Moving the Needle on Vaccine Uptake

Addressing vaccine hesitancy is not a new challenge in public health. But the issue has been thrust into the spotlight since COVID-19 vaccinations began, often with a myopic focus on the refusal of people to use available doses. The result? A single story that clouds the real, complex barriers to vaccine uptake.

A child is immunized in Kwitanda, Malawi. Photo credit: Paul Joseph Brown

Vaccine hesitancy is defined as the delay in acceptance or refusal of vaccines despite their availability. According to the World Health Organization’s “3C’s model” there are three main factors at play: confidence, complacency and convenience.

• Complacency appears when there is a low perceived risk of vaccine-preventable diseases so vaccination is not deemed necessary and other health issues may become a higher priority.
• A lack of confidence reflects low levels of trust in vaccines, the delivery system, or health authorities. This may include doubts about vaccine efficacy, motivations of policymakers, or mistrust rooted in a history of unethical public health practices.
• Vaccine convenience is the extent to which barriers related to physical availability of vaccines, geographic accessibility, affordability and acceptability of services impact vaccine uptake.

These factors are of course also compounded by well-documented broader vaccine delivery challenges, such as unreliable funding and an already-stretched health workforce.

Given the challenges around COVID-19 vaccine delivery, we need solutions informed by the range of complex reasons for vaccine hesitancy. Getting people vaccinated is not as simple as getting a supply of doses. It is critical to reach people where they are with overlapping strategies to address complacency, boost confidence, and improve convenience.

That’s why VillageReach is implementing a number of initiatives to address hesitancy and ensure health services reach the most under-reached communities.

First, social listening is a valuable strategy to understand concerns and community priorities, whether it’s about vaccines or another health service. Better data on the drivers of hesitancy are needed, so countries can effectively tailor communications and demand generation strategies that make a compelling case for COVID-19 vaccines. Through social listening and integrated data collection efforts, countries can access a clearer picture of the specific barriers to vaccine uptake and design interventions that are more effective.

We’ve worked with Praekelt to develop a communication and data collection platform in the Democratic Republic of Congo (DRC) and Côte d’Ivoire called VaccineCheck. The app not only provides accurate vaccine information but also tracks community concerns and misinformation. Utilizing data harvested from the app, ministries of health can develop strategies to better reach communities with information about the risks of COVID-19 and the urgent need to get vaccinated.

We also know that health workers can play an essential role in combating vaccine hesitancy by building trust in vaccines. But in remote communities, barriers of convenience can hinder critical, consistent in-person contact. The Malawian Ministry of Health and Population has been leveraging Chipatala cha pa Foni (CCPF), a toll-free health hotline staffed by trained health workers, to provide accurate information. VillageReach supported CCPF from the very start and more recently has helped by adding COVID-19 vaccine-related content to the hotline.

Finally, it’s important to ensure that the process of getting vaccinated is convenient, by making it as accessible as possible. VillageReach works with governments to strengthen supply chains and find innovative ways to deliver healthcare to remote communities. In the DRC, for instance, we have taken on direct-to-facility supply chain optimization work that has improved the availability of several vaccines.

It is only by understanding the wide range of factors leading to vaccine hesitancy that we can develop effective solutions to increase vaccine demand and ensure a rapid, equitable rollout of COVID-19 vaccines. In addition, the global community must support this work by investing in the right delivery systems and supportive tools — simply securing doses for low-income countries will not be enough.

Ultimately, we must push for a well-funded, people-centered approach built on trust so that countries can meet individuals where they are, effectively deliver vaccines, and end this pandemic as soon as possible.