Authors: Kristen de Graaf, Ekaterine Adamia, Nona Beradze, Ivdity Chikovani
On November 18-19, 2019, delegates from the Learning Network for Countries in Transition (LNCT) participated in a vaccine hesitancy workshop in Geneva, Switzerland. The meeting brought together 12 actively engaged LNCT members from Armenia, Georgia, Ghana, Lao PDR, Uzbekistan and Vietnam with experts from the London School of Hygiene & Tropical Medicine (LSHTM), Gavi, Curatio International Foundation, WHO, UNICEF, Common Thread, and Results for Development. LNCT member participants included key representatives from Ministries of Health, EPI managers, and global and country-level partners.
This two-day workshop built upon the in-depth interviews, focus group discussions and preparatory work done by LSHTM and Curatio with relevant LNCT countries and aimed to strengthen skills and better assess and address specific vaccine hesitancy challenges raised by countries. With a focus on building trust, social media monitoring, managing safety perceptions, health worker hesitancy, and engaging minority and vulnerable populations, participants shared experiences, identified global and regional tools to address challenges, and developed action plans, which they will now implement with follow-up support from LNCT and partners.
We are grateful to the country participants and facilitators for their engagement and thoughtful insights. Among their experiences and expertise shared during the workshop, a few key takeaways emerged, including:
- LNCT countries face a wide variety of challenges related to vaccine hesitancy. Issues of low confidence and trust are a common driver of vaccine hesitancy among the LNCT countries. Confidence in vaccination is important to achieve high uptake and efforts to build and maintain public trust are needed.
- The influence of the spread of misinformation on social media has been a particularly important challenge across LNCT countries.
- While adverse events and other hesitancy challenges are often inevitable, preparedness, planning and resilience are key. Activities to address concerns and mitigate rumours need to take place on an on-going basis.
- Hesitancy among healthcare workers (HCWs) was highlighted as a particular concern by LNCT countries. With appropriate training, support, education, mentoring and coaching, HCWs can help maintain or rebuild confidence in vaccination. Efforts to address vaccine hesitancy among HCWs should include information and training programs to address their concerns and knowledge gaps, training to support communication between providers and patients – including managing difficult questions, and stronger accountability mechanisms.
- Specific vulnerabilities of minority populations should be addressed with strategies that are based on inclusion and trust-building. Collecting and analysing “social data” on the social and economic characteristics of under-vaccinated populations may help countries identify at-risk groups and better understand the specific barriers they face when accessing services.
- A wide variety of global and regional tools are available for countries to adapt. As a starting place, countries can look at UNICEF ECARO’s Communication for Immunization Resource Pack, which provides brief descriptions of over 100 resources.
Countries also shared innovative and successful strategies they have used to address hesitancy challenges, which may provide helpful learning experiences for others. For example,
- Armenia significantly increased its HPV coverage by launching a large communications campaign, which included, among other strategies, training and addressing hesitancy issues amongst many types of health care workers, including gynaecologists and neonatologists, recognizing that parents get information from medical sources not directly involved in immunization.
- Georgia conducted a healthcare worker Knowledge, Attitudes and Practices (KAP) survey as part of its HPV demonstration, which it used to develop a national communication strategy and conduct interpersonal communication (IPC) trainings for health workers prior to national introduction, with UNICEF support. The IPC trainings included videos demonstrating effective and ineffective communication techniques and on-the-job training components.
- Ghana created a communications group to engage traditional media and look at social media’s influence on the spread of information on vaccines. They also added an immunization course to the HCW curriculum and created a new hire orientation (with CDC) that includes immunization topics, including administering multiple vaccines and how to communicate with caregivers.
- Lao PDR formed an AEFI committee to address public safety concerns proactively and they plan to review their risk communications strategy for the HPV vaccine before its introduction. They have developed job aids for EPI staff on AEFIs and vaccine preventable diseases to help HCWs communicate more effectively.
- Uzbekistan developed a strong hesitancy response plan in advance of its highly successful HPV introduction, drawing on the experience of its neighbours and allowing it to respond quickly when hesitancy issues arose. Among other strategies, they found holding town halls that allowed caregivers to talk through their concerns face-to-face with experts to be particularly effective in addressing rumours spread over social media.
- Vietnam held communications workshops with journalists to address persistent AEFI concerns and help them better understand the science of vaccines and AEFIs.
The LNCT delegation from Georgia described their key takeaways from the workshop:
The workshop was useful to get an understanding of how social monitoring can play a role in addressing vaccine hesitancy, and what are key points in shaping the response. Very interesting and instrumental in understanding key barriers was the caregiver journey. We learned that problems related to HPV vaccine are very similar in other countries and heard some interesting examples from the country representatives. The first action we will take after returning to our country is the establishment of a social media monitoring system along with other near- and long-term actions targeting health care worker education and performance, as well as population and media (journalists’) awareness of vaccines.
The workshop provided a valuable opportunity for LNCT members of the to engage in learning, networking and action planning to assess and address vaccine hesitancy challenges. For those of you who did not attend the workshop, presentation materials and audio recordings are available on the LNCT website. LNCT will also host a follow-up webinar in February 2020.