Is There Really a Problem?

1. Immunization Communication:Building TrustNew DelhiAugust 2004Dr. Heidi LarsonSenior Communication Adviser, UNICEF NYHQ Vaccination in Tomorow's Society - Fondation Merieux

2. Is There Really a Problem? • Everybody in the delivery system -- from practitioners, policymakers to donors -- is intensely motivated • Anti-vac groups are disorganized and on the fringes • Benefits are obvious to any thinking parent • Problems in the developing world are technical (delivery systems, storage, availability, funding) not perceptual

3. Were We Ever Wrong! Generally.. • Vaccines are one of public health’s greatest successes-and one of its most unheralded • Taken for granted by a complacent majority • Attacked and questioned by a vocal minority

4. GLOBAL ENVIRONMENT • For the past 30 years immunization has dramatically decreased childhood illness and death around the world • But, because we are seeing less disease, have a number of new vaccines, and have more access to information—the public is asking more questions • There are additional concerns around injection safety and waste management

5. GLOBAL ENVIRONMENT • Proliferation of research giving sometimes incomplete or controversial information • There is a global vaccine divide between industrialized and developing countries • The public is increasingly challenging “quality” and “safety” of commodities

6. Manufacturers Leaving the Developing Country Market (1992-2001) GLOBAL ENVIRONMENT

7. GLOBAL ENVIRONMENT • Stronger rights-based, “right to know” environment - growing civil society demands on access to information • Increased and more rapid communication channels,more global media - internet, satellite TV (Bangladesh vaccine-related deaths were used in US anti-vac movement within 24 hours) • Previously locally isolated adverse events now national/international media events

8. GLOBAL ENVIRONMENT - P Davies, S Chapman, Department of Public Health and Community Medicine, University of Sydney; J Leask, National Centre for Immunisation Research and Surveillance; March 21, 2002

9. LESS PUBLIC TRUST • The issues are far more complex than just the vaccine…need to understand the political, socio-cultural context • Need to build trust in the provider as well as trust in vaccines

10. LESS PUBLIC TRUST 5 Types of AEFI • Vaccine Reaction • Programme errors • Injection reaction • Coincidental events • Unknown BUT, not all issues of Public Trust are related to AEFI. Some are rumours and distrust related to the other issues

11. LESS PUBLIC TRUST • Politically, economically, ethnically and socially marginalised groups have less trust in government provided commodities or services - increasing rumours and opposition to vaccination due to lack of trust in the provider (eg. OPV sterilizes, causes HIV/AIDS)

12. LESS PUBLIC TRUST • Do not under-estimate people’s memories—individually and collectively • Memories of real sterilization campaigns • Memories of clinical trials gone wrong • Memories of coercive smallpox vaccinations • Memories of not getting the health services asked for—the felt needs Communication needs to be ongoing-distrust in vaccines cannot be addressed in a one-time response

13. Challenges • Negative public reaction to vaccines is usually related to human emotion--feeling of marginalization (“THEY are trying to sterilize us”)—or perceived damage to a child due to a vaccine

14. So what do we need to do?? • Scientists (and the Media!) must not to treat fear and reservation as ignorance and then try to destroy them with a blunt “rational” instrument. Pattison – BMJ 2001;323:838-840

15. The Anti-Vaccine Lobby Anti-vaccination groups are becoming increasingly sophisticated, developing communication strategies to promote their message, utilizing the Internet, prominent politicians, the mass media, professional lobbyists and advertising methods.

16. So what do we need to do?? • Scientists must not to treat fear and reservation as ignorance and then try to destroy them with a blunt “rational” instrument. Pattison – BMJ 2001;323:838-840

17. So what do we need to do?? • Not enough anymore to just say “Vaccines are good” • Need tangible evidence that reminds the public that health improves with immunization—and is at risk when immunization coverage drops • Need to re-position the BENEFITS of vaccines OVER the RISKS • Need new revitalized communication

18. I II III IV Prevaccine Increasing coverage Loss of confidence Resumption of confidence Disease Vaccination Coverage Outbreak INCIDENCE Adverse events TIME

22. What are media looking for? • Disaster or other high profile event • Drama with a personal aspect • Controversy or conflict • The unexpected • Polarity of views • Local relevance • A celebrity link

23. What are media looking for? • 57.9% of children were immunized in Kano in recent rounds (against only 4-5% routine) • Media pushing for an angle, “Close to one half population still refuses OPV” instead of bringing attention to the progress

24. What do the media like? • Accuracy and simplicity • Statistics with an explanation, if possible • Context (part of a wider picture) • Explanation from the highest authority • Controversial issues • Both sides of the story • A FASTresponse

25. They will ask • WHO is affected and WHO is responsible • WHAT has happened? WHAT is being done? • WHERE has it happened? • WHEN did it happen? • WHY did it happen? • WILL is happen again?

26. Opportunities • Cultivate the media as key partners promoting (and defending ) the rights of the child • Remind journalists that their coverage can significantly influence parents willingness to take their children to be immunized (or not!)

27. Major principles of the Convention The best interests of the child In any decision or action which may affect them, children and young people havethe right to have their best interest given primary consideration (article 3.1) Ask yourself: When you write a story, is the angle in the best interest of children?

28. Major principles of the Convention Respect and support for parents and carers Although the main responsibility for bringing up children lies with parents and carers the government has a duty to provide support, advice and services to help them fulfil their roles (articles 5,18) Ask yourself: Does your story recognize the role of governments and parents in protecting the health of children?

29. Major principles of the Convention Privacy and confidentiality Children have a right to privacy. Privacy related to the disclosure of information discussed with health professionals must be respected (article 16) Ask yourself: Is your story respecting a child’s right to privacy? Or, are your exploiting a child’s illness or disability to sell a newspaper?…

30. Need for new paradigm • NOT enough to just say: “Vaccines are good” “Give your child vaccination” • Need to be ready with MUCH more information on: WHY immunize? Why THIS vaccine (versus another one….)? WHY again and again the same vaccine when there is no apparent disease?

31. Need for new paradigm • While we need to have a new level of readiness to pre-empt and respond to negative media following AEFI • We should not divert our communication efforts to responding to negative media and rumours, but keep the focus on BUILDING PUBLIC TRUST

32. Need for new paradigm • In the 1980s, vaccines were new, there was an excitement generated about them • Need new rationalization for continuing to vaccinate • Need to understand contemporary context and make vaccines relevant