Heidi Larson, UNICEF Vaccination in Tomorow's Society - Fondation Merieux

Immunization Communication:

Building Trust

Is There Really a Problem?

Everybody in the delivery system -- from practitioners, policymakers to donors -- is intensely motivated

Anti-vac groups are disorganized and on the fringes

Benefits are obvious to any thinking parent Problems in the developing world are

technical (delivery systems, storage, availability, funding) not perceptual

Were We Ever Wrong!Generally..Vaccines are one of public health’s

greatest successes-and one of its most unheralded

Taken for granted by a complacent majority

Attacked and questioned by a vocal minority

GLOBAL ENVIRONMENT For the past 30 years immunization has

dramatically decreased childhood illness and death around the world

But, because we are seeing less disease, have a number of new vaccines, and have more access to information—the public is asking more questions

There are additional concerns around injection safety and waste management

GLOBAL ENVIRONMENT Proliferation of research giving sometimes

incomplete or controversial information

There is a global vaccine divide between industrialized and developing countries

The public is increasingly challenging “quality” and “safety” of commodities

GLOBAL ENVIRONMENTManufacturers Leaving the Developing

Country Market (1992-2001)

GLOBAL ENVIRONMENT Stronger rights-based, “right to know”

environment - growing civil society demands on access to information

Increased and more rapid communication channels,more global media - internet, satellite TV (Bangladesh vaccine-related deaths were used in US anti-vac movement within 24 hours)

Previously locally isolated adverse events now national/international media events

GLOBAL ENVIRONMENT

- P Davies, S Chapman, Department of Public Health and Community Medicine, University of Sydney; J Leask, National Centre for Immunisation Research and Surveillance; March 21, 2002

LESS PUBLIC TRUST

The issues are far more complex than just the vaccine…need to understand the political, socio-cultural context

Need to build trust in the provider as well as trust in vaccines

LESS PUBLIC TRUST 5 Types of AEFI Vaccine Reaction Programme errors Injection reaction Coincidental events Unknown

BUT, not all issues of Public Trust are related to AEFI. Some are rumours and distrust related to the other issues

LESS PUBLIC TRUST

Politically, economically, ethnically and socially marginalised groups have less trust in government provided commodities or services - increasing rumours and opposition to vaccination due to lack of trust in the provider (eg. OPV sterilizes, causes HIV/AIDS)

LESS PUBLIC TRUST Do not under-estimate people’s memories—

individually and collectively Memories of real sterilization campaigns Memories of clinical trials gone wrong Memories of coercive smallpox vaccinations Memories of not getting the health services

asked for—the felt needs

Communication needs to be ongoing-distrust in vaccines cannot be addressed in a one-time response

Challenges

Negative public reaction to vaccines is usually related to human emotion--feeling of marginalization (“THEY are trying to sterilize us”)—or perceived damage to a child due to a vaccine

So what do we need to do?? Scientists (and the Media!) must not

to treat fear and reservation as ignorance and then try to destroy them with a blunt “rational” instrument.

Pattison – BMJ 2001;323:838-840

Anti-vaccination groups are becoming increasingly sophisticated, developing communication strategies to promote their message, utilizing the Internet, prominent politicians, the mass media, professional lobbyists and advertising methods.

The Anti-Vaccine Lobby

So what do we need to do??

Scientists must not to treat fear and reservation as ignorance and then try to destroy them with a blunt “rational” instrument.

Pattison – BMJ 2001;323:838-840

So what do we need to do?? Not enough anymore to just say

“Vaccines are good” Need tangible evidence that reminds

the public that health improves with immunization—and is at risk when immunization coverage drops

Need to re-position the BENEFITS of vaccines OVER the RISKS

Need new revitalized communication

INC

IDE

NC

E

TIME

Disease

VaccinationCoverage

Outbreak

I II IV

Prevaccine Increasing coverage

Resumption ofconfidence

Adverse events

III

Loss ofconfidence

INC

IDE

NC

E

TIME

Disease

VaccinationCoverage

Outbreak

I II IV

Prevaccine Increasing coverage

Resumption ofconfidence

Rumours / media event

III

Loss ofconfidence

INC

IDE

NC

E

TIME

Disease

VaccinationCoverage

I II IV

Prevaccine Increasing Coverage

Resumption ofconfidence

Crisis communication

III

Loss ofconfidence

INC

IDE

NC

E

TIME

Disease

VaccinationCoverage

Outbreak

I II IV

Prevaccine Increasing Coverage

Resumption ofconfidence

III

Loss ofconfidence

Increased need of evidence-based

information / education

Adapted from J.Bonhoeffer et al.

What are media looking for?

Disaster or other high profile event Drama with a personal aspect Controversy or conflict The unexpected Polarity of views Local relevance A celebrity link

What are media looking for?

57.9% of children were immunized in Kano in recent rounds (against only 4-5% routine)

Media pushing for an angle, “Close to one half population still refuses OPV” instead of bringing attention to the progress

What do the media like?

Accuracy and simplicity Statistics with an explanation, if possible Context (part of a wider picture) Explanation from the highest authority Controversial issues Both sides of the story A FAST response

They will ask

WHO is affected and WHO is responsible WHAT has happened? WHAT is being

done? WHERE has it happened? WHEN did it happen? WHY did it happen? WILL is happen again?

Opportunities

Cultivate the media as key partners promoting (and defending ) the rights of the child

Remind journalists that their coverage can significantly influence parents willingness to take their children to be immunized (or not!)

Major principles of the ConventionThe best interests of the childIn any decision or action which may affect them, children and young people have the right to have their best interest given primary consideration (article 3.1)

Ask yourself: When you write a story, is the angle in the best interest of children?

Major principles of the ConventionRespect and support for parents and carers Although the main responsibility for bringing up children lies with parents and carers the government has a duty to provide support, advice and services to help them fulfil their roles (articles 5,18)

Ask yourself: Does your story recognize the role of governments and parents in protecting the health of children?

Major principles of the ConventionPrivacy and confidentiality Children have a right to privacy. Privacy related to the disclosure of information discussed with health professionals must be respected (article 16)

Ask yourself: Is your story respecting a child’s right to privacy? Or, are your exploiting a child’s illness or disability to sell a newspaper?…

Need for new paradigm

NOT enough to just say:“Vaccines are good”“Give your child vaccination”

Need to be ready with MUCH more information on:

WHY immunize? Why THIS vaccine (versus another one….)? WHY again and again the same vaccine

when there is no apparent disease?

Need for new paradigm

While we need to have a new level of readiness to pre-empt and respond to negative media following AEFI

We should not divert our communication efforts to responding to negative media and rumours, but keep the focus on BUILDING PUBLIC TRUST

Need for new paradigm

In the 1980s, vaccines were new, there was an excitement generated about them

Need new rationalization for continuing to vaccinate

Need to understand contemporary contextand make vaccines relevant