Vaccine Champions Training Program: Empowering Community Leaders to Advocate for COVID-19 Vaccines

"High priority communities who face unique challenges to vaccination can benefit from strong community engagement practices that are community centered and led and build trust and confidence in vaccines....This is particularly relevant to the strong influence that social norms play in supporting vaccination."

Strong community engagement has been critical to support COVID-19 vaccine uptake in Australia and elsewhere. Engagement is particularly important in communities with greater vaccine hesitancy, lower health literacy, and mistrust in authorities. Early in 2021, the Collaboration on Social Science and Immunisation (COSSI) developed a programme to train and empower community, faith, industry, and healthcare leaders to advocate for COVID-19 vaccines in Australia. This report examines the content and implementation of the Vaccine Champions programme, assesses its impact in a snapshot evaluation, and describes its adaptation for countries in the IndoPacific.

As the authors explain, vaccination decision-making is influenced by social norms: what we think others are doing and what we think trusted or influential people want us to do. We are more likely to trust people who look like us or who we feel represent us and our communities; for this reason, it is important to empower different types of people from different communities to advocate for vaccination. Vaccine champions work by shaping social norms and capitalising on trusted relationships and roles. They do not require academic or clinical qualifications bur must only hold a trusted position in a community or workplace and be passionate about encouraging people to receive vaccines. Some of the key features of an effective vaccine champion are listening to people's questions and concerns with an open mind, knowing where and how to find reputable information about vaccines, and sharing personal vaccination experiences.

At the start of the COVID-19 vaccine rollout in February 2021 in Australia, a team of clinical and social science experts from COSSI engaged in a partnership with the Victorian Department of Health. They had identified certain groups with lower intention to receive a COVID-19 vaccine, including people from culturally and linguistically diverse (CALD) backgrounds, people living in remote or regional areas, Aboriginal and Torres Strait Islander people, and people with a disability. Drawing on social and behavioural science and vaccine communication evidence and strategies, they developed a programme to: provide education on vaccine development, safety, and effectiveness; acknowledge and address community concerns; and engage a range of key leaders to advocate for vaccines.

Vaccine Champions training sessions were designed to reflect health literacy principles, including avoiding jargon, using pictures and graphical representations of complex information, focusing on action-oriented recommendations, checking comprehension, and encouraging an open forum for discussion and questions. The programme was designed for delivery face-to-face or online between March 2021 and June 2022. Each of the 91 training sessions comprised a 60- to 90-minute webinar using PowerPoint slides, scripted role play demonstrations, and interactive question and answer time. The sessions were delivered by one or two presenters with expertise in vaccines, pediatrics, infectious diseases, communication, and social and behavioural science.

The researchers evaluated a sub-set of 20 sessions delivered in Victoria in 2022, using a mixed methods approach involving surveys and group interviews. A total of 125 participants provided survey data; 12 participants took part in the group interviews. They survey found that most participants (94%, 118/125) felt more confident to discuss safety and effectiveness of COVID-19 vaccines and find relevant information after attending a session. There was an over 90% participant satisfaction with training content, format, and presentation. Qualitative feedback from two group interviews highlighted the value of vaccine communication role plays and opportunities for discussion.

Eight of those who participated in the study were among the 80 people who, having received the training, went on to become formal vaccine champions and then delivered over 100 locally tailored information sessions. Those who conducted sessions outside of their jobs commented that it was challenging to fit the preparation for, and delivery of, sessions into their busy lives. All formal champions were offered remuneration on enrolment, but most declined. On reflection, some interview participants commented that remuneration would have been beneficial to account for preparation time.

Participants also talked about wanting a way to connect with other vaccine champions and have a consistent way to communicate with them. They described wanting to be able to hear and discuss what questions and concerns were coming from their communities and to share examples of how to answer the questions. Participants wanted the sessions to continue or to have a place where they could meet to receive up-to-date information.

In Victoria, the Vaccine Champions sessions were a key part of a broader community engagement approach that, as reported here, "resulted in Victoria achieving a particularly equitable roll out of COVID-19 vaccines....For example, ...[t]he vaccine uptake amongst the Aboriginal and Torres Strait Islander population was higher in Victoria than any other state at January 2022....In addition to contributing to vaccine uptake, the Vaccine Champions program was instrumental in supporting CALD community champions to share information and combat misinformation, such as in the Syrian and Iraqi communities..."

The Vaccine Champions programme is now expanding with the support of the United Nations Children's Fund (UNICEF), the Australian Department of Foreign Affairs and Trade (DFAT), and the Australian Regional Immunisation Alliance (ARIA). This regional programme involves working with local and national stakeholders in the IndoPacific region to adapt and co-design the Vaccine Champions programme for local priority groups to target barriers to COVID-19 and routine childhood vaccination. Key changes, inspired by the evaluation described herein, include simplifying the content, delivering the training face-to-face, extending it to run for 1-2 days, and incorporating varied opportunities to practice communication skills and receive feedback. Champions are also followed up and supported to design, plan, and deliver their community sessions, including through a peer network.

In conclusion: "Findings from this study indicate the Vaccine Champions training program was an overall success with broad impact and promising implications for diverse and low resource settings. It is critical that established community partnerships are maintained and that ongoing support for formal vaccine champions is provided so they can continue to effectively reach their communities and advocate for vaccines beyond COVID-19."