Lessons Learned and Conclusions - Combatting Antivaccination Rumours: Lessons Learned from Case Studies in East Africa

Lessons Learned and Conclusions

• Tailor immediate and ongoing strategies and respond promptly to questions andrumours.
• Build ongoing relations with all communities (religious, social, media).
• Disseminate consistent messages.
• Lack of information creates questions - leading to apprehension and fears - whichin turn lead to rumours.
• Take time to deal with rumours. Benefits will accrue to routine EPI.
• Social mobilisation should be a continuous process, continuously informing about theimportance of routine immunisation through all channels: e.g. film vans, drama,media (radio, television and newspapers).
• Timing - rumours occur mostly during NIDs.
• Resources for adequate and on-going social mobilisation are rarely included in thebudget.

Communications are viewed as a "technical priority," but these communications arevital to reach resistant groups and to avoid the emergence of rumours.In each country where vaccination rumours were examined the conclusions are similar: asustained, well-planned and implemented social mobilisation campaign must beconducted. Special attention must be given to the campaign on the ground. Yet this isthe one aspect that is most neglected. Officials noted in each country that competingpriorities and the lack of resources - primarily financial resources, personnel, and time - were constraints to doing what they know needs to be done. Intense and thorough sensitisation and education of the masses takes time and money.While the donor organisations place much emphasis on delivering vaccines and technicalsupport, communication elements of vaccination campaigns are overlooked. EPI headsin some countries suggest that UNICEF and WHO should commission technical reportsto investigate social mobilisation for EPI. Also, appoint a panel of experts to makerecommendations to the country officials about how to improve communications.Other suggestions for improving EPI and future mass campaigns:

• Ensure adequate planning for clear campaign objectives, clearly defined audiences, messages appropriate for each audience, and activities that readily lend themselves to implementation and evaluation. Planning should involve programme staff, communication specialists and other relevant persons to develop communication activities guided by results of qualitative research.
• Conduct planned social mobilisation throughout the year, not just during national campaigns. Social mobilisation is almost always too short. Plan enough time to sensitise; messages in mass media are not necessarily on the ground. Be sure to include staff sessions for health clinic and hospital workers. Start early and address questions. Involve those who are trusted by the community and supportive of campaign objectives, especially religious and local leaders, chiefs, and elected officials.
• Organise at least two stakeholders meetings a year at provincial and district levels. It takes time and resources to cultivate organisations and their leaders. Many people who were interviewed were willing to participate in the NIDs, but the context or a forum must be implemented.
• Pay particular attention to health workers. Coverage surveys and interviews conducted for this study confirm that mothers cite the health worker as the single most important source of information on vaccinations. Another reason for social mobilisation all year is that mothers asked questions about the NIDs in the clinics, but health workers did not have time to educate them.
• Use religious and political leaders and the business community to promote EPI services. Religious organisations have comprehensive distribution networks. They are also among the most credible organisations. To gain greater organisational support from religious bodies, future mobilisation strategies should aim at building partnerships by giving religious leaders and other leaders some advisory role at the local level to increase their sense of ownership.
• Encourage sponsorship of innovative community based activities that provide a mechanism for engaging leaders and their communities. These can be in the form of sporting events, rallies, contests, tours, etc. Use these spokespersons to promote EPI and mass campaigns.
• Develop materials that are technically sound but assure that communities can easily understand IEC materials. Be aware of language, literacy barriers, and cultural issues in some regions.
• Put special emphasis on importance of immunisation, side effects of vaccinations, schedule of immunisation and timely completion of antigens, reasons (e.g. futureinvestment).
• Address vaccine safety issues and other issues raised by mothers and fathers. Conduct focus groups with parents to assess potential questions. Address the issues before questions arise. (suggestions from Dr. Grabowsky)
  
  • Canned radio and TV spots addressing safety
  • Written materials that emphasise safety
  • Other materials available with specific refutation of the issues raised.

Some important points from interviews for mass campaigns and routineimmunisation:

Churches are an effective tool to counter rumours because the religious leadersare credible and trusted - get priests to understand (when they didn't understand,they passed along their own doubts)

Schools - engage headmasters to give children facts who then give information toparents

Development Groups - women, youth, etc.

Baraza - district meetings, groups are effective and strong

Mobile Units - conduct outreach clinics

Examine the Ministry of Health expectations - are they too high; are they based onaccurate information to begin with?

Possible ways to address rumours are to:

• Immunise health workers against rumours!
• Determine if people or organisations have refused immunisation or government services in the past and provide information through inter-personal communication with these groups and their leaders well in advance of the campaign. This may prevent or avoid suspicion or rumours.
• Clarify the extent of the rumour or misinformation (type of messages circulating, source, persons or organisations spreading the rumour).
• Determine the motivation behind the rumour (lack of information, questioning of authority, religious opposition, or other).
• Conduct the campaign with local leaders at sites where the individuals/groups are comfortable and can feel at ease to ask questions and have peers present.
• Make information available on how to combat rumours and/or create a rumour registry or toll-free rumour hotline; or create a rumour call in radio programme. Have a place to register rumours.