The Drum Beat 805 - Hesitancy, Engagement, and Polio

• 1.Meeting the Challenge of Vaccination Hesitancy
  The papers in this compendium from the Sabin-Aspen Vaccine Science & Policy Group look at the multiple layers and root causes of vaccine hesitancy, laying out actionable steps to build confidence in vaccines and vaccinations, to strengthen vaccine acceptance, and to promote timely immunisation. The Group proposes three "big ideas": (i) create a new collaborative partnership between the vaccination community and social media platforms; (ii) develop a prioritised research agenda to generate knowledge about sources of vaccine hesitancy and the evidence to inform mechanisms to counter it; and (iii) craft a strategy to shift the conversation around immunisation to one that focuses on its many benefits. The latter involves reaching beyond traditional public health and vaccine advocacy groups to find and engage non-traditional players, including local activists, entertainers, politicians, patients, and members of disease advocacy groups. [Jun 2020]
   
• 2.Insights into Vaccine Hesitancy from Systems Thinking, Rwanda
  by Catherine Decouttere, Stany Banzimana, Pål Davidsen, et al.This study explores the mechanisms underlying vaccine hesitancy in Rwanda that contributed to local underimmunisation for measles and a subsequent measles outbreak. Using the 3Cs framework (confidence, complacency, and convenience), it analyses immunisation service delivery and derives a conceptual model of vaccine hesitancy to assist in the design of sustainable interventions. For example, government-led information and vaccination campaigns, community advocacy, and direct communication from community health workers (CHWs) during home visits can be capitalised on to boost the perceived benefit of vaccination and community engagement. [Sep 2021]
   
• 3.Overcoming Vaccine Deployment Challenges among the Hardest to Reach: Lessons from Polio Elimination in India
  by Alejandra Bellatin, Azana Hyder, Sampreeth Rao, et al.A key challenge in the final years before India was certified polio free in 2014 was resistance from vaccine-hesitant groups. In Uttar Pradesh, for example, vaccine hesitancy among vulnerable, healthcare-deficient groups was indicative of their mistrust towards nonessential government interventions. Thus, starting in 2008, the polio campaign pivoted to horizontal health care, where polio vaccines were bundled with additional medical services or medications to address the community's most basic needs, as defined by the community itself. Organisations involved in polio elimination observed preexisting social structures and identified key actors who could improve the efficiency of the vaccination effort, because "advocacy of vaccine uptake is more effective when it comes from ingroup members." [Apr 2021]
   
• 4.Community-based Strategies to Engage Pastors Can Help Address Vaccine Hesitancy and Health Disparities in Black Communities
  by Lois Privor-Dumm and Terris KingDespite the promise of COVID-19 vaccines to curb the pandemic, many members of the African-American community distrust them and the system that touts them, given a history of structural racism and mistreatment and many other current concerns. This paper presents a framework to build trust and acceptance, including: understanding history and context; listening and empathising; engaging Black pastors as trusted messengers; creating partnerships with shared responsibility and power; and co-creating solutions with faith leaders and their community, governments, and institutions to create sustainable, long-term change. [Mar 2021]
   
• 5.Development of a Culturally and Linguistically Sensitive Virtual Reality Educational Platform to Improve Vaccine Acceptance within a Refugee Population: The SHIFA Community Engagement-Public Health Innovation Programme
  by Samantha Streuli, Najla Ibrahim, Alia Mohamed, et al.Having carried out a community health assessment and identified the drivers for a low rate of vaccination in the Somali community (e.g., cultural and language barriers, distrust in the healthcare system, and the misinformation that vaccination results in autism), a group of researchers developed a virtual reality (VR) vaccination education platform with and for a Somali refugee community in San Diego, California, United States. They find that VR can effect behaviour change through content that is culturally relevant and appropriate to varying levels of health and digital literacy, that stimulates an awareness and expectation for what vaccines do and do not do, and that provides an immersive experience. [Sep 2021]
   
• See also:
  Caregivers' Willingness to Vaccinate Their Children against Childhood Diseases and Human Papillomavirus: A Cross-Sectional Study on Vaccine Hesitancy in Malawi
  

• 6.Tackling Inequities in Immunization Outcomes in Urban Contexts
  by Robin Nandy, Helen Rees, Jeff Bernson, et al.Many of the world's fastest growing megacities are in low- or middle-income countries, where inequities - such as in immunisation coverage - can be stark. The Equity Reference Group for Immunisation (ERG) suggested that unimmunised people may not seek health services in part because of mistrust of the system or discrimination. Through collective action (e.g., community forums), communities can hold health systems accountable for service delivery, improving engagement and quality. Media campaigns that include community voices were suggested to the ERG as methods to address hesitancy and misinformation and encourage behaviour change to increase demand. Traditional routes (e.g., radio, television) have made for effective campaigns. The increasing prevalence of mobile phones, internet access, and social media provide another type of opportunity for community engagement in urban areas. However, over-reliance on these technologies can widen inequity based on gender, as women own mobile phones at a lower rate than men. [Dec 2018]
   
• 7.Strategies to Improve Coverage of Typhoid Conjugate Vaccine (TCV) Immunization Campaign in Karachi, Pakistan
  by Farah Naz Qamar, Rabab Batool, Sonia Qureshi, et al.In Pakistan, a lack of community awareness, misconceptions, religious beliefs, illiteracy, rumours, and fears related to vaccines circulating through social media contribute to vaccine hesitancy and resistance. In response to the emergence and spread of extensively drug-resistant typhoid, a mass immunisation campaign was conducted in Lyari Town, Karachi. A multi-component campaign approach incorporated several strategies to raise awareness and increase engagement at multiple levels of the community, which helped reach the target immunisation coverage rate and earn the community's trust, cooperation, and support for typhoid vaccination. One reflection: In the case of urban slum areas, pamphlets, handbills, banners and announcements alone are not enough; opportunities for open, direct communication with parents and children are important. [Nov 2020]
   
• 8.Gender and COVID-19 Vaccines: Listening to Women-Focused Organizations in Asia and the Pacific
  From the Asia-Pacific Gender in Humanitarian Action Working Group, this report provides a picture of gendered barriers to COVID-19 vaccine uptake and supply, supplemented by analyses drawn from a virtual listening session with women-focused organisations on the COVID-19 vaccine rollout in Asia and the Pacific. One example of a recommendation that emerged: develop strong platforms and action plans for risk communication and community engagement to ensure people are receiving the necessary information on COVID-19 vaccines - e.g., develop targeted and inclusive materials for key population groups, such as transgender populations, to transform behaviours for adoption of the vaccine. [May 2021]
   
• 9.Effects of Faith Actor Engagement on the Uptake and Coverage of Immunization in Low-and Middle-Income Countries (LMICs)
  by Sara Melillo, Doug Fountain, Mona Bormet, and Carolyn J. O'BrienThe United States Agency for International Development (USAID) MOMENTUM initiative undertook a global landscape analysis to bring to light existing evidence and common themes around vaccine hesitancy relating to faith. Among the evidence-based recommendations included here: Engage religious leaders and church structures in social mobilisation (SM) and advocacy; address religious concerns about vaccines through theological analyses, dialogue, and sensitivity; communicate effectively in response to concerns about the halal status of vaccines; engage faith-based organisations in the rollout of new vaccines; and leverage church infrastructure, faith-based health facilities, and rituals for vaccination points, including in humanitarian settings. [Jul 2021]
   

• OTHER DRUM BEATS OF INTEREST
  The Drum Beat 795 - Resuming and Ramping Up Polio Activities Toward Eradication
  The Drum Beat 769 - Vaccine Hesitancy in the Polio Context
  The Drum Beat 755 - Community Engagement for Polio Action
  The Drum Beat 740 - Governance in Community Decision-Making Related to Polio Immunisation
  

• 10.THSTI-CGPP Sabin Vaccine Hesitancy Project 2019-2021: Final Report
  With the goal of promoting vaccine acceptance, CORE Group Polio Project (CGPP), in collaboration with the Translational Health Science and Technology Institute (THSTI), assessed the effectiveness of a SM intervention to increase communication skills and vaccine confidence among Accredited Social Health Activists (ASHAs) in Nuh District of Haryana, India. Data show that the CGPP-THSTI intervention was able to address mothers' concerns and reduce vaccine hesitancy in the intervention areas through: home visits by ASHAs using indigenous and pictorial communication material and distribution of "Timely Immunization Certificates" to motivate parents; village-level meetings; awareness generation through a decorated mobile van with space for street plays/magic shows; and improvement of immunisation session sites.
   
• 11.Significance of a Social Mobilization Intervention for Engaging Communities in Polio Vaccination Campaigns: Evidence from CORE Group Polio Project, Uttar Pradesh, India
  by Manojkumar Choudhary, Roma Solomon, Jitendra Awale, Rina Dey, Jagajeet Prasad Singh, and William WeissCGPP India's network of social mobilisers called Community Mobilization Coordinators (CMCs) achieved high coverage of polio vaccination during Supplementary Immunization Activity campaigns (SIAs) in polio high-risk areas of Uttar Pradesh, India, during the effort to eradicate polio from that country. This paper quantitatively measures the extent and outcomes of CMC CE in SM interventions and polio SIAs. The SM intervention led to at least an 11-percentage-point increase in the CE of CMC areas over time, with about 17% of this achievement attributable to CGPP India's SM efforts. The researchers assert that this increase "made a great difference in engaging communities and building the herd immunity, as most of the CMC areas had pockets of resistance to polio vaccination." [Mar 2021]
   
• 12.Perceived Enablers and Barriers of Community Engagement for Vaccination in India: Using Socioecological Analysis
  by Tapati Dutta, Jon Agley, Beth E. Meyerson, et al.India envisions CE as a strategy for improving vaccination uptake and increasing both communities' understanding of vaccines and their demand for immunisation as their right and collective responsibility. Previous studies have emphasised CE's potential for community-led monitoring and advocacy, community equity, and, ultimately, community control for specific health services. This study reveals that, despite the overarching support for CE in India, its conceptualisation, facilitation, and implementation in different scenarios (e.g., for sub-populations) remain elusive. Furthermore, some existing strategies perceived to be CE may inadvertently reinforce existing power differentials. The data from this study indicate the importance of including CE indicators in national datasets and developing a compendium documenting CE best practices. [Jun 2021]
   
• See also:
  Vaccine Hesitancy as a Challenge or Vaccine Confidence as an Opportunity for Childhood Immunisation in India
  

• 13.30 Years of Polio Campaigns in Ethiopia, India and Nigeria: The Impacts of Campaign Design on Vaccine Hesitancy and Health Worker Motivation
  by Abigail H Neel, Svea Closser, Catherine Villanueva, et al.This analysis focuses on how interactions between the polio programme and the health system influence two key outcomes: frontline health worker motivation and vaccine hesitancy. These two factors, in turn, affect OPV campaign coverage. For example, strategies like frequent campaigns were often quite effective in the short term, but over years, especially when combined with poor incentives and lack of supportive supervision, drove worker fatigue in powerful and at times corrosive ways. Across place and time, effective CE, carried out by motivated workers, led to greater levels of community trust in the workers themselves and, by extension, the vaccination campaign. [Aug 2021]
   
• 14.Vaccine hesitancy: Perspective from the global polio eradication program in Balochistan
  by Jawahir HabibFrom the blog: "Sitting in my apartment in Geneva, my thoughts inevitably return to the streets of Quetta, Balochistan (Pakistan) where I led a network of community health workers in Quetta Block who went door to door to raise awareness and immunize children against poliomyelitis.... In areas as impoverished as Balochistan,... the key is to identify their needs, to hold open dialogues, to listen to their concerns, and to truly advocate for services that will improve their quality of life.... [R]ather than concentrating solely on knowledge, efforts to address the phenomenon [of vaccine hesitancy] must be based on social research, be proactive, and focus on tailored community engagement." [Oct 2021]
   
• 15.'When You Welcome Well, You Vaccinate Well': A Qualitative Study on Improving Vaccination Coverage in Urban Settings in Conakry, Republic of Guinea
  by Julita Gil Cuesta, Katherine Whitehouse, Salimou Kaba, et al.A study was conducted to understand reasons for suboptimal vaccine uptake during a 2017 mass measles vaccination campaign in urban Conakry, Guinea. All health professionals and the majority of caregivers interviewed said that, to increase trust in the vaccination campaign, CHWs should be locally recruited, have local-language competencies, and be familiar with the neighbourhoods. Specific examples included the need for extending an appropriate greeting and introduction, speaking politely, and being suitably dressed. Without adequate attention to these components, caregivers described their reluctance or refusal to vaccinate. [Jan 2020]
   
• 16.Social Mobilization Campaign to Tackle Immunization Hesitancy in Sargodha and Khushab Districts of Pakistan
  by Muhammad Nauman Malik, Masood Sarwar Awan, and Tariq SaleemIn Pakistan, blatant refusals of vaccines are being replaced with immunisation hesitancy. CHWs consulted for the study considered advocacy meetings with local influencers, community group sessions, door-to-door visits by CHWs, and mosque announcements to be the most relevant and appropriate interventions for SM. CE is most effective in rural and hard-to-reach areas when CHWs are skilled in interpersonal communication. One proposal was to develop specific information, education, and communication (IEC) materials on a regular basis to engage religious leaders, politicians, healthcare workers, etc. in immunisation issues at the social and community level. [Dec 2020]
   
• See also:
  Sustaining Vaccination Coverage: Continued National Commitment to Primary Health Care with a Strong Focus on Community Engagement - Case Study Sri Lanka
  

• 17.Enhancing Acceptance and Demand for Vaccination in the Western Pacific Region
  by Ananda Amarasinghe and Lisa MenningGiven that vaccine hesitancy and its determinants are often highly context specific, the WHO Regional Office for the Western Pacific notes that targeted and tailored approaches are required. Thus, this regional guide is intended to support Member States to: increase awareness and understanding of concepts related to demand and vaccine hesitancy; determine the reasons for non-vaccination and vaccine hesitancy; inform the assessment of behavioural and social drivers for vaccination; advocate for investment in evidence-informed strategies to enhance acceptance and demand for vaccination; and build social science capacity to support the application of a more people-centred approach. [Apr 2020]
   
• 18.Addressing Vaccine Hesitancy Challenges: LNCT Workshop and Webinar Resources
  The Learning Network for Countries in Transition (LNCT) is a country-driven network dedicated to peer learning to support countries as they transition away from Gavi support to full domestic financing of their national immunisation programmes. In support of that mission, LNCT hosted two events in late 2019/early 2020 that focused on vaccine hesitancy, and this page provides access to some of the resources available to all (non-LNCT members), such as interview recordings with two participants who discussed their experiences addressing vaccine hesitancy challenges in their country (Vietnam and Armenia).
   
• See also:
  A Toolkit for Engaging Non-Health Stakeholders in Supporting Routine Immunization in Uganda
  

PLEASE HELP US EVALUATE OUR OWN WORK: THE CI SURVEY

What kinds of challenges and opportunities infuse your communication and media development, social and behavioural change work? This survey is a chance for you to let us know! We will report back on results and trends so you can gain insights from your peers in the network.
Click here to lend your voice.