The Role of Faith-Based Organizations in Improving Vaccination Confidence & Addressing Vaccination Disparities to Help Improve Vaccine Uptake: A Systematic Review

"[T]he COVID-19 pandemic has underscored the critical importance of going hyper-local to engage community-based organizations such as FBOs to increase vaccine confidence, allay vaccine concerns, and ultimately drive vaccination uptake."

Faith-based organisations (FBOs) have been shown to bring people together for positive purposes and can serve as powerful agents for health and justice. FBOs' social capital effects are of particular importance in communities with minority and low-socioeconomic groups and elsewhere that social and economic resources are limited, such as vaccinations. This systematic review presents a summary of evidence on the role of FBOs in public health efforts, with a focus on their potential to fuel vaccination efforts and address vaccine disparities.

A search using PUBMED, Web of Science, Science Direct, and COCHRANE was carried out from January to March 2022. Inclusion criteria were: focus on FBO programmes supporting public health emergency efforts, including vaccination efforts, as the primary outcome; articles written in English; and publication dates between January 1 2002 and December 31 2021. Thirty-seven articles met inclusion criteria (n = 26 focused on general public health campaigns; n = 11 focused on vaccination efforts).

The findings related to public health campaigns fell into 4 themes: FBOs' ability to:

• Tailor public health campaigns - Public health campaigns are not one-size-fits-all for FBOs, and there is a need for tailored strategies to enhance community engagement. Due to the involvement in its members' lives, FBOs can address individual concerns in addition to personalising the public health campaign.
• Mitigate barriers - For examle, studies have shown that FBOs provide their members with various coping strategies to address mental health barriers such as prayer, scripture, social support groups, religious services, and aid from religious leaders, showing a potential opportunity for other health-related dialogue such as vaccination.
• Establish trust - Members entrust their leaders to shape their spiritual, physical, emotional, and social environments. By creating a community of trust, FBOs provide an ecosystem of aid. FBOs coordinate and collaborate with health professionals, stakeholders, community members, and social groups. As trusted members of communities, FBOs allow public health interventions to be modified so that individuals are receptive to the messaging.
• Disseminate and sustain efforts - For a public health campaign to be sustainable, there needs to be buy-in from community members, policymakers, and other relevant decision makers and stakeholders. One study found that FBOs are a recognised, valued, and trusted stakeholder in society, allowing them to collaborate among those in the public sector and to engage various community members. These partnerships can facilitate an increase in the public health campaign's awareness, longevity, and effect. Partnerships between FBOs and health professionals can also support evaluation of public health interventions, dissemination of findings, and the fostering of relationships with racially and ethnically diverse populations.

The findings related to vaccine uptake efforts highlight that, "while the value of FBOs and faith-based engagement is identified particularly in supporting underserved and traditionally marginalized populations, most studies underscored the importance of coordination with ongoing vaccination efforts so as to not undermine or duplicated efforts, but rather enhance and build upon them." With regard to vaccination, FBOs' potential roles fell into 3 themes:

• Supporting influenza and human papillomavirus (HPV) vaccination efforts - For example, one study of a church-based social and behaviour change (SBC) intervention found that leaders were amenable to (i) having more trust in the healthcare system and (ii) viewing the HPV vaccine in a less stigmatised manner and promoting uptake of the vaccine among church community members. This study underscored the importance of engaging FBOs and empowering them to provide parents with accurate information to increase HPV vaccination rates.
• Addressing vaccine disparities in minority communities - One vaccination effort, which focused on ethnic minority communities in the United States (US), conducted vaccination clinics at places of worship (churches, a Hindu temple, mosques, a Buddhist monastery) and provided free influenza vaccinations. The collaboration with different FBOs helped address barriers to influenza vaccinations (access, mistrust, transportation) among underserved groups.
• Enabling COVID-19 vaccination - A qualitative case study to assess the strengths of Indonesia's two largest Islamic FBOs and the challenges faced while conducting activities to mitigate COVID-19 nationally found that the collaboration of FBOs with the government aided in mobilising resources to help reduce the impact of COVID-19. Notably, the potential impact of FBOs and faith-based engagement in supporting vaccination efforts may be determinant on the local level faith-community's buy-in and willingness to engage on this issue, as well as the level of religiosity in the community.

In reflecting on the findings, the researchers observe that "effective measures and trusted resources, such as FBOs, are essential to addressing and reducing misinformation, building community trust, and promoting widespread vaccine dissemination, population level uptake, and adherence to vaccination protocols. Upstream factors (e.g., interpersonal, community, health system, policy), relevant cultural and historical factors associated with individual beliefs, risk perceptions, and behavior across multiple levels (e.g., individual, community, etc.) must all be considered."

Among the gaps in the literature identified in this review are:

• Scant attention to the role of FBOs in vaccination efforts among paediatric populations;
• Lack of evidence and outcome-based research on the role of FBOs in vaccination uptake efforts, particularly in assessing the effectiveness of health programmes, community participation, and project continuation; and
• Domination by studies of pandemic and non-pandemic influenza vaccination in the US. Future research should examine differences or commonalities in the role of FBO and faith-based engagement across high-income and low- and middle-income countries.

This review has demonstrated that FBOs have a key role to play in both public health campaigns and vaccination initiatives to support high vaccine uptake and confidence. Vaccination and policy stakeholders should consider engaging with, enabling, and resourcing FBOs in implementing local vaccination programmes and practices.