New vaccine introduction: checklist for planning communication and advocacy: World Health Organization vaccine safety supporting document

How to use this document This document proposes a simple step-wise process for planning communication and advocacy for a new vaccine introduction. It includes suggested activities for four key stakeholder groups: • Health care workers • Influencers • Media • Public Planning a detailed communication and advocacy strategy will help you: • ensure stakeholder groups have a consistent knowledge of the facts and messages • avoid or limit misperceptions • be prepared for vaccine safety events • facilitate high uptake of the new vaccine • build resilience against vaccine safety scares. Use the document for guidance and inspiration when introducing a new vaccine. Use it early in the process, as communication needs to be planned and initiated well in advance of the introduction date. How was this document developed? This document is part of a WHO series of supporting documents concerning events that could erode confidence in vaccination. Such events can be related to vaccine safety, adverse events following immunization, changes in the vaccination programme, negative public debate, outbreaks or pandemics. All documents were developed based on scientific evidence, laboratory research and fieldwork within psychology, social and behavioural science and communication and lessons learnt in countries. For an introduction to the theoretical background and evidence, refer to the WHO publication Vaccination and trust, available here: www.euro.who.int/ vaccinetrust. The supporting documents are intended for use by national • ministries of health • centers for disease control • immunization programmes • regulatory authority institutions. World Health Organization vaccine safety supporting document New vaccine introduction Checklist for planning communication and advocacy New vaccine introduction Prepare through: Follow up with: Plan and conduct activities targeting: 2 Overall goals Ensure high uptake of the new vaccine and population resilience to vaccine safety scares through: • Ensuring high knowledge levels among all stakeholder groups: health workers, experts, public, media, vaccine target groups and other key stakeholders • Avoiding or limiting misperceptions and unfounded rumours about the vaccine • Being prepared to respond to any vaccine safety scare Overall process Health workers Information gathering Implementation, monitoring and response Influencers Media Public These process steps are described in detail on the following pages Information gathering Goals: • To understand all details concerning the new vaccine and its introduction so that you are able to: – Inform, prepare and train the media, public, health workers and other key stakeholders – Prepare for and respond to any possible vaccine-safety event New vaccine introduction 3 To READ MORE refer to: • Vaccine safety messages (frequency of AEFI’s) euro.who.int/vaccinetrust Collect information Think about the possible questions you may be asked – during preparation for new vaccine introduction, during the introduction phase or in response to a safety event. Then gather information so that you can inform the public in advance and answer questions as they arise. Timing: At least 6 months prior to introduction. Collect information about: The disease which the new vaccine prevents: • how severe it is • its indications • age group it affects • what it is caused by etc. Rationale for introducing the new vaccine: • studies conducted • disease burden in your country • hospitalizations in a year • cost-effectiveness analysis • evidence from other countries • WHO recommendations etc. The new vaccine: • how it is administered • type of vaccine (live, live attenuated, inactivated, conjugate, subunit, toxoid etc.) • how it infects cells • how the immune system responds to it • what the vaccine is composed of • contraindications and false contraindications etc. Possible adverse events: • list of possible adverse events associated with the vaccine and how frequent they are • detailed information about the signs and indications of adverse events, including possible time span following vaccination • experience from other countries that introduced the vaccine, including possible rumours, misperceptions and media stories Background rates for the possible AEFIs: • frequency of these events in your country, among the target group and during the relevant time of year, so that any claim of an increase in these events can be disproved or confirmed The situation: • facts about the routine programme and, if relevant, about the supplementary immunization activities/campaign, targets set, sites of vaccination • changes that will be needed to accommodate the new vaccine • overview of Adverse Events Following Immunizations (AEFI) reported for other vaccines, recently or during the year • any possible misperceptions or rumours circulating about the vaccine that is going to be introduced, e.g. on social media. Target groups for the new vaccine: • gender • age • geographical areas targeted etc. Preparations: • record of how you prepare for the new vaccine introduction, including trainings conducted, information materials produced, stakeholders engaged etc. To READ MORE refer to: • Differentiating coincidental events from events that are caused by immunization: assessing rates euro.who.int/vaccinetrust Activities targeting Health workers Goals: • Ensure their trust and support to the new vaccine • Prepare them so that they can respond to concerns from parents and beneficiaries New vaccine introduction 4 Identify needs of health workers Health workers are a target group themselves – you must ensure that they trust and support the new vaccine – and they are the primary channel to reach caretakers and beneficiaries. Thus, health workers are your single most important target group, and their concerns and capacity building should be taken very seriously. Consult health workers to understand their concerns and to know where they lack knowledge. Timing: At least 6 months prior to introduction. Prepare key messages Help health workers by preparing messages that they can use in their interpersonal communication with caretakers and beneficiaries. Remember to include issues related to false contraindications. Consider preparing a ‘job aid’ for them , e.g. with a list of answers to possible difficult questions from caretakers and beneficiaries. Timing: At least 6 months prior to introduction – your key messages are the basis of all communication, so prepare these before any other communication materials. Train health workers Conduct training, perhaps via training- of-trainers or through their professional associations. Make sure that all health workers who will administer the vaccine are well prepared. Encourage health care facilities to hold meetings with their staff to inform them about new vaccine and to ensure that health care workers are able to respond to questions and concerns of the new vaccine. Consider follow-up training after introduction. Timing: At least 3 months prior to introduction. Prepare a training package Communication training should be integrated in your comprehensive clinical training of health workers prior to the introduction of the new vaccine. Use generic training packages developed by WHO or UNICEF to develop a trainings that addresses the needs in your country and the concerns of your health workers. As part of the training, educate the health care workers in using the messages you prepared for parents and beneficiaries. Timing: At least 6 months prior to introduction. To READ MORE refer to: • How to prepare a message map euro.who.int/vaccinetrust Activities targeting Influencers Goals: • Ensure their trust and support to the new vaccine • Prepare them so that they know how to respond to public concern and to media queries New vaccine introduction 5 Identify Influencers Consider who may have an influence on how the new vaccine is received by media, public and health workers, at national and local levels. Consider also who may be approached by media for an expert opinion, or who may be approached in case of a vaccine safety event. Influencers may be: experts, advisors, National Immunization Technical Advisory Group (NITAG), government, parliament, National Regulatory Authority(NRA), regional/municipal government, interest groups (religious, women, children etc.), religious leaders, local traditional leaders, political leaders, professional associations (doctors, nurses, midwives), WHO, UNICEF, NGOs, celebrities , schools etc. Timing: As soon as your strategy is finalized, at least 6 months prior to introduction. Establish coordination mechanism Invite the most important influencers to be a part of the process and to be regularly informed, e.g. through a working and coordination group. New vaccine introduction processes are sensitive, and even small adverse events can easily develop into crisis situations. By working together, you can ensure a fast and coordinated response to any event. Agree on how you will collaborate and share information, and how often you will meet. Agree on roles and responsibilities in case of a safety event, including who will be talking to the media. Members of such a group could include representatives of the ministry of health, immunization programme, NRA, national center for disease control, communication and spokespersons, experts, advisors, WHO, UNICEF, professional associations. Timing: As soon as your strategy is finalized, at least 6 months prior to introduction. Develop messages and materials You need to make sure that all influencers are well-informed about the new vaccine. Develop key messages which will increase their knowledge, and which they can use in their own communication. Consider preparing information materials for influencers. E.g. a one-pager summarizing your strategy and key messages. Share it with influencers nationally and locally. Share your strategy Make sure that your strategy and plan for new vaccine introduction is widely shared and available to anybody who you would like to engage and keep informed. Timing: As soon as your strategy is finalized. Reach out to influencers Contact and meet with influencers. Share your messages with them and decide on how regular information will be shared with them in the coming months Consider also how credible and trustworthy influencers may be engaged actively to advocate for the new vaccine. Timing: At least 1 month prior to introduction. To READ MORE refer to: • Stakeholder management euro.who.int/vaccinetrust Activities targeting Media Goals: • Prepare yourself for media interest and for possible communication emergencies • Increase knowledge among media/ journalists making sure that – journalists themselves are well- informed – the media can be used to channel correct information and messages to the public New vaccine introduction 6 Prepare key messages and press materials Prepare messages and use these to draft press materials in advance – e.g. media releases, press information packages, briefing papers, web materials, talking points. Designate staff who can develop these materials. Decide who will approve the materials and make sure new materials or adjustments can be made quickly in case of an unforeseen event. Timing: At least 3 months prior to introduction – your key messages are the basis of all communication, so prepare these before any other press materials. Prepare for unforeseen events Develop a contingency plan so that you are able to respond to a crisis. The plan should include a list of people who could be available if a crisis situation occurs (make sure to update the list regularly). Meet with them to give them background information. Determine where the operations center will be. Make sure that support staff will be available as well. Timing: At least 1 month prior to introduction. Inform and engage high level stakeholders Regularly inform the Minister of Health and other key officials and ensure good availability of them to respond to interview requests. Also inform the influencers you collaborate with and request them to be available for interviews. Timing: At least 3 months prior to introduction. Meet with the media Arrange workshops or training sessions with media to explain the rationale for new vaccine introduction and to convey your key messages. Encourage them to help inform the public prior to introduction of the new vaccine. Timing: At least 2 weeks prior to introduction. Designate and train spokespersons Designate one or two spokespersons who can answer questions from the media and will be available to do so at any time. Make sure the spokespersons are part of your coordination and working group and that they are well-prepared with key messages, FAQs and media training. Include spokespersons in meetings and allow them access to top leaders. Timing: At least 1 month prior to introduction. Activities targeting The public Goals: • Create awareness of the new vaccine • Ensure high coverage for the new vaccine • Potentially increase overall immunization coverage • Build trust in the new vaccine among parents and beneficiaries • Create resilience to unfounded rumours, misperceptions or any other negative ”hype” that may arise New vaccine introduction 7 Conduct research Understand how the public – parents, beneficiaries – feel about the planned changes in the vaccination schedule. This can be done by conducting surveys, consulting health workers to know which questions are often asked and by meeting with representatives from the target groups and discussing the issue, e.g. in a focus group. Timing: At least 4 months prior to introduction. Prepare key messages Ensure that appropriate messages are developed. These messages should include information about the disease, the vaccine and why a new vaccine is introduced, possible side-effects and the new schedule. Prepare the messages based on the research you conducted. Timing: At least 3 months prior to introduction – your key messages are the basis of all communication, so prepare these before any other communication materials. Prepare information materials and job aids Use the information from your research and consult health workers to know what kind of materials parents would like to receive. Adapt all your reporting forms, brochures, booklets etc. to include the new vaccine and the new immunization schedule. Share materials with local health facilities. Timing: At least 6 months prior to introduction – you need time to distribute them to health facilities. Prepare web and social media information Where possible, place information on the Ministry of Health website and/or Facebook, Twitter and other social media channels. Use these as platforms for your key messages. Coordinate so that the Ministry of Health and partners (WHO, UNICEF etc.) post identical messages. WHO can also help to ensure that all UN agencies in the country carry information on their websites. Timing: At least 1 month prior to introduction. Establish mechanism for responding to queries Based on your experience, consider whether it would be relevant to establish a mechanism for responding to queries about the new vaccine, e.g. a toll-free telephone line. The people answering the calls need to be well-informed and trained. They should compile the types of questions they get so this can be used to modify messages and officials can know about the public’s concerns. Timing: At least 1 month prior to introduction Inform the public about the decisions Issue a press release to inform the public about the new vaccine that will be introduced. Emphasize the rationale behind the introduction (the disease that is prevented) and inform them about the changed schedule and date of introduction. Timing: When the decision to introduce the vaccine has been made or when deemed appropriate Implementation and monitoring Goals: • Inform about the new vaccine and changed immunization schedule • Monitor the situation so that you are able to respond to: – possible media queries – possible concerns among health workers – possible unexpected events • Respond in case of vaccine safety scares New vaccine introduction 8 Ensure availability Make sure your designated spokespersons and high level stakeholders in the ministry are available and ready to respond to a interview at any time. Timing: The spokespersons must be available at all times. Information materials Make sure that the new and revised information materials and job aids are in place and displayed at health facilities. Timing: One week prior to introduction. Monitor for safety events Use WHO guidelines for monitoring and make sure that everybody pays special attention to anything related to the new vaccine and the disease it prevents. Timing: Continuous. Monitor reactions from media/public Monitor the situation closely and respond immediately in case of media queries or public concern. Monitoring should include: • Efficient Adverse Event Following Immunization (AEFI) reporting systems • Feedback from experts and local stakeholders • Daily monitoring of media (esp. social media, but also news papers, radio, TV) • Feedback from the Toll-free telephone line (if this has been established) Consult your contingency plan before you respond to unforeseen events. Timing: On a daily basis for at least 3 months after introduction. Engage with the media Issue a press release with information about the changed immunization schedule. Unless you expect media or public concern, do not raise issues that may not be of concern to begin with – such as concerns over multiple injections or multiple antigens. This may create unnecessary concerns based on misperceptions. Be prepared to answer questions about this, but wait and respond to these concerns only if and when they do arise. If you believe that there will be public interest and concern you should consider holding a press conference. This depends on the situation in your country, past experiences with introducing new vaccines and experiences from other countries with the particular vaccine in question. Timing: Ongoing as needed and appropriate. To READ MORE refer to: • Crisis communications plan template • How to monitor public opinion • How to ensure a context-specific response to events that may erode trust in vaccination euro.who.int/vaccinetrust To READ MORE refer to: • Safety events: planning the immediate media response euro.who.int/vaccinetrust In case of a crisis: respond immediately! Refer to euro.who.int/vaccinetrust for more WHO supporting documents for guidance on analysing the event and planning the appropriate communication response. Document number: WHO/EURO:2017-3375-43134-60388 © World Health Organization 2017 All rights reserved. This information material is intended for a limited audience only. It may not be reviewed, abstracted, quoted, reproduced, transmitted, distributed, translated or adapted, in part or in whole, in any form or by any means.