WHO Regional Office for Europe

Demand and acceptance activities

IAIM Joint Regional Meeting for the Americas & Europe

Madrid, 1-2 February 2017

Presenter: Katrine Bach Habersaat, WHO Regional Office for Europe

Acceptance and demand

Vaccine confidence-building and crisis response

Intersectoral health education

Technical support to Member States

Responding to vaccine deniers

HPV

Introduction Crisis response

Regional advocacy platform to promote vaccination • Web • New online forum • Reports • Social media • Immunization

Highlights • WHO EPI Brief

Annual advocacy event

Acceptance and demand

MR symposium event

Advocacy for sustainable funding

Presenters: Julie Leask and Katrine Bach Habersaat

Evaluation committee members: Victor Balaban, Eve Dubé, Benjamin Hickler,

Everold Hosein, Julie Leask, Brent Wolff

Evaluation of the Tailoring Immunization

Programmes (TIP) methodology and

implementation in Member States

IAIM Joint Regional Meeting for the Americas & Europe

Madrid, 1-2 February 2017

Challenges of reaching the last 5 – 10 – 15 %

%

%

Susceptible groups

Need for tailored strategies to reach susceptible population groups

Tailoring Immunization Programmes (TIP)

A structured process

informed by behavioural

science and theory

undertaken to understand

enablers and barriers

with a view to defining

evidence-informed

interventions to increase

vaccination coverage

A people-centered approach:

Subjective experience is valuable.

Behaviours are complex.

TIP process

Situation analysis

Research

Tailored strategies

Segmentation

Evaluation

Evaluation activities

Detailed review of regional and national TIP

documents

Regional online survey with 46 Member States

Missions to four Member States

Regular telephone meetings and evaluation committee workshop

Evaluation committee

• Victor Balaban, behavioural scientist, US CDC

• Eve Dubé, anthropologist, researcher at the Research Center of the CHU-Québec,

Adjoint Professor, Université Laval

• Benjamin Hickler, medical anthropologist, Communication for Development Specialist

– Health Section, UNICEF Programme Division

• Everold Hosein, Communication Advisor/Consultant, Adjunct Professor, New York

University

• Julie Leask, behavioural scientist, Associate Professor, University of Sydney, School

of Public Health

• Brent Wolff, team lead for Demand, Policy and Communication team, Global

Immunization Division, US CDC

Leading global experts in social science research in immunization and

in vaccine hesitancy, immunization communication and immunization

programme delivery

Evaluation insights

National TIP projects explored

Bulgaria Lithuania Sweden United

Kingdom Low childhood

vaccination

coverage, esp.

among vulnerable

(Roma)

populations

causing large

measles outbreak

in 2009-2011

Very low uptake of

seasonal influenza

vaccination among

pregnant women

Suboptimal

childhood

vaccination

coverage among

three communities:

• anthroposophic

community;

• Somali

migrants;

• undocumented

migrants

Suboptimal

childhood

vaccination

coverage in

ultraorthodox

Charedi Jewish

community in

North London

resulting in

recurrent disease

outbreaks

Interventions

designed; not

implemented

Interventions

implemented,

evaluated,

expanded

Interventions

designed;

implemented for

Somali community

Recommendations

in advocacy report;

now with

implementers

Examples of insights gained

Bulgaria: Doctors perceived

vulnerable groups had low

health culture, leading to

misunderstandings and false

assumptions re. their

information needs.

Sweden: Parents were worried

about high incidence of autism in

their community, however, health

workers felt inadequate to answer

questions and were hesitant to

mention autism in relation to

vaccination.

UK: No resistance to

vaccination, however, also no

community support. This was

key as social norms are

critical for behaviour in the

community.

Lithuania: Flu vaccination for

pregnant women was not

integrated in routine care,

nor recommended or

supported by health workers.

TIP challenges

• Ensuring translation of diagnostics into long-term

change – and increased vaccination uptake

• Reducing resource requirements – human,

financial, time

• Ensuring local ownership and leadership, avoiding

dependence on WHO

• Ensuring clarity and a good understanding of the

method

TIP strengths

• Informative: insights from a structured process for

deep listening

• Inclusive and participatory: listening to, and

understanding, community perspectives

• Interdisciplinary: using the collective knowledge of

many stakeholders – “This is where the magic

happens” (national vaccination program manager)

• Engaging: leading to new relations and partnerships

• Comprehensive: focusing broader than

communications

• Supported: value of WHO engagement and support

Impacts

Lithuania

• Flu vaccination coverage in the district increased to 107 pregnant women in 2015-16 compared to only 6 in the season before

Sweden

• Plan to evaluate impact in 2017

• Plan for ongoing surveys of attitudes and demographics of sub-optimal vaccination

UK

• Monitoring/ evaluation of interventions recommended in advocacy report

Bulgaria

• No interventions yet

” the success of TIP ultimately must be an increase in vaccination uptake (…) the experience from the first round of TIP shows that implementation, i.e. changing immunization systems and service delivery culture is a long and difficult process

”

Recommendations

Recommendations

• Keep the research methodologies and participatory approach

• Local ownership of process

• Accelerate to the change phase

• WHO support, engagement and branding

• New materials

• Promote TIP

Conclusion