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Capacity Development and Community Engagement to Overcome Misinformation About Vaccination

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"Gaining insight into the parental demands to vaccinate and enhancing compliance for immunisation schedules can be done with the help of behavioural tools." - Anna Sukhodolska, Anastasia Nurzhynska, and Kateryna Bulavinova

Based on social data collected in 2019, the United Nations Children's Fund (UNICEF) Ukraine has developed a communication for development (C4D) response to confront low immunisation rates in the country, and the misinformation that can contribute to the problem. Applying behavioural science to create solutions, the organisation has been engaging (including on social media) with children, health professionals, fathers, and communities to increase their loyalty towards immunisation.

Communication Strategies
This project works to bolster increase in the demand for vaccination among caregivers through testing of behaviour science tools. UNICEF Ukraine grounds its work in the belief that research needs to be conducted to develop and carefully test vaccination messages before appropriating them to public contexts. To that end, message testing found that references to mandatory vaccination policy or fear received negative reactions from parents. This process revealed that it is important to find the right balance between the autonomy of parents' decision-making on their children's immunisation and the public health benefits of vaccination. Based on a systematic review and behaviour science techniques, UNICEF found that a combination of messaging techniques such as recommendations from healthcare professionals and reference to social norms could lead to positive adjustments in vaccination attitudes. Teams of young creators developed branding that was rolled out in 2019-2020, with approval from the Ministry of Health. The key tagline is "Vaccinate for good": Since Ukrainians' main trouble with vaccination is a sense of fear and loathing on the subject, the campaign's identity paves the way for looking at vaccination as an easy, kind, and beneficial act. The logo translates the idea of acceptance of the simple procedure. The hope is that hesitant people could be more likely involved in vaccination, feeling a sort of unseen support of millions vaccinated. Specifically, the logo consists of 3 parts: V for vaccination, a checkmark for easiness and swiftness, and a thumbs-up for acceptance. Banners, leaflets and other printed materials, nameplates, tee-shirts, and digital assets have been created.Following the testing, UNICEF Ukraine launched the campaign on social media and developed recommendations on messages for public institutions. The social media campaign reached 217,999 people, with 2,693 clicks to the Ministry of Health website.

Targeted and tailored interventions were applied to build knowledge among children, support the communication capacity of healthcare providers, and address risk perception of infectious diseases among fathers, as follows:
  • Children: Edutainment interventions included online and off-line activities and products. Based on "Lili Who Made friends with Viruses, a children's book with augmented reality, a World's Largest Lesson action was developed for primary school children that engaged teachers through an online tutorial that was designed to help them integrate evidence-based information on vaccination into the school curriculum. Over 3,000 children took part in the lesson in majority regions of Ukraine in a one-month period. In addition, the book was distributed at the edutainment events across the country, where over 100,000 children took part in learning sessions on vaccination through play. Lesson plans, handouts, and recommendations for primary school teachers on how to talk with children and parents about vaccination were also created; UNICEF Ukraine partnered with an online education platform for teachers in Ukraine to disseminate the materials.
  • Healthcare providers: UNICEF Ukraine proposed a 4-step approach to vaccination counselling for healthcare providers: Be prepared, listen, use appropriate messages, and plan with the patient. A guide was created to synthesise current knowledge on evidence-based vaccination practice, psychology, and behavioural sciences.UNICEF Ukraine also filmed two video tutorials with examples of evidence-based counselling techniques for healthcare professionals.
  • Fathers: Survey findings showed that fathers are less informed about the danger of infectious diseases and benefits of vaccination and are not afraid of infectious diseases. Thus, UNICEF Ukraine addressed fathers with a series of creative communication products shared via digital media activation. Among them is an emotional video, shared via Twitter, with fathers telling others about their feelings about children. And in partnership with Cannes Lions Ukraine, teams of young creators developed a series of images addressing fathers, such as one drawing on a popular sport among fathers, football. This activation has reached over 1.3 caregivers, mainly fathers, and received high engagement from the audience.
Development Issues

Immunisation and Vaccines

Key Points
In Ukraine, less than 80% children are vaccinated, with one of the lowest levels of trust in vaccination and one of the lowest vaccination rates for routine immunisation in Europe and globally during 2016-17. Following a polio outbreak in the country in 2015-16, one of the world's largest measles outbreaks began there in 2017: Over 57,000 Ukrainians became ill with measles in 3 years. Children in Ukraine are still at risk of infectious diseases, as cases of tetanus, diphtheria, and pertussis have been reported from various localities of the country.UNICEF Ukraine claims that its long-term communication and behaviour change interventions have helped positive attitudes towards immunisation in Ukraine to increase from 28% in 2008 to 82% in 2019. There is also evidence of a positive trend for compliance with the vaccination schedule: A national household survey found some 88% of parents stating in 2019 that they are vaccinating children according to the national schedule, while there were 84% in 2017, and 63% in 2014. However, high levels of distrust of vaccination and healthcare system, active disinformation and powerful anti-vaccine propaganda, weak counselling skills of healthcare professionals, lack of political commitment, and vaccine supply shortages remain key barriers to vaccination in Ukraine.According to an August 2019 KAP study ("Assessment of Knowledge, Attitudes and Practices on Vaccination in Ukraine", UNICEF, InMind, N=1,277 mothers), for mothers who made the decision not to vaccinate their baby, the main concerns were: fear of reactions, distrust of vaccinations and vaccine manufacturers, and previous negative experience of vaccination.Research on social media (148,700 messages) undertaken by searching in Ukrainian and Russian, May 14 2019 to June 13 2019, showed that:
  • The age group of 25-34 is the most active.
  • Top arguments against vaccination are supported primarily by the female audience, an average of 76% (from 58% to 82%). The biggest male audience (42%) was interested in a post about Bill Gates and United States (US) elites refusing to vaccinate their children.
  • Fake and manipulative messages form 30-33% of the overall media landscape of a negative character. Fake media waves not only extend, but they also result in a reaction in the comments. This testifies to the "adaptability" of fakes - they get used in discussions in social networks as an argument against vaccinations.
  • The Facebook community is in search of professional medical advice. Questions range from, "Where to get health certificate for school/pre-school institution?" to "Where do I find a vaccine?" to "Which drug is better?", to "Did your child experience these side effects?"
  • Frequent comments about "the side effects of vaccination" and "the lack of responsibility of doctors/medical institution/state for consequences" seem to be always present in the discussions throughout the research period and do not depend on external newsbreaks.
UNICEF Ukraine contends that some of the messages and approaches to counselling on routine immunisation may be relevant to promotion of health behaviours in response to COVID-19. Due to the pandemic, routine immunisation activities were postponed, but UNICEF Ukraine continued to encourage health professionals and teachers to strongly promote vaccination. Considerations include:
  • Positive intentions have the potential to alter behaviour without significant changes to attitudes.
  • Negative audiences are resistant to attitudinal and behavioural changes.
  • Loss framing and whether people consider vaccination to be safe, simple, and accessible is an effective strategy in addressing vaccine hesitancy.
  • Messages from doctors around social norms positively affect mothers' vaccination behaviours.
  • Messages about mandatory vaccination used by public authorities are unlikely to reduce vaccine hesitancy; parental demand for vaccination could be gained with the help of behavioural tools such as those used in the project described above.
Sources

"Restoring trust in routine immunization: case of Ukraine" [unpublished], by Anna Sukhodolska, Anastasia Nurzhynska, and Kateryna Bulavinova - sent via Anastasia Nurzhynska to The Communication Initiative on July 27 2020; "Fighting myths and disinformation about vaccination in Ukraine", UNICEF Ukraine website, July 27 2020; and email from Anastasia Nurzhynska to The Communication Initiative on July 28 2020. Image(s) credit(s): © UNICEF Ukraine