Community Engagement is essential for COVID 19 mass vaccination: Part One
The coronavirus pandemic has affected millions of people across the world and has resulted in many lives being lost. To protect people from COVID-19, vaccines are being developed. Vaccination is a critical intervention to protect populations from COVID-19, especially in combination with key behavioural actions.
The pandemic has exposed the world to several issues related to vaccine uptake. One key issue is dealing with adult vaccination and limited experience in managing it. In addition, vaccine hesitancy has increased steadily in over 90% of countries since 2014 . Given the potential to undermine vaccination coverage, all countries must take steps to understand the extent and nature of hesitancy and to start promoting approved COVID-19 vaccines.
Too much conflicting information on vaccines, misinformation and disinformation have the potential to impact people’s attitudes, beliefs, knowledge and intention to accept vaccination. Digital platforms can also be means to circulate rumours, which may also go beyond the digital space – in traditional media and in communities, from one person to another. Feedback from communities consistently shows that due to the influence of misinformation, disinformation and rumours, many community groups across the globe believe a cure either already exists or they rely on herbal remedies and other unproven treatments. The differences among vaccines, cures and treatments are still unclear for many people.
There is growing evidence of vaccine delays or refusals due to a lack of trust in the importance, safety and effectiveness of vaccines, alongside persistent access issues . Community trust is key to ensuring vaccine uptake and buy-in. To build trust, it is key to understand how communities perceive the disease and their main questions, doubts and fears around vaccines, generally, and towards COVID-19 vaccines, more specifically. Previous experience of epidemics and communities’ risk perception about the disease can also influence vaccine uptake. Lack of trust in service providers, past negative experience of vaccination and poor quality of services may also affect the decision to accept a new vaccine in certain contexts.
WHO recommends that each country should develop a strategy to increase acceptance and demand for vaccination. The strategy will need to have a robust community engagement component that addresses trust and acceptance, including vaccine demand, and responds to questions around prioritization criteria of the vaccine delivery, such as who is going to get vaccinated first and why. This will need to be tailored to specific contexts to address needs of different populations. A combination of interventions based on evidence from behavioural and social science research will need to be implemented, which will include community engagement; mass, community, and social media campaigns; and health care professional and community worker trainings.
When done appropriately, community engagement increases the likelihood that communities lead on issues that affect them, use services, and build resilience. Community engagement expands the influence of local actors, facilitates the access to and understanding of information, enables and promotes the right to provide feedback on the received services, and builds on existing local capacities . In this case, community engagement is expected to support the buy-in and uptake from communities and individuals of COVID-19 vaccines. Community engagement also plays a crucial role in promoting vaccine safety and addressing possible adverse events following immunization (AEFI).
Vaccination is a critical intervention to protect populations from this coronavirus. However, due to vaccine manufacturing constraints, the COVID-19 vaccines will be introduced in phases. Certain populations will be prioritized based on risk, such as health workers, older people, and others at risk of more severe disease. National governments will prioritize populations based on global technical guidance. It is important to manage public expectations and explain why these populations are being prioritized. Communities will have to be engaged and use culturally and language inclusive approaches to disseminate key messages and to maintain public trust.
Community engagement should be ongoing throughout the COVID-19 response – and specific activities related to COVID-19 vaccine introduction, such as collecting, analysing, and acting on feedback, perception, and beliefs, should be integrated into country strategies and plans. Similarly, the subnational level government department responsible for leading and facilitating microplan development should ensure that community engagement is well integrated in the plans.
All plans should account for disenfranchised groups, such as those living in conflict or post-conflict settings and within refugee and migrant populations. For community engagement plans to be successful, the response should also ensure a well-coordinated approach that enlists the support of community mobilizers from community- and faith-based organizations; humanitarian organizations, such as National Red Cross and Red Crescent Societies; and others from civil society. In addition, it will be important to coordinate with the Risk Communication and Community Engagement (RCCE) mechanisms established in countries for COVID-19 and use existing platforms to reach communities and strengthen local actors and community networks on RCCE and advocate for a consistent integration of community engagement principles in all vaccine delivery plans.