Shaping Global Vaccine Acceptance with Localized Knowledge: A Report from the Inaugural VARN2022 Conference

"Global alliances like VARN, which bring together key players in the field, therefore have a central role to play in supporting best practices and pooling of resources, for the greatest impact on vaccine acceptance and demand."

The first conference of the Vaccination Acceptance Research Network, VARN2022: Shaping Global Vaccine Acceptance with Localized Knowledge was held virtually from March 1-3 2022. Convened by the Sabin Vaccine Institute, VARN aims to support dialogue among multidisciplinary stakeholders to enhance the uptake of social and behavioural science-based solutions for vaccination decision-makers and implementers, with a particular focus on convening insights and resources that are rooted in on-the-ground, community perspectives towards action-oriented solutions in the often-marginalised Global South. This report summarises the key learnings, by theme, from the conference that may enhance policies, programmes, and practice related to vaccination acceptance and demand.

The conference, which had over 750 registered attendees across 72 countries (with 306 of those logging in for sessions), centred around 4 key themes:

1. Understanding vaccine acceptance and its drivers - Vaccine acceptance is complex and context-specific, varying across time, place, disease, and type of vaccine. During polio eradication campaigns in northern Nigeria and northern India, communities were refusing polio vaccine while at the same time demanding measles vaccine. Given this complexity, Sabin and key global stakeholders use the term "vaccine acceptance" rather than "vaccine hesitancy", which acknowledges this complexity and the broader structural factors that may influence an individual's decision to vaccinate or ability to become vaccinated. Vaccine confidence is particularly influential on vaccine acceptance; both lie on a continuum and may be gained and lost over time. At VARN2022, discussions of vaccine equity brought forth the concept of the "intention-action gap", wherein an individual's intention to vaccinate does not automatically translate into becoming vaccinated, such as when an individual may face difficulties in getting to a vaccination centre, despite wanting to get vaccinated. Central to VARN2022 was sharing insights on these barriers garnered from vaccination research and programme implementing partners working closely with marginalised communities, often located within low- and middle-income countries (LMICs). Notably, willingness to vaccinate is often high in LMICs.

2. One size does not fit all: community- and context-specific approaches to increase vaccine acceptance and demand - Central to identifying the root causes of low vaccination is working directly with the community itself to fully understand the sociocultural factors influencing vaccine acceptance and demand. Presenters shared learnings from work with diverse communities, highlighting the importance of developing pragmatic, user-friendly, and contextually relevant interventions that are acceptable to the community. Empowering local community leaders and stakeholders through capacity-building efforts is essential to provide the community with the tools and knowledge to continue projects once original (often external) partners disengage. These steps are also essential for the decolonisation of research and programmes. Health and vaccine-related messaging also need to be delivered by trusted individuals in the community, and VARN2022 presenters across global regions spoke about the need to identify and engage with key community influencers who already have strong relationships with their community. There is a need to better train healthcare workers on health and vaccine literacy to ensure they serve as a trustworthy knowledge base for their community, particularly around vaccine eligibility and safety. In addition, several presentations at VARN2022 discussed how social norms and gender inequity create additional barriers around vaccine access for women and potentially for their children. Communities of practice were characterised as an essential tool to drive community participation in interventions around vaccine acceptance and demand.

3. Fighting the infodemic and harnessing social media for good - Central to tackling the infodemic is building people's ability to spot and combat misinformation when encountered in all its forms. The conference looked at practical tools, including applications, courses, and games, that have been developed to build capacity to combat misinformation and training "infodemiologists" to recognise and combat misinformation. Participants specifically considered how social media can be harnessed to share accurate information about the COVID-19 pandemic and COVID-19 vaccination, including messaging to promote vaccine acceptance and demand. Given the context-specific nature of vaccination acceptance and demand, public health messaging must be persuasive and tailored to resonate with the intended population.

4. Frameworks, data integrity, and evaluation of best practices - Understanding barriers to and drivers of vaccine acceptance and demand in a community requires the collection of quality data on vaccination access and immunization coverage rates, as well as standardised methods for measuring personal beliefs, perceptions, and cultural sentiments. However, there is a need to improve data quality and confidence in the data collection process, with consideration of how different protocols may lead to under or overreporting of outcomes and/or introduce biases.

Figure 7 in the paper highlights the key lessons shared through the conference. For instance, there was agreement that tackling low vaccine acceptance and the infodemic requires a multi-disciplinary and multi-sectoral collaborative approach, as the associated drivers are multifactorial and varied. VARN2022's evidence from around the world highlights the need for a human-centred approach to address low levels of vaccine acceptance, recognising that tailored, people-focused, and community-specific solutions are needed to drive confidence in vaccines.

In conclusion: "The insights gathered at VARN2022 have set the stage for the development of a roadmap for research, policy making, and program decision-making in the future."