This is a guest post from Amy Jackson, Technical Advisor at Options – an international development consultancy delivering innovative solutions to some of the world’s most complex health challenges.
Last month, I listened to a radio programme during which listeners could call in and ask a doctor questions on the new COVID-19 vaccine. “If I get the vaccine, will I infect my wife before I get the second dose?”, “It’s all been such a rush. How can I trust them?” and “They haven’t tested it on pregnant people, so how is it safe for anyone?” While the doctor tried his best to answer these questions, he became increasingly exasperated at the lack of understanding around the seemingly simple mechanics of the vaccine.
The pandemic has devastated economies worldwide and put life on standby. Every day, we hear of people dying from the virus, unable to access other essential health services or losing their incomes, businesses and livelihoods. With the spread of the virus showing no signs of ceasing, a vaccine is the key to a return to normalcy. The World Health Organisation already identified vaccine hesitancy as one of the top ten global health threats back in 2019. No one could have anticipated then just how much of a problem it would become.
The world now has several effective COVID-19 vaccines. An enormous effort has gone into developing and rolling it out. But since it cannot stop the pandemic unless people take it, this investment is at risk unless we can address the reasons why citizens across the world are hesitant to get vaccinated. Dismissing them as ‘anti-science’ or getting exasperated by their lack of understanding won’t change minds, and fails to recognise hesitancy as a long-standing problem that desperately needs addressing. Professor Heidi Larsson, Director of the Vaccine Confidence Project recently said: “The scientific community has taken public trust for granted. A lot of public engagement and consultation took place on the first 6 major vaccines. Subsequently, this has dropped. We are taking advantage of a social contract that we haven’t put enough effort into renewing.”
Renewing this social contract on a global scale is a huge undertaking. But to tackle vaccine hesitancy, we won’t need to look far. Donors, governments and organisations working to roll out the vaccine can apply valuable lessons from the global health community on cutting maternal and new-born mortality rates by 38% from 2000 to 2017 and increasing the number of women using contraception around the world.
Options has been working to improve the accessibility of and demand for health services, specifically reproductive and maternal services, for decades. To do this has required us to understand and address why women do not use family planning or maternity services within their communities, and build trust between health providers, government, and citizens. Through our work, three key lessons have emerged that are critical for increasing vaccine uptake and ensuring that the enormous investment in the COVID-19 vaccine pays off.
Here are three ways to overcome COVID-19 vaccine hesitancy:
1. Build trust
Reasons to seek or not seek health services are extremely personal. We are all suspicious of a stranger who asks us personal questions and tell us to change our behaviour (e.g. stop smoking, stop drinking, use contraception), if they haven’t built a relationship with us first. In communities where COVID-19 is stigmatised, misinformation and public distrust pose challenges in convincing people to take up the vaccine.
Acknowledging the importance of building a high level of trust is therefore critical to success. A ‘participatory ethnographic evaluation and research’ (PEER) approach, for example, which trains trusted community members to conduct focus group discussions with other community members to find out more about their thoughts and behaviour around an issue can be very useful. At Options, PEER has enabled us to build the necessary trust to reach marginalised communities and address complex issues such as female genital mutilation and safe abortion.
We know that vaccine hesitancy rates remain high, but we still don’t know the exact reasons. If we don’t listen or try and understand the social norms around an issue, any effort to overcome vaccine hesitancy risks polarising those who are willing to take the vaccine and those who aren’t even further.
Using a political economy analysis approach can enable us, together with communities, to understand the political, cultural and economic context around vaccine hesitancy, and the networks of formal and informal power structures that can influence it. Doing so at the start of each programme has helped us for example, to better understand community attitudes towards accessing maternal care at health facilities in North East Nigeria, and to embed this understanding into the design of context specific solutions to address these.
3. Partner with communities
We know that an individual’s vaccine hesitancy is affected by the attitudes and behaviours of the community around them. It is important to engage influencers and trusted opinion leaders from the start, who can shift and sustain new community perceptions.
Community representatives, such as local civil society organisations and committees, can play an important role in influencing the attitudes and behaviours of their community members in the long term. Using this approach from the start will ensure that vaccine hesitancy is addressed beyond initial interventions and could also support uptake of other life-saving vaccines. Partnering with communities has helped us, for example, to increase blood donations and shift social norms around family planning in Nairobi.
To effectively roll out the COVID-19 vaccine, governments must take people’s concerns seriously, and address the political, cultural and social drivers behind them. The good news is that we do not need to reinvent the wheel. The global health community has tried and tested approaches that have proven valuable in building trust, changing social norms and ensuring that communities demand the health services they need. We now need to apply these lessons to the roll out of the COVID-19 vaccine.
Options are seeking partners to address vaccine hesitancy from the bottom up by applying these lessons. If you are interested in finding out more, please contact Amy Jackson: firstname.lastname@example.org.
To find out more about how U.K. aid is currently being used to respond to the crisis click here.