Communication for Investigation of Serious AEFIs

"Serious AEFIs are usually investigated within a communication crisis, characterized by public alarm, media scrutiny and official anxiety. Stakeholders need to be continually engaged and informed during all stages of an investigation."

From the United Nations Children's Fund (UNICEF) and the World Health Organization (WHO), this document provides practical, evidence-based, field-tested communication guidance to help plan and manage communications response before, during, and after the investigation of serious adverse events following immunisation (AEFIs).

Although extremely rare, AEFIs are deemed newsworthy and are closely followed by the media, further fueling public anxiety. Often, in the absence of any official communication about these serious AEFIs, rumours and self-styled health experts fill the void and take the opportunity to attack the immunisation programme. The ease with which information can now be disseminated means that negative news about vaccines can go "viral" on the internet, without any balancing professional input. The negative public and media reactions can also erode support to immunisation by political leaders. This also underlines the importance of sensitive and prompt handling of communication issues, caused by serious AEFIs, in maintaining public trust in immunisation. However, in many cases, immunisation programme managers, who are otherwise well-versed in the technical aspects of vaccination, may not be adequately equipped to respond to the communications issues caused by serious AEFIs.

The resource discusses communication with various stakeholders of the immunisation programme, during all the stages of an investigation of serious AEFIs. For example:

• Prior to reports of serious AEFIs: Reports of a single case or a cluster of serious AEFIs may lead to a sudden crisis of confidence in immunisation services, leaving immunisation programme managers little time to act. It is, therefore, critical to anticipate and effectively prepare the groundwork well before reports of any serious AEFIs and the accompanying crisis. Preparatory actions are outlined.
• After reports and before the investigation of serious AEFIs: Timely communication response is vital, and some of the steps to follow, in this early stage, are delineated.
• During the investigation of serious AEFIs: It is noted here that, when an investigation of serious AEFIs is underway, it is important to inform relevant stakeholders at every stage of the investigation in order to maintain trust in the immunisation programme.
• After the investigation of serious AEFIs: This section provides an overview of specific programmatic actions and the related communication messages that follow each of the 5 possible results of any investigation of serious AEFIs. Depending on the situation and the extent of public and media interest, it is advisable to engage the media at different levels (national, district, and local) and communicate with affected families, communities, health providers, and other stakeholders.
• Communication evaluation: Once an investigation is concluded and findings are communicated to relevant audiences, it is time to evaluate the entire process and assimilate the lessons it offers about how events could be handled better in the future.

Further, the document provides a set of key messages tailored to specific outcomes of the investigation. Through the use of examples, it also gives guidance on engaging the media, particularly for news releases, news conferences, and media interviews. WHO and UNICEF stress that understanding the media perspective and what the media wants from a story will help improve communications with it. Helping the media understand the immunisation perspective is, therefore, of critical importance. Immunisation officials should communicate to the media, using simple language and examples, the science behind vaccination, the types of AEFIs, and the risk-benefits of vaccination. Guiding principles in dealing with the media include, in brief: empathy and caring; competence and expertise; transparency and openness; clarity; seriousness; commitment and responsibility; responsiveness; and positivity (involves "re-framing" the situation, using terms such as "vaccine safety", which has a positive connotation, rather than "adverse event".