vaccine visit in uganda

Social Behavior Change for Immunization

Photo by David Snyder for CRS

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“Rushing in the house like a trapped animal holding her grandchild in her hands, my mother quickly went to hide from what I thought was a wild creature chasing her. Who could have made this brave woman run for her life? I wondered. I hesitantly sneaked my head out of the door just to find out that it was a frail community health outreach worker who was going from door to door to vaccinate children…”

child in Uganda

CRS and GAVI help deliver life-saving vaccines to children like this young resident of a home in the Uganda village of Busanza, Uganda. Photo by David Snyder for CRS

As I was listening to my friend relate the story of her mother trying to prevent her nephew from getting vaccinated, I was not sure if one should laugh at this story or rather be sad and alarmed that in this day and age people still shy away from immunization in the belief that they are protecting their children by not vaccinating them. For sure, there is still a lot of work to be done to promote immunization.

 Recent World Health Organization (WHO) estimates indicate that 1.5 million children die every year from vaccine preventable diseases (Sage 2014). As a response to this trend, WHO member states adopted the Global Vaccine Action Plan (GVAP) in 2012 to improve the reach and reliability of vaccine delivery. The main goal of the GVAP initiative was to attain a three-dose diphtheria-tetanus-pertussis (DTP) immunization coverage of 90% in all countries and 80% in all districts by 2020. According to Sage (2014), however, this goal is unlikely to be attained due to a number of obstacles including weak immunization demand related to local social-cultural and religious beliefs (as was the case with my friend’s mum), weak leadership, weak management and coordination, and challenging country contexts such as political conflict and epidemics such as the recent Ebola outbreak in West Africa. Addressing such challenges requires joint efforts from individuals, communities, governments, health professionals and civil society organizations (CSOs) (GVAP 2012). Because CSOs are rooted in the communities they serve, they are in a unique position to understand, articulate, and address the challenges facing local communities. As a result, CSOs are increasingly consulted by international organizations to contribute to health system strengthening in developing countries. The Gavi-funded CSO Constituency Platforms Project implemented by Catholic Relief Services in 24 countries (16 of which are in Africa) provides an instructive example. The project aims to facilitate CSO involvement in strengthening immunization systems. The project seeks to harness CSOs’ capacity to integrate into communities and win their trust, and to expand access to immunization services for those in hard-to-reach areas, including displaced persons and nomadic groups.

community volunteer visit in Liberia

A community volunteer trained a visits parents to encourage them to have their children vaccinated against measles, polio and other vaccine-preventable diseases. Photo by David Snyder for CRS.

Most importantly, CSOs take on the difficult task of changing social behavior. They work to educate households so that caregivers will no longer hinder the vaccination of their children due to preconceived ideas on the effects of vaccines or just maybe because of lack of knowledge on the benefits of vaccines. In fact, CSO platforms taking part in the Gavi CSO Project do not hesitate to explore different avenues to best address caregivers’ hesitance to get their children vaccinated. CSOs often organize vast community mobilization activities, talk shows, radio shows and household visits to educate caregivers on the need for their children to be vaccinated to avoid diseases and strengthen their immune system. CSOs even make use of entertainment education, such as puppet shows in Madagascar and collaboration with local pop stars to create educative songs on immunization. CSOs also increase men’s involvement in child care, encouraging them to accept joint responsibility for ensuring that children are vaccinated.

The success of this health initiative relies on CSOs’ familiarity with local communities, as this enables them to understand and address some of the socio-ecological barriers to immunization. The contributions of CSOs to immunization are broad and include service delivery, demand creation, accountability, disease surveillance, and advocacy for equitable access. More specifically, CSOs activities contribute to the GVAP strategic objectives as follow:


 GVAP Strategic Objectives

CSOS contributions to GVAP Strategic Objectives

1: All countries commit to immunization as a priority

  • support local CSOs and professional associations to contribute to national discussions on immunization and health
  • develop and disseminate the evidence base on the public health value of vaccines immunization and the added value of achieving equity in access and use of immunization
  • include immunization in the agenda of governing bodies meetings
  • create regional forums and peer to peer exchange of information, best practices and tools
  • create expanded and more transparent mechanisms for aggregating, sharing and using information to monitor commitments

2: Individuals & communities understand the value of vaccines and demand immunization as both their right & responsibility

  • engage in dialogue that transmits information and responds to people’s concern and fears
  • create incentives for households and health workers in favor of immunization
  • train health workers in effective communication techniques & advocacy
  • engage enable and support CSOs to advocate the value of vaccines to local communities, policy makers and local and global media
  • develop and implement targeted strategies to sensitize vulnerable communities on their needs for vaccination for their survival
  • use the Internet, radio, television to inform residents and health professionals about vaccines; feature immunization champions such as film stars and famous athletes to communicate information
  • write and publish articles & books about immunization

3: The benefits of immunization are equitably extended to all people

  • engage underserved and marginalized groups to develop locally tailored and targeted strategies for reducing inequities
  • prevent and respond to vaccine preventable diseases during disease outbreaks and humanitarian crises and in conflict zones (Ebola in Guinea)
  • track individuals’ immunization statuses
  • take advantage of communities’ structures to enhance communication and deliver services
  • involve CSOs in community outreach and planning
  • develop new approaches to community engagement for urban and peri urban areas
  • train health workers and CSOs in engaging communities
  • advocate to health officials to ensure that vaccination campaigns cover mobile and rural populations and minorities

4: Strong immunization systems are an integral part of a well-functioning health system

  • develop and promote the use of new technology for collection, transmission and analysis of immunization data
  • promote coordinated training and supervision of community based health workers


5: Immunization programs have sustainable access to predictable funding. Quality supply and innovative technologies

  • advocate for new and more effective vaccines, affordable vaccine prices, funding for vaccine delivery equipment and their equitable distribution


6: Country, regional and global research and development. Innovations maximize the benefits of immunization

  • advocate for new and more effective vaccines, affordable vaccine prices, funding for vaccine delivery equipment and their equitable distribution



Thanks to the efforts and particular expertise of CSOs, and funding and support from Gavi and CRS, more and more people understand the benefits of immunization – and fewer and fewer caregivers are rushing into their houses to hide from wild-beast health outreach workers when they come by with life-saving vaccines.  For sure there is still a lot of work to be done to promote immunization. That said, there is hope and I can see light at the end of the tunnel.