Building Confidence in Routine Childhood Vaccines in Argentina

The process involved influencing positive vaccine attitudes and behaviours through the following phases:

Generating insights: To better understand the factors keeping parents from fully vaccinating their children, the collaborators examined publicly available information online and offline, triangulating data to identify key insights and intervention opportunities to inform messaging strategies.

Specifically, they began their work in Argentina with a literature review to better understand the immunisation landscape and identify opportunities to encourage vaccination. Next, they aimed to better understand how people are talking about vaccines online and identify community concerns by aggregating and analysing publicly available posts about vaccines across multiple social media platforms (i.e., Facebook, Twitter, news outlets, and blogs) in April 2022. They also looked to UNICEF Argentina's previous online vaccination communication campaign (launched in late 2021) to better understand what resonated with local audiences. Through simple vaccine trivia questions, the #VacunAccion campaign aimed to increase demand for routine vaccination among audience members aged 25 to 54 years. Results of an audience survey showed that the campaign was successful in increasing confidence in ability to explain how vaccines work to others. Finally, they concluded the insights-gathering work by launching a national knowledge, attitudes, and practices (KAP) survey online that drew on multiple validated instruments to understand vaccination attitudes and behaviours, including the Vaccine Trust Indicator (to measure trust in multiple aspects of vaccination), the Vaccine Hesitancy Scale, and the Behavioural and Social Drivers (BeSD) of vaccine uptake framework.

Designing responsive messaging strategies: The collaborators leveraged global vaccine messaging principles and behavioural science expertise to create messages in both English and local languages. Underpinned by additional research into the local media landscape, they led campaign development through an iterative feedback process to produce campaign assets that complement messaging approaches.

Specifically, they identified four core messaging strategies for the campaign:
 

1. Reach out to fathers: Given the higher rates of under-vaccinated children reported among fathers, as evidenced in the KAP survey, the collaborators sought to reach fathers directly by addressing their vaccine concerns and offering practical information about vaccination. The Father-Focused Campaign featured basketball star, celebrity, and UNICEF Argentina Goodwill Ambassador Manu Ginóbili explaining why he chose to vaccinate his children. These videos were supported by static creative geared towards fathers that addressed specific vaccine concerns and provided information on how and when children can be vaccinated.
2. Values-based messaging: Given the lack of trust in public health authoritative sources among those who were vaccine hesitant, as revealed by the research, the collaborators focused on the liberty value to remind parents that vaccination was in their control. The Liberty-Based Campaign featured static posts with both photographs and illustrations emphasising the power of parents to choose vaccination to protect their children from infectious diseases.
3. Use influencers to convey vaccination messages: The collaborators worked closely with UNICEF Argentina to select parent influencers who could help convey the importance of vaccination, given that hesitant parents were turning towards online communities for vaccine information. The Parent Influencer Campaign featured two popular parent influencers, @PapaCocina and @UnPapaHipster, who highlighted the power that all parents have to protect their children from dangerous diseases through vaccination.
4. Address specific concerns about vaccines: Messaging focused on addressing concerns surfaced in the survey, highlighting the safety, efficacy, and importance of complete and on-time routine vaccination. The How Vaccines Work Campaign featured children doing a "vaccination dance" set against key messages on when, how, and why to get children vaccinated that addressed specific vaccine concerns, including safety and efficacy.

Testing and iterating: UNICEF deploys advertising campaigns across Meta platforms, grouping and testing messaging strategies across different audiences, regions and languages. To determine the best strategy, 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.

Specifically, the collaborators divided the campaigns into three rounds of testing to allow them to test different communication approaches head-to-head: Round 1: tested a pre-existing vertical video (a video created either by a camera or computer that is intended for viewing in portrait mode) in which basketball player Manu Ginóbili spoke with a vaccine expert against vertical video content that showed illustrated animations of how vaccines work; Round 2: Father-Focused vs Liberty-Based Campaigns; and Round 3: Parent Influencer vs. How Vaccines Work Campaigns. To understand the effectiveness of each messaging strategy, they designed a 5-question survey on Facebook to assess the difference in specific vaccine attitudes between test groups (those exposed to the ads) and control groups (those not exposed to the ads). Each test ran for 4 weeks between September and December 2022.

The campaigns reached a total of more than 26.6 million people through 3 campaign test rounds. Combined, nearly 400,000 people clicked through to UNICEF Argentina's vaccine landing page. Select results:
 

• Based on the testing from Round 1, the collaborators were able to prove that vertical videos were highly recalled across Argentina and significantly lifted the perceived importance of vaccines in prioritised provinces and the rest of the country. Although the content from Round 1 was memorable in Ciudad Autónoma de Buenos Aires (CABA) and Buenos Aires (BA), it did not shift any attitudes at the 90% confidence level. Nonetheless, directional movement was seen from both campaigns in lifting importance, attitudes towards vaccines, and social norms for routine immunisation in CABA/BA to iterate further.
• Round 2 tested the Father-Focused Campaign, which featured Manu Ginóbili in a personal appeal to vaccinate children, rather than in a dialogue with a known expert. This campaign was tested against the Liberty-Based Campaign. While the campaigns did not achieve statistically significant lift in recall overall, the collaborators did see statistically significant lift with priority audiences, particularly males, who they were seeking to reach. In CABA/BA, the Father-Focused Campaign was able to significantly lift perceived ability to protect children through vaccination (self-efficacy). In the prioritised provinces, this campaign significantly lifted the perceived importance of routine immunisation for children. The Liberty-Based Campaign significantly lifted perceived effectiveness of vaccines for both regions, filling a potential gap for basic information around vaccination. The collaborators also noted that static content that featured a photograph with a parent with child drove more reach and impressions than illustrations.
• In Round 3, content used vertical videos exclusively, similar to Round 1. Again, both the Parent Influencers and How Vaccines Work Campaigns were recalled in CABA/BA, and the latter was also highly recalled in prioritised provinces. This finding demonstrates that audiences in the prioritised provinces may have higher recall of vertical videos featuring children, with a demand for basic information, rather than influencers per se.

While routine immunisation rates have historically been high in Argentina, there has been a slow but steady decline in coverage since 2015. The reasons for the decreased uptake remain unclear, particularly in light of the country-wide vaccination mandate for children attending school. According to the literature, key drivers of vaccination include demographic factors and access to private healthcare providers or vaccination centres. General barriers to vaccination include demographic factors (e.g., higher birth order) and access issues, such as low attendance at antenatal visits and living among border populations. This decline in immunisation was accelerated by the COVID-19 pandemic, which led to service delivery interruptions and decisions to delay routine vaccination amidst the outbreak.

Based on the experience summarised above, UNICEF, Meta, YIGH, and PGP recommend the following:

• Collaborate with influencers and other trusted messengers.
  • These campaigns, which featured a sports star and local parent influencers, were consistently highly recalled in CABA/BA and managed to move attitudes in both CABA/BA and prioritised provinces.
  • When done purposefully, this approach can also reach and influence specific demographics within your intended audience.
  • These messengers were effective at conveying the importance, safety, and ease of accessing vaccines.
• Test authentic pictures of parents with children to see if it allows for more effectively reach of the intended audience.
• Incorporate basic information about vaccination in innovative and playful ways and include the national calendar for vaccination and the vaccination card to drive recall.
• Explore vertical videos for compelling creative, given the lift seen in campaigns that featured this format.
• Ensure the main message is given up front in the videos, as many people will see the first few seconds, but few will watch until the end.
• Tailor campaigns to different regions and demographics, since results showed that different approaches performed better depending on the particular audience and their location.