VARN 2023: When Communities Lead, Global Immunization Succeeds

"It is clear that community-centered solutions will be critical to truly understand community needs and co-create local, people-centered solutions to boost vaccine demand and coverage."

The Sabin Vaccine Institute and the United Nations Children's Fund (UNICEF), in partnership with Gavi, the Vaccine Alliance, hosted the Vaccination Acceptance Research Network (VARN) 2023 Conference in Bangkok, Thailand, June 13-15 2023. Highlighting research and policy and programmatic challenges, opportunities, and strategies related to vaccine acceptance, demand, and delivery, this conference report is the result of the 2023 convening of the VARN, which was attended by 231 researchers and professionals across 47 countries.

VARN2023 sought to foster multisectoral engagement, including across global health and policy, research and academia, and healthcare and health communications, and to provide a platform for voices from low- and middle-income countries (LMICs) to be heard. Specifically, the gathering provided an opportunity for the sharing of knowledge from research and practice, as well as agenda, setting around three core themes: vaccine equity, reimagining essential childhood immunisation, and life-course immunisation. Conference sessions focused on both vaccine demand generation and social listening to mitigate rumours and misinformation about vaccines and vaccination, as these components cut across all core themes. Click here to access the recordings.

Across three days, the agenda incorporated the following:

• Five plenary sessions;
• 13 concurrent panel presentation sessions;
• Five interactive skills-building sessions, with speakers:
  • Skills Building Session on Applied Behavioral Science for Health Equity, facilitated by UNICEF;
  • How Understanding Behavior Can Help Us Improve Immunization Services Experiences, facilitation/moderation by The Vaccination Demand Hub and JSI Research & Training Institute, Inc.;
  • Using Motivational Interviewing to Increase Pandemic Vaccine and Routine Immunization Uptake, facilitated by the Global Immunization Division, US Centers for Disease Control and Prevention;
  • Skills Building Workshop on Human-Centered Design Approach to Increase Vaccine Demand, by UNICEF and Nucleus; and
  • How to Tell Your Immunization Story to a Journalist and Why? by Sabin and Internews;
• One evening side event with two panel discussions: Sabin's Social and Behavioral Research Grants Program, Video Narrative Project Screening;
• Two networking events: Vaccination Demand Hub Global Partners Session and an evening reception; and
• Two poster sessions, focusing on life-course immunisation, routine immunisation, social listening and combatting misinformation, and vaccine demand generation.

In brief, the presenters highlighted the still-prevalent inequities around vaccination, most acutely present in the many millions of children who have yet to receive any vaccinations. The implication is that equity must be a focus of immunisation efforts moving forward, requiring a different way of thinking and tailored strategies to understand and fix the underlying causes of inequities in vaccination coverage. Central to this endeavour will be working alongside communities to understand their needs and use those insights to co-develop solutions to reach the most marginalised and systematically missed by programs. VARN2023 also provided a space to share lessons from the COVID-19 pandemic about how to strengthen COVID-19 vaccination and routine immunisations.

The keynote address, "Immunization: The Equity Imperative", by Anuradha Gupta, MBA, President of Global Immunization, Sabin Vaccine Institute, also focused on the moral imperative and evidence for making equity a focus of immunisation efforts. As she noted, VARN community members, with their passion and commitment, can ensure that every child, everywhere, can benefit from the full power of vaccines. The subsequent keynote dialogue, moderated by Gupta, included five experts from global to local levels, who shared their diverse, work-related, and lived experiences pertaining to VARN2023 core themes around immunisation and community engagement.

The conference generated a number of insights in line with four thematic areas, around which the conference report is organised. The themes highlight the need to:

1. Put vaccine equity and inclusion at the heart of programming to improve vaccine confidence, demand, and delivery, and reach diverse and marginalised communities.
   • Inequity, including a lack of gender equity within societies, remains a barrier to immunisation, particularly for marginalised groups, and contributes to growing numbers of zero-dose children.
   • Achieving vaccine equity is complex but is the pathway through which to build vaccine confidence, demand, and uptake for all.
2. Prioritise communities in immunisation service delivery through people-centred approaches and tools.
   • Behavioural design approaches can help us elicit and understand community needs to improve vaccine equity and immunisation service experiences.
   • Community perceptions and lived experiences of immunisation need to be heard by the health sector and policymakers to build trust and combat misinformation.
   • A diverse range of approaches can be used to empower communities and healthcare workers and co-develop strategies to improve vaccine confidence, demand, and access.
   • Improving the immunisation service experience is important to strengthen trust in health systems and improve vaccine demand and uptake.
3. Encourage innovative, community-centric solutions and programmes for improved routine immunisation coverage and to reduce the number of zero-dose children.
   • Innovative, community-centric programmes are needed to continue recovery from backsliding in childhood essential immunisation coverage.
4. Strengthen vaccination across the life course through building vaccine demand and service integration to contribute to pandemic preparedness and maximise the benefits of future vaccines for all.
   • Building vaccine confidence and demand is critical to strengthen vaccination across the life course, which will contribute to pandemic preparedness and maximise the benefits of future vaccines for all.
   • Integrating life-course vaccines with primary healthcare and other elements of service delivery can boost demand, uptake, and service delivery.

The figure below depicts high-level insights stemming from VARN2023.


The conference report features a number of examples, with hyperlinks, and case studies. In addition, all VARN2023 conference presentation recordings, posters, and other materials can be found here.