Key Guidelines in Developing a Pre-Emptive COVID-19 Vaccination Uptake Promotion Strategy

"Well planned, evidence-based, and theory-informed health communication and health marketing can significantly impact behavior and vaccine uptake..."

Research shows that vaccine hesitancy has steadily increased in more than 90% of countries worldwide since 2014. This paper sets forth guidelines that governments and regional bodies across the world can follow when developing behavioural influence strategies to promote the uptake of COVID-19 vaccines. It makes the case for immediate planning for a COVID-19 vaccination uptake strategy - adapted in a locally relevant way - in advance of vaccine availability for two reasons: first, to build a consensus about the order in which groups of the population will get access to the vaccine; and second, to reduce vaccine-related fear and concerns.

A key part of the strategy advanced herein is to counter the anti-vaccination movement that is already promoting hesitancy and resistance. Since the beginning of the COVID-19 pandemic, misinformation and conspiracy theories have flooded the communication ecosystem, with the potential to reduce vaccine uptake. Sections of populations in many countries display low trust in official information about the pandemic and how the governments are tackling it.

Based on best practice guidance, the paper is organised into the following topics, meant to support effective promotion and maintainence of demand for a COVID-19 vaccine:

• Behaviour change planning - The authors urge that organisers set out a plan that is systematic, logical, transparent (open access), and informed by lessons from the fields of management, logistics, and emergency and disaster planning. They briefly describe, and provide links to, select planning models and guides developed specifically for vaccine promotion, as well as generic planning guidance.
• Audience targeting and segmentation - What is needed, the authors argue, is an approach to vaccine promotion that is grounded not in expert opinion but, rather, in data about citizens' attitudes, beliefs, wants, and behaviours, including what people value and what they fear. Also recommended: the setting of measurable behavioural objectives and a targeted approach that uses a different intervention mix for different subsets of the population. (Population segmentation models enable public heath planners to tailor interventions to specific audiences.) For instance, studies show that some healthcare workers hesitate to vaccinate themselves or their family members. This group could be reached by fellow frontline workers, who can themselves be a significant source of trusted advice and information related to vaccines; however, they need support/training in public health advocacy.
• Competition and barrier analysis and action - As outlined here, a pro-vaccination strategy should include action to reduce the impact of four kinds of competition:
  1. Active competition from the anti-vaccination movement - Intervention designers should involve intended populations in building campaigns and use data-supported insights about what will and what will not motivate them to take up vaccines. In general, evidence shows that combination of positive messaging that emphasises the protective benefits of the vaccine (for the individual, family, and community) and the loss associated with not being vaccinated (e.g., poor health) may be effective.
  2. Passive competition in the form of inaccurate media coverage - "Public health authorities and their coalition partners, including both the traditional and digital media sectors, should proactively work together to reduce and remove at speed false content and misleading information."
  3. Competition from negative social norms - "As an initial step, authorities need to understand what informs social norms and beliefs. Persuasive efforts should appeal to the values and beliefs that people already hold, such as a desire to protect family members..." One approach to overcoming barriers is to build a social norm that vaccination uptake is widespread and accepted in society (descriptive and injunctive normative beliefs).
  4. Competition in the form of structural and economic factors - To offset these, for example, vaccine uptake promotion should facilitate availability and convenience.
• Mobilisation - This section of the paper discusses building and sustaining coalitions of governments, the private sector, non-governmental organisation (NGO) sectors, and civil society, who can bolster the effort through the provision of resources, expertise, credibility, and access.
• Vaccine demand building - The authors emphasis the need for such a strategy to be grounded in "a deep understanding of what will enable and encourage uptake". The intervention mix, they say, "needs to include coordinated action in the fields of prioritization and access policy, supply systems, and promotions strategy."
• Community engagement - "Trust is built and maintained through transparency, constancy, active listening programs, and encouraging dialogue."
• Vaccine access - "Relevant agencies should realize the need for a coordinated mix of interventions to promote vaccine access, led by a strong leadership team." For instance, communicators should provide "specific and relatable information to identified subgroups of the population about how and when they can have access to vaccination."
• Marketing promotions strategy - Among the components of a strategy discussed here: the importance of people's familiarity and trust in the messenger, as well as the the need to pilot-test language used, the imagery, and audio-visual effects. "As part of long-term public health strategy, governments and public health agencies should enhance media and digital literacy in schools and community settings, specifically related to health and vaccine topics..."
• News media relations and outreach - The authors explain the importance of developing a proactive strategy for working with traditional media. Strong, ongoing relationships are key in supporting media engagement and ensuring that the audience views the press as accessible and trustworthy when it comes to communication about vaccines.
• Digital media strategy - Social media platform owners are starting to take action against the anti-vaccination movement, but public health authorities "need to build a proactive COVID-19 vaccine trust capacity for active engagement in the social media space as part of their overall promotional strategy."

In conclusion: "A crucial factor in the delivery of such a trust-building and demand building approach is the need for investment in communication, behavioral influence, and community engagement capacity and capability. Communication and behavioral influence are often underfunded or under-resourced in public health organizations and within government ministries. Building communication and behavioral influence capacity and expertise should be a priority." To ensure that we are prepared for future such events, this investment should be sustained over time in line with best practices around risk communication and community engagement.