Trust is the bedrock of immunization programs. When populations trust their health care providers, the health system and their country’s Ministry of Health, they are more likely to follow their vaccination recommendations. However, when this trust is eroded or broken, vaccine uptake can falter, leaving populations at risk for vaccine-preventable diseases (VPD).

One of the most important things governments can do to strengthen trust in vaccination is to follow risk communications and community engagement (RCCE) principles. In the absence of clear communication, rumors about the risks of vaccination, distrust in the immunization program, and refusal or hesitancy to get vaccinated can flourish. Failure to communicate effectively about vaccination can result in serious reputational issues to immunization programs and the health system at large, decreased vaccine acceptance and uptake, and increased risk of outbreaks of VPD among under-immunized population groups.

Principles of Risk Communication and Community Engagement (RCCE) for Vaccination

Following the WHO Strategic Communications Framework’s principles of RCCE improves communication about vaccine-preventable diseases (VPD) and vaccination:

Engaging with communities is essential to understand their needs and perspectives about vaccination. Additionally, collaborating with communities will allow immunization programs to develop better-quality vaccination services and improve systems and policies.

Use the WHO document Human-centred design for tailoring immunization programmes: a practical guide to engage communities to diagnose barriers to vaccination, design and implement interventions to address them, and evaluate and adjust as needed.

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Managing false information about vaccination

False information about vaccination has a very real impact on vaccine uptake. Mis- and dis-information about vaccines have the potential to shake public trust in the routine immunization schedule, as well as new vaccines. Studies have shown that exposure to negative misinformation about vaccines—as little as 5–10 minutes—increases the risk perception of vaccination and is associated with a lesser chance of getting vaccinated; exposure to false information about the risk of vaccination can lead people to perceive risks where there are none (or the risks are extremely low).

Communicators supporting national immunization programs should invest in social listening activities across a variety of platforms to understand what their audiences are thinking and saying about vaccination; they can then use this information take steps to correct false information through pre-bunking and debunking.

Pre-bunking

Debunking

Debunking happens after an audience has been exposed to false information. In debunking, the myth is clearly labeled and the facts are presented. Debunking is tricky for a few reasons: first, false information is so sticky that even after it’s been refuted, it tends to stick in people’s memories. Second, the timing needs to be just right in order to not preemptively draw attention to a rumor that might otherwise fizzle out, but also to not let a rumor go unaddressed for so long that it spreads wildly.

Communicating about Vaccination-related Risks

For both pre-bunking and debunking, social listening is critical to understand what audiences are saying about vaccination and what rumors that might impact uptake are circulating.

For more information about handling false information related to vaccination, see the PAHO publication Communicating about Vaccination-related Risks. The document also includes practical dos and don’ts regarding risk communication and community engagement processes and principles, messaging, risk perceptions, handling false information, collaborating with partners, and pharmacovigilance, as well as real-world examples.

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Health workers and vaccination

Health workers (HW) are consistently ranked as among the most trusted sources of information on vaccination. A HW’s recommendation in favor of vaccination can be incredibly impactful in terms of vaccine uptake. However, for these recommendations to have the maximum effect, HWs must deliver them empathetically and with fact-based information, keeping in mind cultural considerations and possible barriers. For this reason, PAHO strongly encourages national immunization programs (NIP) to invest in their HWs by training them in two-way interpersonal communication about vaccination. In addition to trainings, NIPs should develop tools, trainings and visual aids to ensure HW have the scientific knowledge they need on hand when conversing with clients and community members who may come to them seeking advice on vaccination.

Likewise, health communications professionals should consider developing specific campaigns, strategies and interventions—or at least targeted messaging that has been pretested with the audience—geared at HW to help reinforce key points they should keep in mind when it comes to communicating with clients and the general public about vaccination.