What Can Be Done to Build Confidence and Uptake of Vaccines?

This information was originally distributed by the MOMENTUM Routine Immunization Transformation and Equity project’s Immunization In Focus Newsletter on November 10, 2021.

For a novel vaccine against an unfamiliar disease like COVID-19, there will be earlier and later adopters, and many people are in the “wait and see” category. But given the urgency of the pandemic and the short shelf life of most COVID-19 vaccines, countries need to accelerate the pace of acceptance. While there are no simple solutions, countries can implement a combination of steps to promote acceptance and uptake of both COVID-19 and routine immunization.

• Identify and understand the reasons for low uptake. Conduct rapid formative research and apply human-centered design methods to identify both the barriers to and enablers of immunization, recognizing that some problems may be rooted in issues of service quality and access. It is especially important to understand health workers’ views. Track rumors regularly to monitor the types of misinformation circulating, get out in front of it before it flourishes. Also explore what is behind the rumors to address what motivates them and makes them believable. Apply the findings to inform communication efforts as well as health worker training and supervision.
• Develop segmented strategies to promote acceptance and uptake. Different people have different information needs, and messages that speak to their concerns influence their actions. For the general public, simply providing scientific evidence to debunk rumors is likely to fail; it can amplify the rumors by repeating them while giving information that may not be understood or accepted. Messages about how COVID-19 vaccination can improve the well-being of individuals and their families are more likely to be effective, but their content needs to be determined locally. By contrast, messages that provide scientific evidence are important for building confidence among health care providers.
• Seek community input in microplanning to help ensure that demand generation/communication activities represent community needs. This is especially important when it is not possible to conduct formative research.
• Engage trusted, influential messengers to spread the word through credible channels. While social media is effective in spreading misinformation about vaccines, interpersonal communication from personally known and trusted individuals is powerful for building trust and reassurance for both routine immunization and COVID-19 vaccine rollout. Use multiple channels to spread key messages so that they are commonly encountered, and update messages for health workers based on rumor tracking and new information.
  • Intensify efforts to build acceptance and active support among health care providers. It has been known for decades that health care providers are powerful messengers in promoting acceptance of vaccines for routine immunization. For COVID-19 vaccination, engagement of the professional associations to which they belong is emerging as a promising approach that can quickly reach many providers through people they respect. Providers can then become adherents and proponents of both routine and COVID-19 immunization.
  • Enlist the support of key influencers, such as entertainers, athletes, educators, and high-level officials to publicize their own acceptance of vaccination and reassure the public about vaccine safety and effectiveness.
  • For COVID-19 vaccine, enlist the voices of early adopters to share their personal experiences around vaccination with those in the “wait and see” category.
• Seek input and assistance from influential community members, civil society organizations, and non-traditional stakeholders about their concerns, insights, access to priority populations, and ideas for increasing acceptance of and access– both for COVID-19 vaccine and routine immunization. The engagement of local officials and community and religious leaders as full partners changed the direction of the Ebola outbreak in West Africa in 2015–16. They become part of the solution, co-creating contextually appropriate, feasible solutions to address local concerns. Engaging with non-traditional stakeholders, for example in the education or HIV sectors, can expand access to populations have not traditionally been reached by immunization programs.
• Make it easy to access accurate, current information. Establish mechanisms such as call centers with trained, capable staff who can quickly provide callers with accurate information and compelling language to respond to rumors without repeating them, which perpetuates their spread.
• Make it easy for people to get vaccinated. Keeping the needs of clients first, map the journey to vaccination faced by the clients and caregivers and the healthcare providers who serve them. This process needs to take into account the gender barriers (such as hidden costs, unsupportive family decision making, and inconvenient services) that hinder uptake for routine childhood immunization and may contribute to the reported lower coverage for COVID-19 vaccine among women. Provide key information and personalized nudges about where and when to go for all doses of vaccines. This requires strong coordination of service delivery, supply chain, and communication efforts. Encourage partnerships with major employers to conduct on-site vaccination drives for their employees. If pre-registration for COVID-19 vaccination is being used, identify those who cannot easily pre-register, provide opportunities for them to receive the vaccine, and communicate that they will not be denied vaccination.
• Make vaccination a good experience. Information that a vaccination session is well organized and feels welcoming and safe can spread into the community and encourage others to come. Health worker behavior and communication style affect demand.

What tools are available to help?

For building strategies to improve vaccination acceptance and uptake:

• The Demand for Health Services Workbook: A human-centred approach walks users through practical steps for understanding the caregiver’s journey to vaccination and health, providing tools and processes for identifying obstacles and solutions to increase the use of immunization and health services.

For managing misinformation about immunization and communicating about COVID-19 vaccine safety:

• The brief guide, Communicating on COVID-19 vaccines in a Changing Environment provides practical steps for those working at national and sub-national levels on the design and delivery of demand and communication strategies.
• The Vaccine Misinformation Management Field Guide helps organizations address the global infodemic about vaccines through the development of strategic, coordinated national action plans to build demand for vaccination and rapidly counter vaccine misinformation.
• The technical brief, Creating a Real-Time Rumor Management System for COVID-19, includes important considerations and resources for creating a functional rumor management system that enables two-way communication with affected communities.
• The manual, COVID-19 Vaccine Safety Communication, provides comprehensive guidance and resources on communicating about COVID-19 vaccine safety.

Useful websites with more information on these topics include:

• • Breakthrough Action COVID-19 technical resources.
  • The Vaccine Demand Hub, for information both on routine immunization and COVID-19 vaccination.

Building trust, acceptance, and uptake of vaccination is a complex undertaking that requires ongoing adaptations to adjust to changing circumstances. While the introduction of COVID-19 vaccine has highlighted that vaccine acceptance and uptake is critical to controlling the global pandemic, most of the same actions are needed to improve equity for routine immunization. The rollout of COVID-19 vaccine presents an opportunity to build capacity for improving immunization acceptance and uptake in both the immediate and long term.