Building Confidence in Routine Immunization in the Philippines

To understand the trends associated with vaccine hesitancy in the Philippines, the Data for Good team at Meta analysed public posts about vaccinations on Facebook and insights about trust in healthcare systems from a global survey. The assessment found that there was some distrust toward vaccination programmes and concerns about vaccine safety. Though the analysis revealed salient concerns in the Philippines, there were positive feelings towards vaccines overall as well, including people expressing appreciation for healthcare workers and local officials promoting the country's routine immunisation campaign, with many people sharing stories about getting vaccinated.



Using these insights, UNICEF, Meta, and YIGH developed five social media campaigns, four in Filipino and one in English, which were designed to reach people aged 18-55 years in the Philippines in order to increase confidence in routine vaccination. With content designed by PGP, all campaigns linked to a UNICEF resource page that had information about why, where, and how to access vaccines for children. Campaign themes included:

 

1. Addressing Concerns with Emphasis on Safety and Efficacy (in Filipino language): Since Facebook public posts revealed that vaccine safety was a prominent concern, this campaign focused on providing parents with information about how vaccines are both safe and effective. This campaign included information on vaccine safety. The campaign also included hashtags found in popular pro-vaccine posts and surfaced the norm that childhood vaccines are used around the world in a variety of settings.
2. Increasing Salience for Self-Efficacy, Response-Efficacy and Self-Agency for Vaccination in threat of Vaccine Preventable Diseases (VPD) (in Filipino): Given that concerns about vaccines are driven by worry about children's well-being, this campaign emphasised that vaccinating children is a powerful tool for both protecting and caring for them. This message attempted to turn the worry about vaccination side effects on its head by showcasing vaccines as a way to ease worry and give parents peace of mind.
3. Values-based Messages [Liberty/Values based] (in Filipino): Given that the analysis of posts suggested that there was some lack of public trust in vaccines, this campaign sought to emphasise liberty and parental agency in the decision to vaccinate their children. Using messaging like "The safety of your child is in your hands," the campaign attempted to show that parents are free to have their children vaccinated and this is ultimately their choice.
4. Testimonials/Storytelling with Health Professionals and Parents (in Filipino/English): This campaign used the approach of testimonials and storytelling with two unique types of messengers. The testimonials campaign featured messages from healthcare workers on the importance of vaccines and the protection they afford. (Both public posts and survey data alike indicated a high level of appreciation and trust for this group.) The testimonials also leveraged the concept of social norms and included stories from parents who either plan to or have had their children vaccinated, including a UNICEF Goodwill Ambassador. Social norming approaches have shown to be an effective way of influencing people's attitude towards vaccination and reducing their hesitancy, especially if the message is coming from people in the same context whom parents are likely to trust. Two versions of this campaign were run, one in English and one in Filipino.

UNICEF, Meta, and YIGH tested the effectiveness of these four approaches over a three-week period in July-August 2021. Viewers of each ad set were randomly divided into two groups: those who saw the ads and those who did not, and viewers from both groups were randomly surveyed to determine whether the ads successfully influenced attitudes on vaccination. Selected results include:

• The four campaigns reached a combined total of over 17.9 million people in the Philippines and achieved high recall among those who saw the various messages. Every campaign was successful in achieving a statistically significant lift in post-campaign results about both the importance of childhood vaccines and the likelihood that people would recommend childhood vaccination to others. These questions were used as metrics for measuring relative effectiveness of campaigns as they provided the closest reflection of willingness to vaccinate.
• The testimonial campaign in Filipino achieved statistically significant outcomes across all survey questions. The campaign worked well for improving the likelihood that people would advise their close friends to vaccinate their children. While the testimonial content in Filipino earned consistently strong results, the liberty-values based campaign achieved a higher lift on vaccine importance and a comparable lift on likelihood that people would recommend immunisation to their friends/family. The message addressing vaccine safety and efficacy was successful in increasing both attitudes toward vaccine importance and willingness to recommend vaccination. The campaign achieved a statistically significant 2.1 percentage point lift on both metrics, which would potentially equate to over 224,000 additional people recommending that friends and family vaccinate their children and endorsing the importance of vaccinating children. Self-efficacy and liberty-based messages also achieved statistically significant lifts (1.6 and 1.8 percentage points, respectively), which would potentially mean between 144,000-160,000 people recommending that friends and family vaccinate their children.

In 2022, UNICEF, Meta, and YIGH drew on these campaign results to launch an updated, three-arm campaign strategy, working to select, adapt, and create responsive assets with key design considerations of audience, messages, messenger, and tone. They constructed messaging using behavioural insights. For example, they selected high-performing ads from the previous campaign and updated the content with new voices from the field. Insights from the previous campaign led UNICEF, Meta, and YIGH to feature diverse parents and caregivers with their children in authentic testimonials. The key message and copy in this story showcases the three-part protection-motivation behavioural communication strategy.



Next, they launched these campaigns on Facebook Feed, reaching out to males and females aged 21-44, for a one-month period country-wide. Over 46 million people were reached through these campaigns, generating over 171 million overall impressions. The initiative led to over 332,000 people clicking on the UNICEF Philippines routine immunisation web page. Of the three messaging strategies tested, the testimonials campaign performed the best, generating statistically significant movement on the importance of vaccination and being highly recalled.

Immunisation and Vaccines

Routine immunisation coverage among children in the Philippines has not reached the ideal 95% target, with the coverage rate for many vaccines declining from 2010 to 2021. This decline resulted in measles and polio outbreaks in the country in 2019. In addition to these challenges, fear of entering health facilities and disruptions in the healthcare system overall during the COVID-19 pandemic only exacerbated declining routine immunisation rates. Between 2019 and 2021, there were estimated declines in the coverage of diphtheria, tetanus, and pertussis dose 1 (DTP1), DTP dose 3 (DTP3), measles, and Bacillus Calmette–Guérin (BCG) from roughly 75% to 57%. In 2021, the Philippines was listed as one of 10 countries with the highest number of zero-dose children worldwide.



To better understand constraints on vaccine adoption, the Data for Good team at Meta (previously Facebook Data for Good) is leveraging its Insights for Impact programme to help equip UNICEF and its key partners with information and tools to build public confidence in routine immunization. Beginning as an eight-country pilot in 2020, this collaboration has expanded to include broader support for UNICEF's vaccine messaging efforts in more than 100 countries with the help of Meta's Health Partnerships team.



Learnings from the Philippines initiative that can be applied to future vaccination campaigns include:

• Address prominent concerns surfaced by the community: The message on vaccine efficacy and safety directly addressed the most common concerns about vaccines and was most successful in its potential impact on vaccine uptake, with lift in importance and recommendations to friends and family.
• Message in local languages: Of the two campaigns that used storytelling and testimonials, the one in Filipino achieved the largest ad recall of all campaigns and reached nearly a million more people than the English version, which did not achieve statistically significant recall.
• Consider value-based messaging, especially when trust is low: The success of the liberty-based campaign suggests that value-based messaging may be particularly impactful in the Philippines. Liberty-based messaging may be particularly effective in environments where parents' skepticism towards vaccination programmes hinders vaccine uptake.
• Use testimonials and storytelling from trusted messengers: Storytelling campaigns in the Philippines confirmed that authentic testimonials and stories are powerful mechanisms for effecting change. These messaging approaches demonstrate the power of social norming, storytelling, and the importance of sharing information from trusted and relatable sources.