Centering equity in vaccine delivery: How digital technologies can combat vaccine hesitancy and misinformation among women and marginalized communities

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A healthcare worker is inoculating a woman with a COVID 19 vaccine
© World Bank / Curt Carnemark

 

This blog is part of a series on digital safeguards and enablers for COVID-19 vaccine delivery.

 

As COVID-19 vaccine rollout advances globally, countries must address issues around vaccine hesitancy and the spread of misinformation. Inaccurate information about COVID-19 has caused people, especially, women and marginalized communities around the world to be wary of COVID-19 vaccines. This can be a key barrier to vaccine uptake and prolong the effects of the pandemic. 

As women are often responsible for most household healthcare decisions — including for children, parents, and extended family members — their vaccine hesitancy can have significant ripple effects and it is essential to build their trust during a vaccine rollout. Digital technologies can help governments, civil society organizations, and healthcare service providers in outreach and persuasion, combating misinformation, and post-vaccination follow-up 

Vaccine hesitancy is endemic worldwide. In June 2020, a survey of nearly 13,500 participants in 19 countries showed that only 72 percent of the participants were likely or somewhat likely to take a vaccine, with wide inter-country variances. In a GeoPoll study in Côte D’Ivoire, DR Congo, Kenya, Mozambique, Nigeria, and South Africa, only 42 percent of respondents would “definitely” get the vaccine as soon as possible. Whilst not universal, there is a trend of higher vaccine hesitancy amongst women including in Africa and Latin America, as well as the UK and the US. This is a key health equity issue: vaccine hesitancy is higher in traditionally disadvantaged communities. A study in Chandigarh, India, showed that scheduled castes or scheduled tribes had 3.48 times greater odds of vaccine hesitancy compared to others. Those most hesitant are unfortunately also the hardest hit. 

The cost of ignoring vaccine hesitancy is high, and it leaves a vacuum for misinformation. In 2015, two Ebola vaccine trials in Ghana had to be stopped, due to media accusations that researchers were infecting participants with Ebola. Rumors that polio vaccines could be contaminated with anti-fertility agents, HIV, and carcinogens led to a boycott of a polio vaccination campaign in 2003 in Nigeria. This boycott led to a five-fold increase in polio incidence and contributed to outbreaks across the continent.

So, how can digital technologies help? 

First, research suggests that peer networks and trusted sources are effective in spreading important health information compared to mass media campaigns. Digital technologies are critical to social connectedness, and can help galvanize family, group, or community-level conversations to combat hesitancy. Stakeholders can utilize digital and in-person platforms that engage social and community networks. For example, Nigeria’s National Primary Healthcare Development Agency uses online media campaigns as well as regular advocacy sessions with community, religious and political leaders. And the World Health Organization has launched a WhatsApp-based HealthAlert service in various languages for outreach, building on the successful program of MomConnect in South Africa.

Digital technologies can also provide opportunities for smaller groups to engage in robust conversations to help clarify the science and facts about the vaccine development and distribution process in a safe yet trusted environment. Social media networks -- now actively cracking down on vaccine misinformation -- can also provide real-time public data to understand community attitudes and behaviors, which can then inform communication strategies around immunization. 

Second, while some evidence suggests that people in countries with greater internet access are significantly more likely to be skeptical due to the easier spread of disinformation online, research also shows the effectiveness of using digital technologies to combat this. In Zimbabwe during COVID-19, WhatsApp newsletter messaging from a trusted civil society organization may have substantively large effects not only on individuals’ knowledge but also ultimately on related behavior. Co-developing inclusive communications campaigns with local community networks and organizations can help. Specific messaging targeting women with disabilities, from ethnic and religious minorities, rural and other marginalized communities, developed in local languages, is most useful. Digital platforms such as U-report hosted by UNICEF can serve as a tool to encourage dialogue, share information, and develop joint solutions to community-level vaccine skepticism. Earlier studies also show that being exposed to denial arguments without a rebuttal can have a negative effect on trust and support of vaccination, however putting forward the facts in a discussion have positive effects on attitudes. 

Third, healthcare professionals globally have called for more diverse populations in vaccine trials, and for better understanding the effects on marginalized populations. Digital technologies can help operationalize a vaccine safety monitoring system -- smartphone apps such as V-SAFE in the US and the DIVOC platform in India enable a mobile-first population to report adverse events and conduct post-vaccine follow-up reporting with ease, providing more representative data on populations that may not have been fully included in clinical trials.

Finally, demographically disaggregated vaccination data and monitoring systems matter. Demographic markers based on the country can also help to ensure that the vaccine rollout is equitable. Data should at least be disaggregated by sex and age and shared transparently with the public and within high-risk communities. Data management and monitoring systems must comply with regulations and standards for collecting, sharing, storing, and securing patient data to build trust.

Unfortunately, these digital outreach efforts may not be accessible to many -- nearly 40% of the world still does not have access to reliable broadband connectivity, and the elderly, women, and low-income communities are amongst the most vulnerable and suffer the greatest. Complementing digital efforts with traditional communications campaigns that speak to marginalized communities’ contexts and sources of hesitation is essential.  Identifying and proactively addressing gaps in public confidence and developing targeted efforts is key to building trust and, ultimately, to ensuring an inclusive recovery from this pandemic. 

 

This work is supported by the Digital Development Partnership, administered by the World Bank. For more information or how you can receive assistance with these topics, please contact [email protected]    

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Authors

Sharada Srinivasan

Young Professional, Digital Development Global Practice, World Bank

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