The Critical Public Health Value of Vaccines Tackling Issues of Access and Hesitancy: Proceedings of a Workshop (2021) / Chapter Skim
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6 A Systems Approach to Increasing Vaccine Confidence and Uptake: Opportunities for Community-Based Strategies
6 A Systems Approach to Increasing Vaccine Confidence and Uptake: Opportunities for Community-Based Strategies
Pages 115-142
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From page 115... ...
Clarissa Hsu, assistant investigator at the Kaiser Permanente Washington Health Research Institute, presented on the Immunity Community, a communityengagement strategy to boost vaccine confidence. Louise Letley, nurse manager for Research, Immunisation Operations at Public Health England, provided an example of engaging with faith communities to increase vaccine acceptance and uptake in North London's Charedi Orthodox Jewish community.
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From page 116... ...
contexts have crosscutting implications and could potentially inform social mobilization strategies in the United States. Jalloh and colleagues published a commentary on lessons learned from social mobilization for immunization comparing experiences in different LMICs, including Bangladesh, India, and Sierra Leone, among others (Jalloh et al., 2020)
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From page 117... ...
With only 6 percent of the country's children vaccinated against the six antigens by 1985, Sierra Leone's vaccination coverage lagged behind most nations worldwide, including most countries in Africa. In an attempt to improve vaccine coverage, Sierra Leone's Ministry of Health (MOH)
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From page 118... ...
Jalloh remarked that social mobilization has played a pivotal role in other immunization campaigns -- such as the successful eradication of polio in Uttar Pradesh, India -- but he focused on how social mobilization was used to improve vaccination coverage among Rohingya refugees who 3 Based on the majority religions, the MOH and UNICEF organized the country's religious leaders into two action groups: the Christian Action Group and the Islamic Action Group. 4 In a country such as Sierra Leone that is administered by chiefdoms, a paramount chief is the highest-ranking leader in a given region.
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From page 119... ...
Data from the rapid assessment were used in real time to inform the next vaccination campaign. By engaging religious leaders, traditional healers, and women leaders in the Rohingya camp, they were able to increase vaccination coverage by 10 percent in the next campaign.
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From page 120... ...
He noted that UNICEF had recently published a document that highlights the minimum quality standards and indicators for community engagement,5 which can help shape the design and evaluation of high-quality social mobilization efforts. He suggested that such standards should be used to understand process-oriented issues related to social mobilization and to 5 UNICEF's minimum quality standards and indicators for community engagement is available at https://www.unicef.org/mena/reports/community-engagement-standards (accessed October 22, 2020)
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From page 121... ...
ADAPTING COM-B FOR THE TAILORING IMMUNIZATION PROGRAMMES APPROACH TO INCREASE VACCINATION ACCEPTANCE AND UPTAKE Presented by Catherine Jackson, Valid Research Limited Jackson described how the COM-B model of behavior change was adapted for the WHO TIP approach to increase vaccination acceptance and uptake.6,7 She provided an overview of how both models can be tailored for vaccination behavior, and she described how the combined approach was used to inform the design of interventions to increase vaccination among internal migrant families in Kyrgyzstan. The Tailoring Immunization Programmes Approach The TIP approach is typically initiated to address below-target or declining vaccination coverage in specific unimmunized and underimmunized populations at the national level or within certain population groups or geographic areas.
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From page 122... ...
The COM-B model is applicable for evaluating the vaccination behaviors of various stakeholders, including parents and health workers. A growing body of global evidence on the determinants of vaccination behaviors has confirmed the relevance of the three factors identified by the COM-B model, she said.
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From page 123... ...
She noted that data that are relevant to the factors and sub-factors of the original model are still being collected. Using COM-B in the Tailoring Immunization Programmes Approach Jackson described how the adapted COM-B model of vaccination behavior is embedded within the TIP approach.
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From page 124... ...
Using the Tailoring Immunization Programmes Approach in Kyrgyzstan Jackson provided an overview of the geographic distribution of TIP use. To date, most use has occurred in Europe across a diversity of countries and target populations, covering health workers, caregivers, and parents.9 To 8 Types of interventions include information/education, persuasion, incentivization, coer cion, training, restriction, environmental restructuring, and modeling.
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From page 125... ...
, Sweden (Somali community, undocumented migrants, and the Anthroposophic community) , and the United Kingdom (orthodox Jewish Charedi community)
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From page 126... ...
IMMUNITY COMMUNITY: A COMMUNITY ENGAGEMENT STRATEGY TO BOOST VACCINE CONFIDENCE Presented by Clarissa Hsu, Kaiser Permanente Washington Health Research Institute Hsu presented on the Immunity Community, a community engagement strategy to boost vaccine confidence. The Immunity Community was created through VAX Northwest, a public–private partnership focused on children's health, and implemented by WithinReach, a Seattle-based nonprofit that connects parents in Washington State with needed health resources.
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From page 127... ...
Based on these findings, VAX Northwest developed a program to engage parents by working within existing organizations, such as schools and day care centers, to spread positive messages about vaccination. Immunity Community was then created with the help of a community advisory board and BC/DC Ideas, a marketing firm that specializes in social marketing campaigns for nonprofits.11 The campaign developed a large number of materials, including a parent action guide and viral images for social media.12 The parent action guide was used to train the parent advocates and included (1)
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From page 128... ...
In monitoring vaccination rates, parent advocates played multiple roles. Although Washington State requires elementary schools, day care centers, and preschools to collect immunization information on the children who are participating in their program, the state has lacked resources to monitor and hold those organizations accountable.
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Impact on Policy Immunity Community was able to effect organizational-level policy changes, primarily related to the collection of immunization information, said Hsu. In one notable policy change, WithinReach and two of the parent advocates worked with the organization overseeing all of the state's cooperative preschools to adopt changes to their risk management manual, including new information about immunization and reports of immunization.
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She noted that when Immunity Community attempted to implement low-resource Immunity Community models, they were unable to get past the recruitment phase. ENGAGING WITH FAITH COMMUNITIES TO INCREASE VACCINE ACCEPTANCE AND UPTAKE IN A CHAREDI ORTHODOX JEWISH COMMUNITY Presented by Louise Letley, Public Health England Louise Letley, nurse manager for research and immunization operations, Public Health England (PHE)
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From page 131... ...
Analysis of Findings from the TIP Process Letley described the findings that emerged from the TIP process in the Charedi community. In addition to confirmation that the uptake of immunizations was lower within the Charedi community, data analysis showed that recurring vaccine-preventable diseases were placing a burden on the community, particularly in children under 4 years of age who would be protected by the routine childhood vaccination schedule.
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From page 132... ...
Data from general medical practices serving the Charedi community indicated that children under 4 years of age composed 10–17 percent of the registered community, compared to 6 percent nationwide. Thus, the Charedi community was weighted toward the younger age group, but did not have additional resources to support this population composition.
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From page 133... ...
Lastly, local authority and immunization providers explored options for community venues for immunizations, such as children's centers and other locations that might be more accessible to parents than general medical practices. ENGAGING WITH IMMIGRANT COMMUNITIES TO INCREASE VACCINE ACCEPTANCE AND UPTAKE IN A SOMALI AMERICAN COMMUNITY Presented by Patsy Stinchfield, Children's Minnesota Stinchfield described efforts to engage with the immigrant Somali American population in Minnesota to increase vaccine acceptance and uptake after anti-vaccination messaging affected the MMR coverage rate in that community and outbreaks of measles occurred.
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From page 134... ...
This resulted in mosques spreading the message that parents should not give their children the MMR vaccine, said Stinchfield. By 2014, the MMR coverage rate in the Somali American population in Hennepin County had dropped to 42 percent.18 Work is still ongoing to close the vaccination gap between Somali American and non-Somali American children in Minnesota, but the 17 More information about 2017 American Community Survey estimates is available at https://www.census.gov/programs-surveys/acs/news/data-releases/2017/release.html (accessed November 5, 2020)
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From page 135... ...
The study suggests that beliefs that the MMR vaccine causes autism contributed to an immunization gap between Somali American and non-Somali American children, noted Stinchfield. Measles Outbreak in the Somali Population By April 2017, MMR vaccine rates had dropped dangerously low among the Somali American community in Minnesota, leading to an outbreak of measles.
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From page 136... ...
In addition, Children's Minnesota conducted a series of interventions to connect with the Somali American community. The organization developed a Somali American employee resource group that continues to thrive today, said Stinchfield.
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Informational materials have been translated to make them accessible to more people and Children's Minnesota is working to build a hospital staff and leadership that reflect the families the organization serves. In terms of public health interventions, the state health department conducted outreach via Somali American imams and Somali American health care providers, held multiple Somali American community meetings with health leaders and legislators, and ran culturally appropriate ads in Somali American radio and television outlets.
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From page 138... ...
. She also noted that as the COVID-19 pandemic is decreasing vaccine rates worldwide, creativity will be needed to safely immunize children and maintain MMR vaccine rates.
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From page 139... ...
Letley said that attaining and sustaining community engagement can be challenging, but it is helpful to engage community leaders from the outset and ensure that they remain involved at all stages. For instance, Charedi community members provided cultural awareness training to health care professionals to educate them about community beliefs, practices, and religious holidays.
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From page 140... ...
The overall rates are now recovering, but there is concern that the coverage rates for the large Somali American community in the state will not recover at the same rate. Hsu and colleagues are interested in conducting work to understand community-level responses to the COVID-19 pandemic and vaccination campaign.
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From page 141... ...
Engagement increases as a function of the extent to which social mobilization structures are engrained and sustained within a community and used to address crosscutting issues, he noted. When health providers only come to a community to discuss specific public health objectives, a top-down method is being used.
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From page 142... ...
During the current COVID-19 pandemic, professionals must work together to advocate not only for resources to develop COVID-19 vaccines but also for resources to ensure these vaccines are delivered to the populations for whom they are recommended. He noted that even vaccinees benefit from high vaccination coverage rates because no vaccine is 100 percent effective; when everyone is vaccinated, it protects people who have vaccine failures.
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