Communication is key to increasing vaccine confidence in PH

AS countries in the Asia Pacific, including the Philippines, grapples with Covid-19, there is much interest in the potential of vaccines to help end and contain the pandemic. Health system capacity and access to vaccines remain key challenges in vaccine delivery. But it’s not just supply getting in the way of increasing vaccine coverage. The pandemic has highlighted another significant barrier — a lack of confidence in vaccines and hesitancy among different groups to get vaccinated. Countries in the Asia Pacific have witnessed increasing suspicion against the vaccines ahead of mass immunization drives.

Vaccine confidence is a complex and “volatile,” everchanging field and, in the words of Heidi Larson, the director of the Vaccine Confidence Project, “Sentiments toward vaccines reflect both external events as well as internal emotions.”While concerns around efficacy and safety explain people’s unwillingness to get vaccinated, it goes beyond that to include their trust in government institutions and motivations of policymakers, perceived reliability of health systems, equitable access, and compatibility with religious and cultural beliefs.

Fears over dengue vaccine

Between 2015 and 2021, vaccine confidence dropped in the Philippines which resulted in a “knock-on” effect in reducing childhood immunization coverage more broadly. The history of a country’s experience of previous vaccine rollouts also plays a key role. In the Philippines, fears over a dengue vaccine which posed a risk to individuals who had not previously been exposed to the virus, prompted outrage and panic across the population. This resulted in tragic consequences as it disrupted routine immunization, resulting in major outbreaks of measles which caused the death of hundreds of children. This illustrates how vaccine uptake across the region is informed and influenced by a complex relationship of confidence in vaccines, providers and systems.

How can issues of vaccine hesitancy then be addressed through effective and accurate engagement and communication? There is an urgent need to build a strategic response to address these trends, including effective public communication strategies.

Transparency, equitable approaches and accountability around the Covid-19 response and vaccines increases confidence in the government and in the vaccines themselves.

The new government, which will be sworn in on June 30, will need to adopt these approaches to increase public support for its policies and decisions by making sure that they understand the rationale behind it.

So how can the government develop effective, integrated, evidence-based communication strategies to drive public demand for vaccinations?

Best practices

We draw on best practices from similar contexts and develop a framework that can be usefully adopted by governments to assess gaps and pinpoint weaknesses in national vaccine preparedness guidelines and implementation road maps. Global pandemics afford policymakers the opportunity to look to other countries for inspiration and sharing on communications practices that could be adapted to their countries’ unique circumstance.

An evidence-based approach to devising these guidelines is the first step. Longitudinal surveys to understand public and health care worker (HCW) hesitancy to get vaccinated can provide context-specific insight into drivers of hesitancy.

Second, timely, consistent and transparent communications across different levels of government reinforce messaging to the public. In Singapore, a clear legal framework and emphasis on a “whole-ofnation” approach through a coordinated multi-ministry government task force helped raise public awareness and elevate public trust. As the pandemic evolved, the Malaysian government has taken a proactive rather than reactive approach to messaging, formulating specific messages and accompanying IEC materials for different phases of the pandemic.

Third, it is important to adapt the communications plan to community dynamics and characteristics while involving local stakeholders. This includes identifying vulnerable population groups and understanding their unmet needs.

Fourth, it is imperative that governments strategically use media and communications ambassadors to promote vaccination. In Malaysia, religious leaders were co-opted to amplify the government’s messaging. The religious affairs minister publicly reassured the Muslim community that the Covid-19 vaccine was permissible, while the ulama (religious scholars) reinforced the messaging at the community level. Corporate Malaysia, equally anxious that their customers and employees get immunized, pitched in as sponsors of the vaccination drive. Companies like Lifebuoy, Antabax, AEON, Grab and Mydin helped arrange town hall meetings, webinars, training and education sessions.

Fifth, the education of HCWs and government institutions on the importance of communications, in addition to the scientific content, can help curb misinformation and deliver successful vaccine rollouts. For example, in Rwanda, communication was made a priority in the HCW training module, incorporating interpersonal communication skills to help physicians more persuasively address and help overcome vaccine hesitance. The Rwandan government also worked with various public health organizations and NGOs to develop and implement risk and communication training for all HCWs, including hospital directors, doctors, nurses, data managers, surveillance officers, and religious and community leaders.

Multipronged

Finally, to counter the proliferation of misinformation and fake news on online and social media, multipronged efforts are required to monitor and measure the spread of misinformation. In Côte d’Ivoire, for instance, near real-time media monitoring was facilitated by engaging and training community contributors who reported misinformation. In Singapore, regulation- or law-based provisions have been implemented for taking punitive action against those who spread misinformation and fake news. The Singapore government actively works with popular social media sites such as Facebook to prevent the spread of misinformation.

Effective communication and engagement to alter public, government and HCW perceptions can achieve a significant and immediate impact on vaccine hesitancy. An understanding of the underpinnings of vaccine hesitancy is a prerequisite for a robust vaccine communication plan. Campaigns to counter vaccine hesitancy should reflect the local context and be cognizant of prevailing public attitudes toward vaccines and the justification for their use.

Importantly, for developing countries in the Asia Pacific like the Philippines, future pandemic preparedness requires thinking about communication regarding vaccines at the outset rather than as an afterthought. This will require concerted capacity building that fully leverages technology (for conducting surveys, social listening and data monitoring), public-private partnerships (with enterprises and NGOs that claim outreach expertise and those that offer valuable resource support) and behavioral science expertise.

Prof. Tikki Pangestu, is the co-chairman of the Asia Pacific Immunization Coalition and a visiting professor at Yong Loo Lin School of Medicine, National University of Singapore.