Faced with the outbreak of the novel coronavirus and its consequences on the health and wellbeing of communities and economies across the world, ‘vaccination’ has become the most anticipated buzzword these days. Despite all the urgency associated with the coronavirus vaccine, the process is not as simple as it seems.
While validation, mass production, affordable sourcing and equitable distribution of Covid-19 vaccines seem like a long road ahead, it will be vital for countries to learn from their past efforts of mass immunisation and work simultaneously on their on-ground promotion strategies.
Based on review of several global and Indian studies on vaccination behaviour, it is clear that policymakers and healthcare providers need to go beyond mere education and awareness-building on availability of vaccines to focus on creating effective interventions shaping the behaviour of patients, parents and communities to uptake vaccination. Globally, it has been observed that usually, childhood vaccination has better acceptance and public support in comparison with adult vaccination. For Covid-19, a cohesive strategy that creates behavioural change on the ground to persuade both children and adults will be needed.
India’s mass immunisation campaign for Polio eradication is hailed as one of the most successful health communication campaigns across the world. In 1994, when Polio was endemic in India, the government of India piloted the first-ever mass immunisation drive with Oral Polio Vaccine (OPV). This was followed by the launch of ‘Pulse Polio’ campaign with the iconic tagline of ‘Do Boond Zindagi Ki’. The biggest problem back then was not access to vaccines but the uptake of it — most families especially in rural India were reluctant to go to government vaccination camps.
While Amitabh Bachchan became the face of a campaign and later several celebrities also joined in, the success was a result of an effective narrative, integrated communication strategy, coupled with a collaborative approach between the government, international organisations such as the WHO, the Rotary Foundation, healthcare workers across States and civil society. Although India has been officially ‘polio-free’ for over nine years now, the sustenance of this well-planned behaviour change campaign has a huge role to play in keeping India from a relapse.
Talking of Covid-19 vaccination (when it is ready for use), firstly, there has to be a common commitment among all countries to treat immunisation as a priority and ensure that its benefits are equitably extended to people across segments. Following this, the Indian government will have to systematically invest in both mass communications and community outreach to educate not just about the value of vaccination but also promote the act of seeking vaccination, as both are not synonymous in practice.
Recent experience with inculcating social distancing and mask-wearing practices shows that this is not an easy task. Uptake of any health behaviour whether it is handwashing, getting vaccinated or eating right is a complex process needing a multifaceted strategy.
People’s response to knowledge of a certain health-related action is linked to several aspects such as understanding, motivation, perceived threat, attitudes and even socio-cultural contexts. Therefore, some of the key areas that need to be focused upon while planning for an integrated communication and behaviour change strategy are:
● Educate through compelling narratives: The key messages and call-to-action have to be socio-culturally contextual to resonate with the public. It is well-known that risk perceptions and trust deficit affect vaccination decisions and behaviours drastically. Thus, a core component of the strategy also is busting myths and misinformation surrounding vaccination.
● Facilitate action by onboarding and collaborating with relevant stakeholders: Identifying mobilisers and influencers, and converting them into community-level champions to facilitate action on the ground will be vital. These stakeholders will have to be trained to promote participatory decision-making to improve community involvement in successful implementation of immunisation efforts.
● Create enablers and reduce barriers: Keeping in mind uniqueness of different community settings and contexts, there is a need to create an effective and well-coordinated surveillance system that supports the community to develop strategies for identifying and tracing immunisation gaps. Accordingly, localised interventions have to be designed to address these.
● Leveraging data to predict behaviours: Targeted strategies require intelligence about risk of transmission and likelihood of adherence at the hyperlocal level — something that big data can help us achieve. Artificial intelligence companies are already predicting with reasonable accuracy which child will drop out of routine immunisation programmes and there might be potential to transplant this into mass campaigns as well.
● Shape behaviour at the grassroots level: Thinking scientifically about behavioural nudges for vaccination, especially for vaccine-hesitant persons, can lead to an enduring behavioural change. This includes developing incentives and motivators, demonstrating value and necessity, and a call-to-action for behaviour and attitude change. It needs to be normalised as a ‘must-do’.
Today, our challenges are not just limited to getting the Covid-19 vaccine ready; overcoming barriers to equitable and seamless uptake once ready will remain a huge area of work in itself. It will require policymakers and healthcare providers to learn from the varied global resources of best practices and invest in a long-term, multipronged intervention to create desired outcomes.
(Suryaprabha Sadasivan is vice-president & healthcare policy lead, Chase India. Abhinav Verma is a lawyer and policy consultant working on health systems strengthening)
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