- Christina A. D’souza, Healthcare & Pharma Vertical Lead
India has kicked off the world’s largest Covid-19 vaccination programme to combat and reverse the Covid-19 pandemic. There has been a lot of news reports or commentary about the mammoth size of the challenge of immunizing more than a billion people against this dreaded disease.
From the Universal Immunization Program (UIP) initiated in 1985 to Project Indradhanush in 2014, India is no stranger to large-scale immunization programmes.
It is widely accepted that vaccines are among the most successful measures in public health, saving between 2 and 3 million lives per year. At the same time, however, 1.5 million lives are lost every year from vaccine-preventable diseases, of which 500,000 are lost in India.
Injecting Trust
What has the government been doing to help achieve immunization across the country?
There is cause for significant concern regarding one of the main indicators called “vaccine coverage” – the proportion of the population that has been vaccinated. Globally, the figure has stagnated at 86 per cent for almost five years; and in 2016, it was just 62 per cent in India.
Mission Indradhanush has been launched to increase vaccination coverage to 90%, but we will not know whether this goal has been achieved for another year or two. The explanations for this very worrisome output are complex and manifold; resolving them would require overcoming a variety of communication difficulties.
The UIP covers 12 diseases from TB and polio to adult vaccines for Japanese encephalitis and pneumococcal conjugate vaccines for pneumonia, blood infections and bacterial meningitis.
All vaccines in the UIP are free to the people taking them; the government buys the vaccine from vaccine makers; a flu vaccine for older adults, especially above the age of 60, is also being considered for inclusion in the UIP.
Despite the proven efficacy of vaccines, 14 million children were not vaccinated in 2019, according to the World Health Organisation (WHO).
Add another 5.9 million children who were only partially vaccinated, meaning they received the first dose but not the subsequent doses. Three-fifths of these nearly 20 million children live in just 10 countries, a list that includes our own – India!
So why is vaccine coverage so low (including in India)? Is it a matter of attitude?
In 2019, a survey of 140,000 people from 140 countries on people’s attitudes towards science and major health challenges was published by The Wellcome Trust, a London-based research charity. The Wellcome Global Monitor asked three questions to ascertain public perceptions and attitudes towards vaccines:
- did people think it was important that children be vaccinated?
- did they think vaccines were safe?
- did they think vaccines were effective?
Overall, an average of 92% of respondents believed that it was important for children to be vaccinated. Globally, only 7% of those surveyed disagreed that vaccines were effective. And only 5% did not believe that vaccines were successful. Vaccination coverage has stagnated at 86% in the last few years.
In India, 98% of respondents believed that vaccines were safe, and a similar number agreed that they were successful. However, only 62% of children below 5 years of age were completely vaccinated.
Similarly, France was very sceptical about safety, with one in three people not agreeing that vaccines were safe; and only 18% believed that they were effective. Yet, 97% of all children in France are vaccinated.
To help explain the reasons for these contradictions, I would like to refer to the WHO Strategic Advisory Group of Experts (SAGE) which defines the concept of ‘vaccine hesitancy’: delay or refusal of completion or refusal of vaccination and immunization schedules. They point to three factors: complacency, convenience and trust.
Complacency is the perception that the risk of vaccine-preventable diseases is low. Convenience is a problem when people must travel some distance to get vaccines.
Confidence (and trust) in vaccine effectiveness is dented by misconceptions – including those shared by the community and religious leaders. This is where healthcare communications can step in to address all three factors.
- First, communications should meet a public purpose.
- Second, it should combine domain knowledge with appropriate content creation, aligned with public and development goals that are aimed at creating the trust (and confidence) in vaccines.
- Third, communications should include well-designed campaigns, disease awareness programmes and audience-specific messaging, using the full range of traditional, online and social media channels.
Healthcare communications focus on creating sustained behavioural change. Healthcare providers, vaccine makers and drug manufacturing companies define the spectrum of their activities as being patient-centric.
So should their communications: when it comes to vaccines, healthcare communications should move the needle from vaccine hesitancy to vaccine confidence.
As India gets ready to be vaccinated against the global Covid-19 pandemic, there is no better time to leverage all our communication capabilities to underscore the importance of life-saving vaccines.