The Immunity Community: A Community Engagement Strategy for Reducing Vaccine Hesitancy

"...it is possible to engage, train, and support parent volunteers to be vaccine advocates in their communities."

To address vaccine hesitancy in Washington State, United States (US), a public-private partnership of health organisations implemented and evaluated an intervention to promote vaccination and vaccine confidence across the lifespan called the Immunity Community. This article provides a brief description of the intervention and summarises key evaluation findings, including the level of parent advocate (PA) engagement and the impact of the programme on local policy and parental knowledge, attitudes, and behaviours.

Following a literature review that looks at research regarding educational outreach and social marketing efforts to address vaccine hesitancy, the article describes the programme. Created by the Vax Northwest in response to the need for creative approaches to vaccine hesitancy, Immunity Community was based on the principles of social marketing. The programme recruited, engaged, and supported volunteer PAs to spread positive messages about vaccines in an effort to provide a counterbalance to the negative rhetoric about vaccines being circulated on social media and in the press. The goal was to empower parents to be immunisation advocates, improve awareness of immunisation as a social norm, and change those parents' attitudes and behaviours. The programme also focused on influencing organisational and/or local policies associated with communication about and monitoring of children's vaccination status.

A creative communications agency specialising in the development of social marketing strategies for nonprofit organisations was hired to help design the programme, in collaboration with representatives from the partnership and a community advisory panel. The result was the Immunity Community brand and logo along with materials and resources that included the following: a Parent Action Guide (a resource for PAs), posters, postcards, stickers, and branded giveaway items (e.g., first aid kits, notebooks), which were used by PAs at their schools, at events, and on social media. The partnership also created the Immunity Community website. The programme's suite of materials was revised and expanded each year, based on formative feedback from parent focus groups and key informant interviews with staff and participants.

The evaluation was mixed-methods, with an uncontrolled pre-post survey designed to measure impact on parent knowledge, attitudes, and behaviour, supplemented by interviews, focus groups, and observation.

Table 2 in the paper shows increased knowledge of local and state vaccination rates, familiarity with vaccine hesitancy, and understanding the concept of herd immunity on the pre and post surveys. The only statistically significant pre/post change was an increase in knowledge of the vaccination rates at their children's child care or school. Qualitative interviews revealed that PAs and site representatives believed the programe did a good job of raising awareness and knowledge about vaccine-related issues among the parents at their sites. They also agreed that parents at sites were more amenable to conversations about immunisations as a result of the programme. PAs specifically commented on the importance of having a presence and being a source of accurate vaccine information for their peers. The primary ways knowledge was increased, according to PA and site representative report, was through posting materials, outreach events, peer-to-peer communications, and school newsletters.

Pre/post results from 16 survey questions pertaining to vaccine-related attitudes and beliefs indicate that, of these, 13 were trending in the desired direction, and 5 of those were statistically significant (p = .05) - e.g., the percentage concerned about other parents not vaccinating their children increased from 81.2% to 88.6%. Table 3 shows there was also a statistically significant increase in the number of parents reporting confidence in vaccinating their child as a good decision, as well as a statistically significant decrease in the number of parents reporting themselves to be "vaccine hesitant" (from 22.6% to 14.0%). Qualitative interview data from the programme's third year revealed that more PAs than in the first and second years believed that the programme had influenced parents to think more positively about vaccinations.

Impact was also recorded in the form of a statewide policy change and several organisational changes in policies and procedures.

It is unclear how effective the programme would be in contexts with different vaccination norms and values, different resources available to support vaccination, and/or different vaccination policies. Furthermore, in order to test the long-term impacts of such a programme, researchers would need to identify ways to accurately calculate immunisation rates at participating sites. Future research is planned to assess whether programme impact can be maintained with fewer resources.

All that said, in conclusion: "This study demonstrates the promise of using parent advocates as part of a community-based approach to reduce vaccine hesitancy."