Vaccination Communication Strategies and Uptake in Africa: A Systematic Review

"The findings from this review indicate that various communication strategies have been implemented across Africa and that appropriate vaccine communication activities can significantly improve vaccine coverage."

Vaccination efforts in Africa face numerous systemic and individual challenges. Vaccine hesitancy, in particular, delays or prevents vaccination uptake. Effective communication is crucial to bridging the vaccination uptake gap. This systematic review summarises commonly adopted vaccination communication strategies across African countries and evaluates their influence on vaccine uptake, with the goal of improving vaccination coverage and public health protection.

A systematic search was conducted in five bibliographic databases between 2000 and October 2023 and supplemented with an additional Google Scholar search. Studies with data on vaccination communication and uptake in the English language were considered. All population groups are at risk of vaccine-preventable infectious disease, so they were all considered in this review. The interventions of interest were vaccine communication strategies, acceptance, and uptake. The exposure of interest was the spread of vaccination education and information. Ultimately, 41 studies from 14 African countries met the inclusion criteria.

Several communication strategies were implemented for 13 different vaccines, mainly childhood vaccines. Capacity building to improve interpersonal communication was a common strategy for reaching health workers. To reach members of the public, mass vaccination campaigns (e.g., using radio, television, and/or social media) were the most common communication method, and other direct (e.g., home visits and text reminders) and indirect (e.g., training of community leaders or barbers, who educated their communities) approaches were used. Community engagement was an essential part of indirect communication approaches. Examples of these approaches included social mobilisation, advocacy with stakeholders, house visits, community drama to share vaccination messages through entertainment, and use of a five-colour-coded bracelet representing different immunisation contacts given to newborns. Open-door announcements around the communities were an integral part of disseminating vaccination-related information.

The review found that vaccination acceptance and uptake are likely to be enhanced through multichannel communication. Thus, implementing well-designed vaccination communication strategies and interventions, such as the creative and innovative measures identified in the included studies, could help increase overall vaccination coverage. For instance, Indigenous communication media such as town criers can be used in rural African communities, radio drama can increase vaccination awareness and knowledge, and new media such as text messages, electronic reminders, and immunisation campaign websites have been extensively noted to increase immunisation coverage rates. Adapting such nudge-based interventions is necessary to appropriately tailor how information is framed and delivered to intended audiences.

The information included in the vaccination communication was from various contributors. However, the most common sources were the national ministries of health. Non-governmental organisations (NGOs), foundations, and trusts were also significant information sources. On a broader scale, journalists and media outlets were essential in shaping public perceptions about vaccines.

The purpose of most vaccination communication was to inform and educate the public about either the disease targeted by the vaccine and/or the vaccine itself. Another commonly reported communication aim was to ensure timely vaccination compliance using a reminder system. Some vaccination communication efforts were implemented to improve vaccine uptake and acceptance, including encouraging caregivers to vaccinate their children.

Overall, vaccination uptake increased in all countries following vaccination communication interventions. For example, one study in Ethiopia reported a significantly higher proportion of children getting fully vaccinated with polio, Bacillus Calmette-Guérin (BCG), and measles vaccines after trained health extension workers paid home visits. See the full article for data from various countries.

Various barriers and facilitators to vaccination communication intervention and general vaccine uptake were identified in the included studies (see Table 2 in the paper).
 

• Key barriers included lack of vaccine information, vaccine hesitancy, access issues, and high cost. One study in Nigeria showed low literacy as a barrier to vaccination uptake among community members, and another study reported controversial religious theories about vaccines that affected polio vaccine uptake. Similarly, several studies reported a lack of appropriate information and misinformation as a significant barrier affecting vaccine uptake.
• Key facilitators included improved vaccine education, reminders, trust-building initiatives, and community involvement.

Based on the results of the review, the researchers stress that a communication strategy incorporating appropriate and available communication tools should be part of every immunisation programme. They offer several recommendations, including:
 

• Engage all stakeholders involved in vaccination delivery, communication, decision-making, and acceptance is to achieve maximum vaccine uptake and completion rates.
• Provide training to improve the interpersonal communication skills of healthcare workers, who are considered the most trusted expert messengers. Such training can help them become more assertive while practising shared decision-making and deliberation with their patients.
• Deliver information through various sources, address different groups, and provide tailored messages from the outset to address concerns, especially about experimental vaccines and their effects on other issues, such as fertility, to pre-emptively counter rumours and misinformation that negatively influence vaccination programmes.
• Empower the media to provide effective, transparent, and objective information to the public and fight false and misleading information.
• When turning to other communication tools, including mobile phones, for message reminders, ensure that devices are available, compatible, and operable by users to avoid disengagement.
• Address logistical challenges at a national level, such as the availability of vaccines and competent staff, distance to facilities, and vaccine cost, to help reduce the broader barriers to vaccination.

"Findings from this systematic review provide a roadmap for public health campaigns to improve vaccine coverage and support Africa's progress toward global immunisation targets."