Demand promotion and community engagement
Tackling inequity by promoting demand for immunisation
Tackling inequity by promoting demand for immunisation
Ensuring sustainable demand for immunisation is only possible when caregivers and communities trust the safety and efficacy of vaccines, as well as the quality and reliability of immunisation services. They also need to have the necessary information, access and motivation to complete the recommended immunisation schedule on time.
Governments increasingly cite low demand as a key obstacle to achieving high and equitable coverage of vaccines. Even where supply chains are robust and comprehensive, low demand can have a negative impact on immunisation programmes.
Efforts to promote demand for vaccines help to reduce missed opportunities to vaccinate and increase the proportion of children that complete a full course of vaccines.
Today, few countries have comprehensive and effective demand promotion programmes in place. A major challenge is funding, especially at the sub-national level and for populations that are already underserved.
Where programmes are funded they may not be strategic and fail to reflect context-specific challenges or socio-behavioural considerations. They often lack robust monitoring and evaluation, hampering efforts to identify what interventions work best, or how to improve.
Too often health workers are not supported to improve interpersonal communication skills. Poor communication, and poor quality of care, can significantly erode community trust.
To prioritise the most susceptible populations, health programmes need underlying data systems that support the systematic identification and reach of the least visible and most marginalised children. Furthermore, these insights should deepen the programme’s understanding of individual decision-making and action taking. For example, drivers to action (such as timely reminders to activate intentions) and barriers to action (such as social distance or poor perception of services) can influence caregivers’ decisions relating to immunisation.
There are many ways to measure people’s attitudes to immunisation, from traditional surveys and interviews to more recent electronic tools. Listening to people’s views and concerns about immunisation can also inform strategies to encourage more people to be vaccinated. Social listening data collection tools range from sophisticated artificial intelligence and machine learning platforms to telephone hot lines, broadcast radio talk shows and documentation of community dialogues.
The private sector has demonstrated that there is value in advanced digital data gathering approaches for commercial activities, but these are just recently being explored for use with public health programmes. Finding the Signal through the Noise: A landscape review and framework to enhance the effective use of digital social listening for immunisation demand generation provides an overview of the current state of digital approaches to social listening for immunisation through a combination of desk research, key informant interviews, a review of relevant frameworks, evidence and learning from country experiences.
The Vaccine Alliance has developed a demand promotion strategy that encourages countries to embrace a range of evidence-informed approaches that are targeted and tailored to the local context. These include social and behaviour change communication, political will and advocacy, health workforce capacity development, social mobilisation and community engagement activities.
We support countries in their demand promotion efforts by:
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Strengthening programmes, accelerating innovation.
Gavi supports countries to stimulate sustainable demand for immunisation – a crucial means of improving coverage and equity. Together with our partners, we help countries to reduce the number of children that do not complete a full course of vaccines, or who do not complete it on schedule.
We provide grants to enhance demand promotion programmes through our health system strengthening (HSS) support, as well as through vaccination campaigns and new vaccine introductions. This includes activities aimed at generating, collecting and analysing data that make demand promotion interventions more evidence-based and tailored to the needs of specific populations.
Gavi also invests in programmes to train and support health workers to better meet community needs. Other investments help countries anticipate and proactively respond to rumours or misinformation around vaccines.
Countries receiving Gavi grants are encouraged to ensure that demand interventions are applied across national immunisation efforts. Civil society organisations play a crucial role in generating lessons learned, helping countries to develop robust programmes and supporting implementation.
We help to ensure that adequate technical expertise and support are provided to countries through the Gavi partners’ engagement framework.
For example, partners may help countries to set up technical groups and coordination mechanisms to improve the financing, management and technical oversight of demand promotion programmes. Technical support is also provided for developing messaging, using mass media tools, engaging community influencers and building interpersonal communication skills among health workers.
Vaccine Alliance partners actively promote and disseminate best practices and evidence-based models, and encourage countries to share their experiences with each other. Work is under way to develop a “menu” of proven and recommended tools for monitoring and evaluating demand promotion initiatives.
We are engaging in several new partnerships that strive to develop innovative ways to stimulate demand for immunisation. For example, we are currently partnering with Unilever to incorporate messaging about immunisation into existing hand-washing and sanitation projects. This type of collaboration helps to extend the reach of critical immunisation communication into under-immunised communities.
We are also working with the African Football Confederation under the “Africa United” initiative, which sees popular sportspeople and trusted celebrities communicate positive, compelling immunisation messaging to a large audience.
Our partnership with the non-governmental organisation Girl Effect focuses on generating demand for the human papillomavirus (HPV) vaccine.
Gavi is also working with Education Above All (EAA) partners to identify communities with out-of-school children and develop joint community outreach strategies to improve rates of immunisation.
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The evidence base for strengthening immunisation demand promotion: tried, tested and novel approaches to engage and motivate communities.