Keeping Trust in Immunisation: Community Perceptions of Vaccination in the Time of COVID-19

"Maintaining trust in immunisation amid a global pandemic represents an unprecedented challenge. An understanding of community perceptions, considering the different contexts, background and socio-cultural factors, will serve as a foundation for restoring eroded trust and building confidence in essential health services."

Maintaining trust in immunisation has been a challenge during the COVID-19 pandemic, with the growing spread of misinformation and disruptions to immunisation systems threatening confidence in health services globally. In November 2020, community health workers, immunisation champions, and experts in social behaviour and communication change (SBCC) strategies convened virtually, sharing first-hand testimonies/experiences and exploring the roles of civil society organisations (CSOs) in restoring/sustaining public trust in routine immunisation, as well as in the COVID-19 vaccines to come. Facilitated by Safari Doctors' Sheetal Sharma, a public health physician working in remote and fragile states of Kenya and Vice Chair of the Gavi Civil Society Steering Committee, the discussion emphasised the need for a greater understanding of community perceptions of vaccination and offered recommendations to overcome obstacles such as vaccine hesitancy.

Topics covered in the webinar, which was hosted by the Gavi CSO Constituency in partnership with ACTION: Global Health Advocacy Partnership, RESULTS UK, Save the Children, and Gavi, included:

1. How the COVID-19 pandemic has affected the perceptions of vaccinations;
2. How this affects routine immunisation service; and
3. The roles played by different actors in restoring trust in immunisation systems.

The speakers were:

• Nazish Mujhgan Karim, Provincial Master Trainer with a United Nations Children's Fund (UNICEF)-funded immunisation project in Pakistan, who detailed the knock-on impact of the COVID-19 pandemic on routine immunisation services. In Pakistan and Afghanistan, between July and August 2020, approximately 50 million children were left unimmunised due to COVID-19. Ms. Karim looked at how COVID-19 has further damaged already declining confidence in health systems, noting that, with many governments unable to ensure patient safety, fear of contracting COVID-19 is reducing the number of people accessing local facilities. These challenges are compounded by misinformation filtering down to communities. Addressing lack of knowledge through meaningful, personalised communication requires close collaboration with grassroots organisations, Ms. Karim (and others) stressed. Empowering and developing the capacity of local health workers and civil society will be critical for effective social mobilisation and communication strategies needed to address vaccine hesitancy. Ms. Karim articulated the need to include religious and political leaders whilst working with CSOs and local non-governmental organisations (NGOs) to identify marginalised populations.
• Rina Dey, Communications Director, CORE Group Polio Project India, who described the stigmatisation faced by community health workers accused of spreading the disease whilst conducting door-to-door visits. This breach of trust prevents delivery of essential and basic health services to the population. She went on to laud the success of campaigns to improve confidence in routine immunisation and polio services in the states of Uttar Pradesh and Haryana, indicating that the first step towards addressing mistrust is developing an understanding of social science and interpersonal relationships within communities. In particular, interactions in small focus groups have been integral in understanding doubts about immunisation, in her experience. She emphasised how the lessons learned in polio eradication are being used to address similar issues concerning mistrust during COVID-19.
• Dr. Joseph Seriki, Senior Technical Health Specialist with Save the Children in Somalia, who explained that fear and misinformation were not the only factors contributing to the erosion of trust. For example, in Somalia, COVID-19 related logistical hurdles have made it difficult for people to access vaccines. Thus, trust in COVID-19 vaccine programmes will also depend on the effectiveness of systems designed to deliver them, in addition to ensuring COVID-19 vaccines are safe and widely available, with community health workers supported sufficiently to administer them. Furthermore, the severe economic impact of the pandemic has led to many people in Somalia prioritising feeding their families over accessing routine immunisation services.
• Edmund Duodu, a registered community nurse and Director of the Divine Mother and Child Foundation in Ghana, who reminded attendees that the choices we make with respect to sustaining routine immunisation services will set the precedent for our ability to meet the Sustainable Development Goals (SDGs) by 2030. Emphasising the need to understand the perceptions and concerns of communities to increase vaccine uptake, he added that much is still unknown about the beliefs - including cultural, religious, and traditional beliefs - leading to vaccine hesitancy. Mr. Duodu encouraged a focus on innovative and personal engagement with communities, noting that generating trust in COVID-19 vaccines will require the ability to "communicate in meaningful, relevant and personal terms to crowd out misinformation".
• Radharani Mitra, BBC Media Action's Global Creative Advisor, who explained that communities require targeted and tailored communication strategies to address the issue of trust in health systems. She warned that relaying scientific information and facts will not be enough to change beliefs and attitudes concerning vaccination; instead, "communications solutions aimed at building trust have to be able to capture people's imaginations and have a powerful emotional connection." Radharani further explained her and her colleague Yvonne MacPherson's "5 mantras to keep trust in immunisation" and highlighted the need to "get ahead of the challenge" so that there is strong demand for COVID-19 vaccines once they become available.

The webinar was interactive, with attendees encouraged to share questions and comments at any time during the presentation by submitting them in the messaging box or the chat box found on the right-hand of the screen. The organisers set aside time at the end for some of these questions to be asked of the speakers. Many of the host organisations live-tweeted throughout the event, which was live-streamed to the public. Participants were also invited to join the conversation online by using the hashtag #VaccinesWork.