The COVID-19 Vaccines Rush: Participatory Community Engagement Matters More than Ever

"Listening to those who have the most at stake will pave the way for much needed change and widespread engagement with and support for COVID-19 vaccination campaigns."

Written at the time of the announcement that COVID-19 vaccines would soon be made available, this article outlines recommendations to achieve meaningful engagement with diverse communities in preparation for the vaccine roll-out. The approach proposed here is bottom-up in that it gives the power of design and implementation of communication strategies to local actors, supported by evidence syntheses, with the goal of enabling them to mobilise local expertise. This approach, the authors argue, holds promise for engaging with and shifting attitudes on vaccines and wider government handling of the COVID-19 pandemic.

They note that, from the outset, it is necessary to distinguish between people wholly opposed to vaccination (anti-vaxxers) and those who have genuine concerns and questions due, perhaps, to limited or inaccurate health information (vaccine hesitant). The risk of failing to appreciate that those who do not accept vaccination are on a spectrum, and critiquing all of them as refusers, is that people can feel misunderstood and can react defensively; trust and confidence are thus further eroded.

Trust is crucial at this time because COVID-19 vaccines are arriving on the scene just as many people, especially those in vulnerable groups, have expressed low levels of confidence in their government's response to the pandemic. In the United Kingdom (UK), for example, a parliamentary report highlighted that more than 60% of Black people do not believe their health is protected by the National Health Service (NHS) to the same extent as White people. Such attitudes can be traced to the fact that the pandemic has further marginalised historically oppressed and excluded groups, such as people with disabilities.

To cite an example, which sheds insight, too, on how mistrust can be overcome, in Nigeria, polio eradication campaigns in 2003 were boycotted due to concerns about the motives of sponsors, inadequate testing and consent procedures, and unsatisfactory engagement with local knowledge about health and illness. The situation was eventually turned around through widespread community dialogues that helped to foster social learning, establish equity, and generate and restore trust and participation in the programme. In general, examples of successful immunisation campaigns, such as India's polio eradication efforts, are rooted in wide-scale social mobilisation and systems strengthening.

The authors stress that the public "is not a homogeneous entity....A top-down, one-size-fits-all approach has derailed countless well meaning global health solutions, and in the context of vaccine implementation risks leaving many groups behind, again. Policy makers need to understand this diversity and adopt comprehensive local approaches that give communities a voice, and the necessary resources to put ideas into action. Such community-led strategies can ensure diverse local voices are heard, map local concerns and alliances, and codesign programmes to maximise vaccine uptake from the ground up." Specifically, policymakers are urged to:

• Accelerate dialogue and support the development of community networks, leveraging and supporting existing local channels that influence decision making, such as community and faith leaders, teachers, sports and youth clubs, and online communities and networks; and
• Pair these efforts with investment in structures that enable people to contribute to this process, including global financing to ensure low-income countries can implement similar schemes.

A table in the paper outlines a pathway to enabling community engagement in COVID-19 response and vaccine roll-out at local, regional, and national levels. It offers guidance related to aims, key actors, responsibilities, and delivery mechanisms.

In conclusion: "In this new phase of the COVID-19 response, successful vaccine roll-out will only be achieved by ensuring effective community engagement, building local vaccine acceptability and confidence, and overcoming cultural, socioeconomic, and political barriers...that lead to mistrust and hinder uptake of vaccines."