle that we all have that is a little over the edge. And we kind of started not using him as a punching bag, but portraying the family situations where he can’t go to the party where everyone’s vaccinated or masked. He refuses to get masked and vaccinated. And we all have that guy in our family—he probably won’t hear this podcast. But it’s that portrayal of the Latino family that we hardly get to see in TV and the media. We only get certain portrayals, the narco family or something. In my cartoons, we have this very average family in this extraordinary situation of this pandemic. And I think people like to see themselves. I bet you, Uncle Rigo in everyone’s family will love seeing themselves even though we kind of slap him around a little bit.

Talasek: That’s a wonderful example and I appreciate you sharing that. I would say, Jill, since you’ve had experience with a broad section of artists who are working with communities, and also in this sort of position of eventually evaluating some of these so that we can learn from the experience, what are maybe some other examples that you’ve come across with other communities and other artists who are working maybe in a different medium?

Sonke: There are so many great examples happening right now and the guides feature some of those examples, the CDC field guides. But I really love, for example, what’s happening in Lalo’s home state of California, in San Francisco with the Creative Corps program, and at the state level with the Creative Corps program, the major financial investment on behalf of the state and local governments to invest in artists in this moment. So in San Francisco, for example, the Creative Corps is designed to employ 60 community artists as community health ambassadors, so putting artists overtly in the position of being ambassadors in communities and preparing them with accurate and up-to-date health information so that they can be facilitating those dialogues in small groups and in broader ways through arts participation.

I also love the White House has the Shots [at] the Shop program. It’s a program of similarly educating barbers and hair stylists, because they’re folks who are talking to people, who have time to sit one to one with people in communities, so preparing them with, again, accurate and up-to-date health information so that they can facilitate those dialogues.

I also really love what’s happening in New Orleans. We were talking about New Orleans earlier, J.D., and they are just doing a beautiful job of embracing Mardi Gras culture. They implemented early in the pandemic a program where they’re engaging those Mardi Gras performers and Mardi Gras traditions, everything from popup performances on the streets to billboards around the city that use that culture as a relatable means for people to consider vaccination in their community.

Talasek: Those are really wonderful examples. Thanks Jill. Since both of you are in the trenches, are there questions that I haven’t thought to ask? Are there issues or concerns that you would like to bring up?

Alcaraz: Can I jump in and say, what Jill just said made me think of the challenges of implementing that up-to-date information. I mean, it’s a back and forth with me trying to come up with a concept and then having it alter the punchline because it’s scientifically wrong. I’ve never been in that space where I’m like, “Well, this punchline is not scientifically correct.” I’d never thought of that before in my life, but here we are. Just yesterday, an animation that we were working on, the punchline was a Thanksgiving dinner and the turkey believed in social distancing, ba-dum-bump. The turkey’s running away from Thanksgiving dinner.

And the client, which was the State of California Department of Public Health, said, “You know, social distancing is going to trigger someone because that’s a past protocol that we’re not really embracing right now.” And I’m like, “You just killed my punch line.” But I came up with another one because that’s what we do. That’s a cartoonist’s superpower, I think that’s an artist’s superpower, is taking a massive concept and simplifying it. And that’s always fun for me.

Talasek: Yeah. Taking something complex and simplifying it, but also making us feel the complexity in a way that you can’t articulate with words is another sort of role to manage.

Sonke: I think there’s so many layers of that, that are really important right now. I especially love, Lalo, the way your work draws people in individually, and it has a collective impact as well. I mean, it’s reaching a lot of people. It exemplifies the ways in which the arts do draw people in. I mean, if I have a choice to look at a standard informational public health billboard as opposed to a comic, I’m a little more interested in that comic. Similarly, standard PSA or really beautiful music video—I’m going to be drawn more into those mechanisms. And as Lalo articulated, the arts have a way of clarifying information; they also use mechanisms like melody, rhythm, repetition. They use aesthetic mechanisms which we know not only draw people in, but they linger in the senses, they stay with us.

And when people have aesthetic experiences that are paired with ideas and information that’s important to them, they’re very likely to talk about those experiences to others. We know from work that’s been done, for instance, in Uganda with HIV health behaviors, that the people who hear about, for instance, a radio drama from someone who heard it and is impacted in those ways, that person who hears secondhand through that social learning process is even more likely to change their behavior. So there’s a lot of power to delivering information in these aesthetic ways that linger in the senses and that people want to talk about, because I’m affected by the passion of someone I trust. And it’s going to help me again consider my own values and be more likely to lead to a really sustainable or approachable behavior change. Lalo, I would love to hear, what are you hearing from people who read your comics?

Alcaraz: Well, we recently had an event to showcase the artwork in the Central Valley. We went to Merced, California, and did a special appearance for a couple days there, and the reaction’s great on the ground. I’m encouraged that the nonprofits that are on the ground are welcoming the artwork and the effort, the thrust. These people are going to swap meets and getting people vaccinated and just giving out good information. They’re going to swap meets at 6:00 in the morning on Saturdays. They are on the ground reaching out to where the people are at. That’s the part where I’m not involved, I just create the stuff and I send it off. And I hope that the various agencies that are involved with our program are handing it off, getting it delivered, getting it to eyeballs. But I’m encouraged by all the other organizations that aren’t involved that want to get the cartoons and distribute them. I’m like, yeah, hell yeah. So I feel encouraged by the organizations on the ground that want to expand on this concept. And we’re breaking new grounds.

Sonke: One thing I’m super excited about that I think is going to emerge here is new partnerships that can be sustained and used for other public health needs and issues. I think the relationships being made in your program, such a beautiful example, Lalo, between public health programs and professionals and artists and culture bearers will serve not only this moment, but probably even more so after those organizations have more experiences of working together, getting to know each other, and seeing the value across each sector in the partnership. So I’m really excited to see what’s going to happen.

And that’s one thing that we’re excited about continuing to look at from a CDC perspective, as well as how sustainable and durable these partnerships will be in the future. The arts, I want to say, came organically to bear right away in COVID. When people started engaging the arts, artists started making work about COVID right away. So that happened organically, but the connection between the public health sector and the art sector was slow to come to bear in this pandemic. And I really hope that we’re building a foundation now that will be able to come to bear much more efficiently and quickly in whatever health emergencies come our way in the future.

Alcaraz: Yeah. You said it. I was about to say it, it still feels like an emergency and that’s why I jumped into it when I was approached by Dr. Lopez. He had told me, years ago, we had met over a bowl of menudo in Boston, in the Cambridge area because we were at a conference at Harvard—that was our origin story. But he told me, “We’re going to work together one day,” and then boom, this thing happened. I hope it goes on and we’re less of being in an emergency situation where—it’s stressful enough to come up with cartoons on deadlines. We’re fighting a fire here, you know.

Sonke: That’s right. I mentioned Uganda earlier; I’ve done a lot of research on how the arts are used in health communication and public health in Uganda. And when I’ve been there, I’ve had more than one artist say to me, “Thank God I’m an artist, because I can always work.” Because the arts are so central to public health. And I really hope that we will get there in this country as well with recognizing the importance of arts and culture in public health.

Alcaraz: Since we’re cross chatting here, I’ve mentioned my parents were Mexican immigrants. Children of immigrants are basically translators and we become mini adults. And we have to navigate bills, and the contact with the schools, and also doctor’s offices. I mean, I can’t tell you how many doctor’s offices I was in as a child, and I had to translate for my mom what was going on. But being in those offices, I always remember the posters inside the offices that are kind of graphic, like a cross section of your intestines and your heart. And those would always fascinate me, but they were kind of just these kind of passive, anatomical posters with their charts. They didn’t have much life to them—or they were a pitch from a pharmaceutical company. But I’m excited, this is a new thing and I’m really digging it.

Talasek: And Jill, I wonder, what would you say are the next steps? I mean, you talked about having this sort of methodology and this protocol set up for other crisis situations. What do we need to do to build this network and to build this protocol that we could go to more quickly, as you say? What would you say are the most urgent needs?

Sonke: So, I think there are a number of things that will be helpful in this regard. One is just that the major public health organizations like the CDC need to be more aware. That’s happening right now, the World Health Organization has launched a major arts and health initiative, the CDC is on board. We need also to be measuring outcomes. Right now I think we’ve got strong theoretical and lived experience framework that we’re building from. There is some really good research from other parts of the world in particular, and we need more research in the United States to really understand the potential power and efficiency of these methods to impact health communication. And I think what’s important in that is that we need to measure how they’re an important partner in health communication as well.

And I think policy and funding always come to bear. So these partnerships that we’re advocating for have needed funding. Fortunately, the CDC Foundation has stepped in, in partnership with the National Endowment for the Arts to make funding available. The National Association of Museums has also funded thus far 50 arts-based vaccine confidence programs taking place in museums and libraries. And they’ve got another RFP out now. So there are really great individual examples, and I mentioned the state of California before as well. But I think we need to put in place funding opportunities from major funding agencies that combine departments of those agencies that are often separate.

Health most often works separately from arts and culture in those funding organizations. So I think funding organizations need to be providing more cross-departmental, or cross-unit funding, or braided funding opportunities, because it’s taken us well over a year to get those funding opportunities in place in this pandemic. So I’d love to see them in place going forward—not just for emergency situations, but for all of the health issues that we’re working on every day and the health inequities that we’re working on every day in this country.

Talasek: Jill, thank you. I wonder if you could tell us what are the websites or locations we can go to, to find more information about the work the CDC is doing on the field guides, as well as your work at the Center for Arts in Medicine?

Sonke: Sure. You can go to the CDC website, cdc.gov/vaccines/covid-19/vaccinate-with-confidence, and you’ll find the two field guides there. You can also find those field guides on the Center for Arts in Medicine website. We also developed a repository of programs, so you can find examples of programs, organizations working in this space, a lot of resources there. And there’s a webinar featuring the CDC and National Endowment for the Arts and artists who are doing this work. Those resources are available both on the CDC website and on the University of Florida Center for Arts in Medicine websites.

Talasek: Wonderful. Thank you, Jill. And Lalo, one of the disadvantages of being a visual artist on an audio podcast is we can’t see your work. Where could we see your work?

Alcaraz: Trust me, it’s beautiful and very effective. You can go to covidlatino.org and look for it there. We just got a new web guy that’s going to revamp the site so that people can download the art, print it out, do whatever they want except make t-shirts. I mean, don’t make t-shirts of my art—or mouse pads. But you can go there and see all the art cartoons I’ve done, and also the other artists from Arizona that have done some standalone pieces. And then they have some animation that they’ve done. And we are working on a new animation that’s a little more raw called Super Vaccine Vato, and he is a cholo superhero that interacts with Tío Rigo, that one uncle.

This thing’s headed into new dimensions with animation for me, so it’s really great. Real quick, for the future I would love to tackle diabetes in the community, plus all the other problems we got going. But diabetes I think is a really—one of my haters (and I love my haters) said, “Why weren’t you concerned about heart disease or diabetes?” Well, you can’t give me diabetes, I give that to myself. I can’t contract diabetes from you because you’re not vaccinated against diabetes. But it is an endemic problem in the Latino community. I know people who have suffered from it, and I would love to do something on that and just the wider issues, we got so much.

Talasek: Well, I suspect you saying that opened up a lot of doors, so I think you should get ready. Jill, Lalo, both of you inspired me so much. Thank you both for joining us. Art is a powerful tool for connecting with and communicating with many different communities, and both of your work have shown us the value of building a strong relationship between artists and public health programs.

Thank you for joining us for this episode of The Ongoing Transformation. Check out our show notes to find links to Lalo’s artwork, the CDC field guides, and other resources. Please subscribe to The Ongoing Transformation wherever you get your podcasts. Email us at [email protected] with any comments or suggestions. If you enjoy conversations like this one, visit us at issues.org and subscribe to our print magazine. I’m J.D. Talasek, the Director of Cultural Programs at the National Academy of Sciences. Thanks for joining us.