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What is the world doing about COVID-19 vaccine acceptance?

Yvonne MacPherson

Director, BBC Media Action USA

The world’s hopes for a vaccine for COVID-19 cannot be overstated.

A vaccine will help prevent new infections, and more than that, it will help businesses and schools in hard-hit countries get back to normal. Vast amounts of money have been invested in finding a vaccine and media reports update us regularly on the progress of over 200 candidate vaccines under evaluation.

There is also important work on ensuring equitable access once a vaccine is available, and some mention of concern about vaccine hesitancy – the delay in acceptance or refusal of vaccines even when vaccine services are available. Public health officials recognise vaccine hesitancy and refusal is a problem, but there is little evidence that countries around the world have plans to address it. 

The vaccine hesitancy problem 

Even before the COVID-19 crisis, the WHO declared vaccination hesitancy one of the Top 10 threats to global health in 2019. At that time, the world saw spikes in vaccine-preventable diseases – global uptake rates for the measles, mumps and rubella vaccine slipped by 10 per cent. In reference to COVID-19, the WHO Director of the Department of Immunization, Vaccines and Biologicals, Katherine O’Brien, said: “We don’t have a vaccine yet and already there is an anti-vaccination voice on it.”

While many see a COVID-19 vaccine as the main route to restoring social and economic normalcy, a small minority of doubters could scupper the massive global effort to discover a vaccine and roll it out effectively.

There are studies, mostly in the US, that show a lack of confidence in a COVID-19 vaccine. A May 2020 Associated Press-NORC Center for Public Affairs Research poll found that 31% of Americans were unsure if they’d get vaccinated against COVID-19, with another one in five saying they would refuse the COVID-19 vaccine outright. These acceptance figures are a moving target as the science around the virus progresses and is shared, and people’s personal experience of the impact of COVID-19 is felt.

There is urgent need to get in front of this challenge – before a vaccine becomes available. Experts have called the need to improve public health communication and health literacy as the number one recommendation out of six for government action to improve outbreak preparedness and response.

However, historically, health communication is under-prioritized, underfunded, and often mobilised too late to achieve maximum effect. 

Analysis from Gavi, the Vaccine Alliance, for example, finds that spending on creating demand for vaccines, and for broader social and behaviour change communication, between 2011 and 2015, represented just 1.2% of the money it dispersed.

Solutions exist - where is the will?

What those of us working in health communication know is that well-designed efforts can increase uptake of vaccines. Academics and communication practitioners know what works and what doesn’t, gleaned from experience from polio, routine immunisation, Ebola trials and health communication more broadly.

At a recent WHO Global Conference on “infodemiology” (the science of managing 'infodemics'), epidemiologist and Yale Institute for Global Health Director Saad Omar summarised key lessons around what works in addressing health misinformation, which is essential in addressing the persistence of anti-vaccine information. These are:

1) do not affirm a misperception,

2) avoid lingering on the myth,

3) connect to people’s values,

4) account for the anticipatory behaviour,

5) focus on narratives, and

6) avoid false assurances.

These align with those of others who work in the field of tackling misinformation. A recent Johns Hopkins University report sets out similar recommendations, emphasising the need to understand and inform the public and gain their confidence in vaccines early in the process.

Yet despite these recommendations, we are not seeing explicit investment in vaccine education in places where refusal of a COVID-19 vaccine is a possibility. There is also little data available outside the US on which geographic areas or communities may be resistant to a COVID-19 vaccine, which would help inform areas of immediate focus. (The Vaccine Confidence project, analysing five years of global vaccine confidence trends and including implications for new COVID-19 vaccines, is likely to aid in this effort).

The role of health communication

BBC Media Action has over 20 years’ experience in health communication -- the practice of using a range of approaches, including mass media and other information communication technologies, social mobilisation and interpersonal communication, to improve health outcomes. This experience includes working on vaccine acceptance and in global heath emergencies.

And at this moment we are researching, producing and disseminating content on COVID-19 in more than 50 languages reaching tens of millions of people around the world. This content ranges from in-depth TV and radio discussion programmes featuring experts, to using narrative storytelling to tackle the more nuanced angles of the behavioural drivers that impact COVID-19 risk. We are also supporting media on how to report on COVID-19. All of this research and reach can be leveraged to address the vaccine uptake challenge immediately. 

Highlights from our work

As part of a Unicef intervention to mitigate the spread of poliovirus in Somalia, which re-emerged in 2013, we produced a rapid mass media response aimed at increasing the demand for the vaccine.

BBC Media Action developed a 42-episode Somali-language radio programme called ‘Drops for Life.’ Broadcast on the BBC Somali Service, the programme was designed to prepare the ground for the arrival of the mobile polio vaccinators. It allowed people to digest relevant information in advance of the vaccination campaigns and made them more amenable to inviting polio vaccinators into their homes. It incorporated audience feedback and personal stories, and provided a space for them to ask questions to allay their fears.

The programme also addressed specific concerns around vaccination safety, which contributed to a history of attacks on health workers and low uptake.

Audiences placed high levels of trust in information gained from the programme, both because of the credibility attributed to the BBC, and because it featured trusted individuals, such as doctors and sheikhs. The programme also built the capacity of vaccinators and health workers and enhanced the public’s trust in them. These factors – use of trusted media platforms and community members, appropriately timed and grounded in local realities, helped to quash the major barriers to vaccine uptake.

In Nigeria, we worked with mass media combined with community outreach to help overcome the personal and social barriers to vaccine uptake, especially for people in the Northern states where vaccine-preventable diseases, particularly polio, have been a higher risk. We recorded our popular Hausa-language radio drama in front of a live audience in rural and semi-urban communities, then followed the recordings with discussions with vaccinators and health workers, to provide communities with direct answers to questions about routine immunisation and polio vaccination.

Research showed that our audiences knew more about how polio is transmitted and prevented, and took action following vaccinator visits, compared to those who didn’t participate. Evidence also suggested that radio interventions helped to debunk misinformation and harmful myths around the polio vaccine, and that the drama was used as a tool to challenge vaccine refusal within families and beyond. This work finished in 2019, the same year Nigeria was declared “polio free”. 

We need to act now

Vulnerable countries urgently need a plan to address the risk of vaccine refusal, starting with investing in research that can isolate where and among whom the risk is likely to be highest. Health departments need support to as they prepare for a COVID-19 vaccine, by conducting this research and creating spaces and content that help answer people’s questions and address their fears. Let us draw on the vast experience of the health communication field to support the responsible, community-focused roll-out of national coronavirus vaccination programmes.

What we say and do now will impact how successful we will be in halting the spread of COVID-19.