Building Confidence in Routine Childhood Vaccines in Indonesia

This initiative drew on social media processes in an attempt to influence positive vaccine attitudes and behaviours. It involved a 4-phase process:

1. Generating insights: Collaborators sought to better understand the factors keeping parents from fully vaccinating their children, looking specifically at attitudes that often determine their uptake. Examining publicly available information online and offline, they triangulated data to identify key insights and intervention opportunities to inform messaging strategies. Specifically, following a foundational literature review, the collaborators studied public posts on social media. Analysis revealed that the majority of routine vaccine-related posts on Facebook were written by those in the 25-34 age group and that women were more likely to post about routine immunisation than men. The majority of posts about routine immunisation received positive engagement, demonstrating significant public sentiment in favour of vaccines. They also reviewed recent online campaigns launched by UNICEF Indonesia that tested the effectiveness of different messaging approaches. "Emotional" content that featured photos of parents and children with short, inviting text was the winner, showing high user engagement, ad recall, and a demonstrated ability to shift audience attitudes toward recognising the importance of vaccines. Comments on these vaccine posts pointed to two key concerns that may be dampening uptake: (i) the belief in natural immunity as superior or that being unvaccinated is healthier and (ii) safety concerns related to side effects. Religious objections did not feature prominently in public comments about routine vaccines but were highlighted as minority concerns and corroborated in qualitative project research. Notably, while comments on previous campaigns were positive, nearly one-third mentioned a lack of available vaccines in their location, indicating a need for vaccines to be consistently available, particularly in rural areas.
2. Designing responsive messaging strategies: Underpinned by additional research into the local media landscape, collaborators co-designed strategies to respond to data insights in partnership with UNICEF Country Offices. They looked for opportunity areas that (i) respond to real community perspectives and concerns and (ii) are strongly backed by evidence. Using this criteria, they identified four key messaging strategies in Indonesia: (i) Build on existing positive sentiment towards routine vaccines, and frame vaccination as a social norm; (ii) use values-based messaging (e.g., focused on "purity" - pure from disease); (iii) incorporate testimonials of devout parents to provide social proof of religious acceptability; and (iv) leverage gateway topics to promote vaccination (e.g., use polio successes as an entry point to discuss childhood immunisation more broadly). They then created campaigns based on these strategies and four key campaign considerations: Audience (Who do we want to reach through our messaging?); Content (What do we want to say?); Messenger (Who should say it?); Tone (How should it be said?). For example, with regard to the latter, the materials were designed to convey a positive, engaging tone through clear, colourful, high-quality photos with conversational, peer-to-peer style word choices. All assets were co-branded by UNICEF and the Ministry of Health to leverage the value of authoritative messaging. Collaborators developed a total of 19 individual online assets, segmented into three separate campaigns to be tested.
   • The Emotive Campaign: Collaboratos identified and compiled the highest-performing individual content pieces from successful past UNICEF campaigns into a single campaign. In some cases, they tweaked the messaging to incorporate additional behaviour change principles and reworked them into a testimonial format.
   • The Informational Campaign: This campaign sought to raise awareness of the availability and importance of vaccines. In addition to the messages themselves, collaborators embedded a link to a landing page with more information to encourage uptake.
   • The Values-Based Campaign: Collaborators selected a values-based messaging strategy that aligns the preference seen for natural immunity with vaccination.
3. Testing and iterating: Collaborators launched and tested the three communication campaigns - emotional, informational, and values-based - across regions with higher and lower vaccination coverage, over four weeks in July and August 2022. They deployed Facebook advertising campaigns, grouping and testing different messaging strategies across different audiences, regions, and languages. They used anonymised surveys called brand lift studies to assess and compare vaccine attitudes between groups that were (and were not) exposed to the campaigns.
4. Measuring impact: Together, these three campaigns reached a combined total of more than 91 million people in Indonesia. Approximately 2.1 million people clicked through to the landing page, highlighting both a widespread demand for additional information on vaccination and a cost-effective way to drive traffic to resource pages (US$0.06 per person). While the campaigns reached more people in high immunisation coverage areas, there was more engagement in low- and medium-coverage areas, potentially indicating a higher need for vaccination information in low- and medium-coverage areas. Specific findings:
   • Campaigns that featured parents with children had greater reach than those with illustrations. Ads that featured children by themselves did not reach a large audience. This could imply that the intended audience needs to recognise themselves in the images. Ads that featured devout parents worked well, showing that references to religion and religious acceptance of vaccines could be a good strategy in Indonesia.
   • Campaigns that focused on risks and rights (the informative campaign) did not perform well in regions where routine immunisation coverage was high. In low- and medium-coverage regions, this informative campaign did create some directional movement in agreement with the statement that parents can protect their children through vaccination, especially among women.
   • Purity (the values-based campaign) resonated more in low- and medium-coverage regions than in high-coverage regions. Across the purity campaign, directional movement was observed in agreement that vaccination keeps children pure of disease, with people 25 and over as the drivers of that movement.
   • In both high- and low-coverage regions, the emotional content was found to be the most memorable. In low-coverage regions, emotional content emerged as the clear winning strategy when evaluating based on agreement that it is better to gain immunity through vaccines than exposure.

• Continuing the ads featuring devout parents with children, and using fewer illustrations;
• Looking into additional creative ways to engage with younger people, perhaps by engaging influencers and by using Reels;
• Dropping the informative campaign for high-coverage regions; and
• Continuing the purity campaign and creating more campaigns with purity-focused messages for regions with low- and medium-percentage vaccination coverage and still high numbers of under-vaccinated or zero-dose children.