News and Insights
Boosting vaccine confidence through community-centred strategies
May 28, 2024
Despite the remarkable success of vaccines in preventing infectious diseases and saving millions of lives annually, vaccine hesitancy remains a significant obstacle to achieving optimal coverage rates. This challenge is particularly evident among certain communities and populations, contributing to growing health disparities. To address this issue effectively, it is crucial to understand the complex factors influencing vaccine acceptance and implement tailored, community-centred strategies that build trust and promote access.
The urgent need for vaccination: whooping cough
The importance of addressing this vaccine hesitancy is underscored by the recent rise in whooping cough cases in the UK. According to officials, there has been a worrying increase in bacterial infection, with 553 cases recorded in England in January alone and high numbers in Wales. Experts fear it could be a bumper year for whooping cough, with the last peak year, 2016, seeing 5,949 cases in England.
Whooping cough, also known as pertussis or “100-day cough” can be particularly serious for babies and infants. The UK Health Security Agency warns of a steady decline in vaccine uptake in pregnant women and children. In September 2023, the number of two-year-olds who completed their routine six-in-one vaccinations, which includes protection against pertussis, was 92.9%, compared with 96.3% in March 2014. Uptake of the maternal pertussis vaccine, offered to women in every pregnancy, also dropped from over 70% in September 2017 to about 58% in September 2023.
Prof Sir Andrew Pollard, a consultant paediatrician and the chair of the Joint Committee on Vaccination and Immunisation, warns that more babies will die from whooping cough in the UK unless vaccination rates go up to slow the spread of the infection. He cites low take-up of jabs among pregnant women as a particular concern, stating that “very worryingly, those have fallen from a peak of about 75% of women being vaccinated during pregnancy to under 60% today, and that’s what puts these very young infants at particular risk.”
Understanding the roots of vaccine hesitancy
Vaccine hesitancy can stem from a multitude of factors, including cultural beliefs, religious traditions, educational levels, and access barriers. Research has revealed that some migrant communities exhibit lower vaccine uptake due to concerns rooted in their cultural or religious beliefs. An analysis of 34 studies by the National Institute for Health and Care Research (NIHR) found that: “Messages aligned to religious teachings on health were helpful” in increasing acceptance among these groups.
Similarly, socioeconomic factors can significantly influence vaccine confidence. A survey conducted during the COVID-19 pandemic revealed that individuals from lower-income households were more likely to refuse vaccination than those from higher-income households. This underscores the importance of addressing structural barriers, such as access to healthcare services and health literacy, to ensure equitable vaccine coverage.
Building trust through community engagement
Improving vaccine confidence requires trust between healthcare providers and the communities they serve. This trust can be cultivated through active engagement with community members, leaders, and organisations. As the NIHR report states, “Understanding and responding to the specific needs of different communities helps build trust and overcome barriers to vaccination.”
One promising approach involves using community advocates who can deliver tailored messages that resonate with their communities’ unique concerns and beliefs. The NIHR review found that “community advocates could increase vaccine uptake, possibly because they could deliver tailored messages that people trusted.”
Bringing vaccines to the community
Accessibility is a critical factor in promoting vaccine acceptance. Traditional healthcare settings may present barriers for certain communities, such as transportation challenges or cultural discomfort. To address this, public health efforts should explore alternative venues that are familiar and convenient for the target population.
The NIHR report highlights: “Migrants preferred familiar and local settings which require minimal travel, such as walk-in clinics at food banks, community centres, and charities.” Similarly, a survey of individuals aged 50 and older found that those undecided about receiving the COVID-19 booster were more likely to be from ethnic minority communities. The researchers recommended “hosting vaccination sessions in religious and other community venues” to increase accessibility and familiarity.
Seizing every opportunity
Missed vaccination opportunities can contribute to lower uptake rates, particularly among populations with limited access to healthcare services. A study involving pregnant women in the UK and EU countries revealed that some women were not educated about the need for vaccination during pregnancy – they had not received recommendations from their healthcare providers.
To address this gap, the researchers suggest that “healthcare professionals stress the importance of vaccination at regular appointments with pregnant women.” This aligns with the National Institute for Health and Care Excellence (NICE) recommendations on opportunistic vaccination, encouraging healthcare professionals to identify and offer vaccines to eligible individuals during routine appointments or encounters.
Tailored communication strategies
Effective communication is essential for addressing vaccine confidence and promoting acceptance. However, a one-size-fits-all approach is unlikely to resonate with diverse audiences. As the NIHR report emphasises, “Public health campaigns must consider differences in the audience’s educational levels, religions, and cultural beliefs. They must deliver the right message to the right group via the right channel.”
One study found that “stressing the personal benefits of the COVID-19 vaccine, rather than the benefits to the community, encouraged some people who were unsure about having the vaccine.” This highlights the importance of framing public health messages in a way that resonates with the specific concerns and motivations of the target audience. Additionally, monitoring vaccine uptake rates can help identify specific groups with lower acceptance rates, allowing for the development of targeted campaigns and engagement efforts tailored to their unique needs and barriers.
Combating misinformation and leveraging technology
The proliferation of misinformation and disinformation about vaccines has emerged as a significant obstacle to achieving high coverage rates. To combat this challenge, public health communicators must employ evidence-based strategies to counter false narratives and restore trust in the scientific consensus.
An analysis of 34 studies conducted by the NIHR found that “communicating the scientific consensus that vaccines are safe and effective, using humour to dispel vaccine myths, and providing people with misinformation warnings (on Google search, for example) were promising strategies.” Conversely, scare tactics or failure to acknowledge scientific uncertainties were found to be counterproductive, potentially increasing fears about vaccine side effects.
Technology can also play a pivotal role in promoting vaccine acceptance. Simple interventions, such as text reminders for vaccine appointments, have significantly increased attendance rates. As the Wellcome Trust report cited by the NIHR notes, “phone call reminders can increase attendance at vaccination appointments by 18%.”
Furthermore, social media platforms present opportunities for disseminating public health messages and engaging with target audiences through channels they already use regularly. During the COVID-19 pandemic, the UK government partnered with social media platforms, including Snapchat, Reddit, TikTok, and YouTube, to encourage vaccine uptake among younger demographics.
The takeaways
Achieving equitable vaccine uptake requires a multifaceted approach that addresses diverse communities’ unique barriers, concerns, and needs. The recent rise in whooping cough cases in the UK is a stark reminder of the importance of maintaining high vaccination rates to protect the most vulnerable, particularly infants and young children.
By actively engaging with community members, tailoring communication strategies, and utilising accessible delivery methods, public health efforts can build trust, combat misinformation, and promote vaccine acceptance. Ultimately, this community-centred approach is essential for ensuring that all people realise the life-saving benefits of vaccines, regardless of cultural, socioeconomic, or geographical factors.
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POSTED BY: Chris Nial
