Improving community readiness for Covid-19 vaccinations

July 21, 2022 PLOS Covid-19

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Pact. A mother with her baby registering to receive her Covid-19 vaccine in Eswatini.

Authors: Sarah Nabukera and Ann Klofkorn Bloome

Nations around the world continue to work toward the World Health Organization’s target of fully vaccinating 70% of the population of all countries against Covid-19, and the 2^nd Global Covid-19 Summit in May spurred commitments to accelerate vaccination efforts. At mid-2022, over 66% of the world’s population has received at least one dose – but only 20% in low-income countries and with wide variation in vaccination levels. Based on our work with community health and social welfare systems, Pact conducted studies on perceptions of Covid-19 and vaccine hesitancy in Colombia, Eswatini and South Africa which surfaced how misinformation contributes to vaccine hesitancy, and the communication and logistical challenges that governments must overcome to improve vaccination. These qualitative assessments also identified opportunities for increasing vaccine acceptance among the communities we serve, particularly in Eswatini and South Africa via programming for orphans and vulnerable children (OVC) and people living with HIV (PLHIV).

Main study results

The three assessments identified two common themes: the confounding role of misinformation on social media and the importance of delivering vaccine services at the community level. These findings emphasize the importance of involving local health care workers and community volunteers in messaging and delivering the vaccine. Although respondents noted the untrustworthy information from social media, many acknowledge that this is the most-used information source, indicating a disconnect between the information that people have most available and the information they feel is reliable. Participants expressed willingness to respond to credible information from reliable sources – government leaders and healthcare workers – as well as trusted sources such as community leaders.

Information is critical for vaccine uptake. In Eswatini, lack of trust caused by misinformation on social media has delayed vaccine acceptance, as have inaccessible vaccine delivery sites. Findings showed a high level of community awareness about Covid-19 transmission and prevention. However, myths and misconceptions have led to fear about vaccine safety, exacerbated by conspiracy theories on social media, especially Facebook, which is reportedly the primary information source. Communities expressed concerns that their fears have not been allayed by government vaccine rollout campaigns and feel they don’t have a voice in the process. The assessment team heard many comments such as “It is a man-made disease.” Nonetheless, when asked whether they would take the vaccine if made available, nearly half (48%) of the 203 community leaders and community members who had not been vaccinated at the time of the assessment stated that they were willing. To take advantage of this willingness, governments will need to address the reasons given for delaying, including the accessibility of vaccine sites and costs for transport and food for the sometimes day-long journey to existing sites.

In Colombia, Pact completed a small rapid assessment with artisanal and small-scale gold miners (ASM). The assessment found that while awareness of basic information regarding Covid-19 was widespread, there was significantly low awareness of the benefits of Covid-19 vaccination. Persistent myths and misinformation posed notable challenges. Barriers to vaccine uptake are largely related to health, socio-political and economic issues, underscoring the need for multi-sectoral solutions to ensure successful vaccine uptake in under-resourced communities, including ASM.

The South Africa assessment reached into rural areas through a unique design involving focus groups conducted via telephone and found different vaccine acceptance between rural and urban populations that will need to be addressed in vaccination campaigns. Respondents cited popular conspiracy theories, with 64% expressing the need for accurate, credible, and responsive information. Participants expressed a desire for encouragement by community leaders and the need for health care and social workers to be adequately trained to provide this support. Community leaders commonly share that “with the right information they are in the position to build trust.” People in South Africa also noted that the vaccination process involving long queues and paperwork deterred acceptance.

The assessments also identified opportunities to address vaccine hesitancy. While participants raised concerns about the cost incurred travelling to vaccine sites, they suggested that Ministries of Health (MOH) should bring vaccines to where people live and work. Suggested vaccine sites included structures such as chief kraals (Imiphakatsi), churches, neighborhood care points, schools, clinics, and sports events.

Many of these suggestions reflect the best practices of HIV programming. These include opening on weekends and after normal business hours to target hard-to-reach groups such as youth and men and addressing privacy concerns by working with trusted community-based organizations that already reach these target audiences.

Using assessment results to inform Covid-19 vaccine rollout

Findings from the three assessments can help national and local governments and their development partners understand community stakeholders’ motivations and barriers to vaccine uptake and can guide the tailoring of community engagement and culturally effective messaging. Results underscored the importance of information from trusted sources for demand creation. Vaccination campaigns will need to address the disconnect between misinformation on social media and accurate information by engaging reliable sources who will counteract myths.

People are open to information, as they want a return to normalcy and will accept the vaccine if they understand its benefits. In South Africa, almost a third of the respondents (31.5%) expressed acceptance and an appreciation that the vaccine would assist the country to return to normality. One participant in KwaZulu Natal, one of the provinces hardest hit during successive waves of Covid-19, said, “When you look, so far the vaccine has helped a lot.”

Communication campaigns need to intentionally involve influential community members, including faith-based leaders. These campaigns must be paired with locally-led vaccination at community sites supported by health care workers and community volunteers trained to communicate scientifically accurate information.

We have learned many important and relevant lessons from the HIV response, including the importance of communication and messaging and the effectiveness of community-based approaches that make uptake of medical prevention methods more convenient and accepted. This is in line with one message from the new U.S. Global AIDS Coordinator, John Nkengasong, who describes in a recent article how scaling up Covid-19 vaccination in Africa will require coordination and partnerships.

Local collaboration will be especially important for reaching PLHIV with the Covid-19 vaccine. Delivery platforms for HIV services are already being used to scale up Covid-19 vaccination, as PLHIV need to be vaccinated for themselves as well as to avoid the emergence of new variants. Development partners can help scale up use of these platforms and improve vaccine uptake.

Conclusion

Collaborative partnerships with communities using trusted civil society organizations as the bridge can ensure that vaccination efforts are appropriate and culturally attuned. This includes leveraging the strengths and reach of faith-based institutions and leaders as champions to enhance community trust in the vaccine. Networks for reaching vulnerable households can expand coverage via locally-led vaccination services.

In Eswatini, the MOH’s Covid-19 response program is using the assessment results to strengthen vaccine promotion, including peer-to-peer mobilization and door-to-door communication. Given the usefulness of the results, USAID is including activities to promote uptake through a Pact project as part of the Agency’s rollout of the Initiative for Global Vaccine Access. Leveraging its existing platform, Pact is working with local governments, traditional leadership and faith communities to expand dialogue. In engaging communities and developing trust, people feel that their concerns are addressed. Partnering with trusted local networks can help vaccine acceptance and link vulnerable households to vaccination sources to ultimately achieve the targeted full vaccination of 70% of the world’s population.

References

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