Institutes Discuss Communications Strategies to Improve COVID-19 Vaccine Acceptance

On June 9, 2021, IANPHI held a meeting for members of its communications discussion group to discuss barriers to vaccine acceptance, approaches to overcome vaccine hesitancy, and strategies to increase overall vaccine uptake.

The meeting featured presentations from three national public health institutes (NPHIs), Public Health Wales and the National Center for Public Health, Mongolia, and the National Institute for Communicable Disease (NICD), South Africa. Presentations were followed by a group discussion where strategies for identifying subpopulations and best practices for assessing effectiveness of communication campaigns were addressed. 

COVID-19 Vaccine Hesitancy Communications in Wales

The first presentation, titled “COVID-19 Vaccine Hesitancy Communications in Wales”, was given by Hannah Lindsay and Jodie Phillips of Public Health Wales. They discussed the logistical and communications challenges which their organization faced throughout the vaccine distribution process and their organization’s utilization of a phased approach to counteract the climate of misinformation surrounding the COVID-19 vaccine. This phased approach consisted of three stages – understanding perceptions, building confidence, and empowering to encourage – and ensured that community vaccine concerns were approached by understanding stakeholder viewpoints and building overall trust prior to enacting traditional communication strategies. 

They emphasized the importance of focusing energy on hesitant individuals who can realistically be convinced to get the vaccine. This means taking the time to understand why an individual is hesitant to get a vaccine and creating messaging to address that specific concern. Public Health Wales has used a variety of strategies to combat hesitancy including making information available in multiple languages, engaging key minority stakeholders though various events, and creating a WhatsApp platform which includes major stakeholders, and actively responding to misinformation circulating on social media.

The presentation concluded with a brief discussion of key lessons their organization has learned from their work thus far. They emphasized the importance of having accessible information for the public, the need for strong partnerships with local stakeholders, and the need to constantly review communications strategies. Additionally, one of the presenters, Hannah Lindsay, remarked that one surprising lesson learned from their work was that it is important “to not assume that we know what the challenges are, you know, really, to focus on what the data is telling us, and not make any assumptions about what we think they might be because it might be completely different and might cause yourself other issues”.

National COVID-19 Immunization Program in Mongolia

The second presentation, titled “National COVID-19 Immunization Program in Mongolia”, was given by Dr. Tsolmon Munkhchuluun, MD, MPH from the National Center for Public Health, Mongolia. Dr. Munkhchuluun discussed demographic features of the Mongolian population, the country’s healthcare situation and the country’s COVID-19 vaccine strategy. One notable succuss from Mongolia’s vaccine strategy thus far is the fact that, at the date of this presentation, the country had given at least one dose of the vaccine to 90 percent of the eligible adult population. This high level of uptake can be largely attributed to their efficient use of the national telecommunications system, their utilization to both stationary and mobile vaccination sites, and, most notably, their creation of a program which allows for a conditional cash transfer for individuals who complete their vaccine cycles and are considered fully vaccinated.

The Mongolian NPHI has been using multiple strategies to combat misinformation surrounding the safety of the COVID-19 vaccine. Some methods which they have found successful in reducing vaccine skepticism include communicating through various communication channels (e.g., TV, social media), establishing a constant and open channel with local news organizations, and the development of national resources (e.g., health hotlines, a Q&A page on the official website, scientific briefings) for the public. 

Strategies to Tackle COVID-19 Vaccine Hesitancy and Improve Vaccine Acceptance Among the Populations of South Africa

The final presenter of the meeting, Sinenhlanhla Jimoh of the National Institute for Communicable Disease (NICD) in South Africa was unable to attend synchronously; however, she provided her presentation, titled “Strategies to Tackle COVID-19 Vaccine Hesitancy and Improve Vaccine Acceptance Among the Populations of South Africa”.

The South African NPHI’s approach has been to “drive vaccine confidence” rather than “fight vaccine resistance”.  Some of its strategies included creating consistent, insight-driven messaging (text and video-based) for different audiences across multiple platforms (NPHI website, Facebook, and Twitter), using a dynamic, responsive, and fact-based campaign integrating the latest available data and trends, and placing emphasis on reassuring the nation and reminding them of their shared responsibility to overcome the pandemic.  

One observation the presenter made was the utility of social listening to inform public reasoning for vaccine efficacy. She stated that, while safety and efficacy concerns were present among those who were hesitant, other factors such as the lack of vaccine availability and accessibility issues were revealed as additional major barriers.

Group Discussion

First, the presenters discussed how to determine which subsets of the population can be convinced versus those who cannot be convinced to participate in a COVID-19 vaccination program. The informative nature of social media and the importance of utilizing key stakeholders from the community to engage in open and honest discussions about the vaccine were also discussed. Some individuals simply do not want the vaccine and cannot be convinced; however, there are many individuals who simply desire more information – something which NPHIs can provide.

The presenters then tackled the role of vaccine apathy in conjunction with vaccine hesitancy as discussed in a recently published JAMA article (“When vaccine apathy, not hesitancy, drives vaccine disinterest”). They talked about the fact that apathy is seen more often in the younger age groups and emphasized the need to communicate clearly why the vaccine is relevant to that population. Specifically speaking about the younger community, it is important to emphasize how the vaccine will change community restrictions (e.g., the vaccine will allow for indoor social gatherings to occur again) and how some consequences of COVID-19 are just as likely to affect young persons as older persons (such as “long COVID”).

The meeting concluded with a discussion of tools which can be useful in assessing the impact of developed communication strategies. Participants discussed examining surveillance data and looking for gaps and outcomes, examining vaccine uptake data and corresponding changes in behavior, and how community relationships can be leveraged to understand social perception of messaging.  Further, they discussed the role which influencers may play in reducing vaccine hesitancy and cautioned that these individuals must be carefully chosen so that communities feel connected to their message and change their behavior in the desired manner.

Communications Strategies to Drive Vaccine Acceptance

  1. Trust is a prerequisite: establish the public’s trust in your institute before building vaccine confidence.
  2. Target your communications efforts towards subsets of the population that can realistically be convinced to receive the vaccine.
  3. Take the time to understand why people are hesitant to get vaccinated and address their specific concerns in your messaging and do not assume preconceived notions about reasons for vaccine hesitancy are correct.
  4. Be critical about which hesitant viewpoints you choose to address with the public. Ensure a viewpoints’ reach is widespread and addressing it will not bring undue attention.
  5. Favor honest and open conversations with the public.
  6. Create consistent, insight-driven messaging using multiple platforms to reach your audiences (website, TV, radio, social media, health hotlines, Q&As, scientific briefings, etc.)
  7. Establish a constant and open channel with local news organizations to feed them your messaging.
  8. Leverage community stakeholders to understand the social perception of messaging and to act as influencers to champion vaccination in their communities.
  9. For younger age groups, emphasize how the vaccine will change community restrictions and how some consequences of COVID-19 are just as likely to affect young persons as older persons (such as “long COVID”).
  10. Assess the impact of your strategies: monitor surveillance data, vaccination data, and corresponding changes in behavior; look for gaps; practice social listening; conduct surveys and KAP studies; keep re-assessing regularly.

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