Social Behavior Change for Immunization

“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…”

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.

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:

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.