Immunization Communication: Building Trust

This 33-slide presentation from the United Nations Children's Fund (UNICEF) explores issues of trust and communication in delivering vaccines around the world. Author Dr. Heidi Larson begins by emphasising that "[e]verybody in the delivery system - from practitioners, policymakers to donors - is intensely motivated" whereas "[a]nti-vac groups are disorganized and on the fringes." She observes that, for the past 30 years, immunisation has dramatically decreased childhood illness and death around the world. However, because we are seeing less disease, have a number of new vaccines, and have more access to information, the public is asking more questions. Other communication-related elements include: the proliferation of research - giving sometimes incomplete or controversial information; growing civil society demands on access to information; and increased and more rapid communication channels and more global media (e.g., Bangladesh vaccine-related deaths were used as evidence in the United States (US) anti-vaccine movement within 24 hours).

In this context, from Dr. Larson's perspective, the issues with regard to public trust are far more complex than just the vaccine; there is a need to understand the political and socio-cultural context, and to build trust in the provider as well as trust in vaccines. She notes that 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. Dr. Larson stresses the importance of not underestimating people's memories (e.g., of coercive smallpox vaccinations) and of developing ongoing communication approaches: Distrust in vaccines cannot be addressed in a one-time response.

Challenges are outlined. For example, negative public reaction to vaccines is usually related to human emotion - feeling of marginalisation ("THEY are trying to sterilize us") - or perceived damage to a child due to a vaccine. Also, "[a]nti-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."

In response, Dr. Larson states, we need tangible evidence that reminds the public that health improves with immunisation and is at risk when immunisation coverage drops. She suggests revitalised communication that re-positions the benefits of vaccines over the risks.

Subsequent slides explore what the media might be looking for when reporting on immunisation - e.g., disaster or other high profile event, drama with a personal aspect, controversy or conflict, the unexpected, polarity of views, local relevance, and/or a celebrity link. Opportunities outlined here include cultivating the media as key partners promoting (and defending) the rights of the child (the presentation features major principles of the Convention on the Rights of the Child, or CRC) and reminding journalists that their coverage can significantly influence parents' willingness to take their children to be immunised (or not).

In concluding, Dr. Larson elaborates the need for a new paradigm, which includes, for example, the fact that it is not enough to just say: "Vaccines are good"; a communicator needs to be ready with much more information (e.g., Why immunise? Why this vaccine (versus another one)? Why again and again the same vaccine when there is no apparent disease?). She stresses the importance of keeping the focus on building public trust, while retaining communication efforts to responding to negative media and rumours.

For more information, contact:

Dr. Heidi Larson

Clark University

helarson@clarku.edu