is there really a problem?
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Immunization Communication: Building Trust New Delhi August 2004 Dr. Heidi Larson Senior Communication Adviser, UNICEF NYHQ. Is There Really a Problem?. Everybody in the delivery system -- from practitioners, policymakers to donors -- is intensely motivated - PowerPoint PPT PresentationTRANSCRIPT
Heidi Larson, UNICEF
Vaccination in Tomorow's Society - Fondation Merieux
Immunization Communication:
Building Trust
New DelhiAugust 2004
Dr. Heidi LarsonSenior Communication Adviser, UNICEF NYHQ
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
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
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
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
GLOBAL ENVIRONMENTManufacturers Leaving the Developing
Country Market (1992-2001)
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
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
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
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
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)
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
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
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
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.
The Anti-Vaccine Lobby
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
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
INC
IDE
NC
E
TIME
Disease
VaccinationCoverage
Outbreak
I II IV
Prevaccine Increasing coverage
Resumption ofconfidence
Adverse events
III
Loss ofconfidence
INC
IDE
NC
E
TIME
Disease
VaccinationCoverage
Outbreak
I II IV
Prevaccine Increasing coverage
Resumption ofconfidence
Rumours / media event
III
Loss ofconfidence
INC
IDE
NC
E
TIME
Disease
VaccinationCoverage
I II IV
Prevaccine Increasing Coverage
Resumption ofconfidence
Crisis communication
III
Loss ofconfidence
INC
IDE
NC
E
TIME
Disease
VaccinationCoverage
Outbreak
I II IV
Prevaccine Increasing Coverage
Resumption ofconfidence
III
Loss ofconfidence
Increased need of evidence-based
information / education
Adapted from J.Bonhoeffer et al.
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
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
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 FAST response
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?
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!)
Major principles of the ConventionThe best interests of the childIn any decision or action which may affect them, children and young people have the 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?
Major principles of the ConventionRespect 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?
Major principles of the ConventionPrivacy 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?…
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?
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
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