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COVID-19
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PROJECT DESCRIPTION
COVID-19 Vaccine hesitancy needs to be addressed

Developing a safe and efficacious vaccine against COVID-19 in record time has been a success, but swift and comprehensive rollout of the vaccine has been marred by a number of challenges.

 

On the supply side, these include funding, accessibility, and the logistical complexity of transporting, storing, and administering vaccines. On the demand side, one key challenge is vaccine hesitancy and resistance. Low confidence in COVID-19 vaccines, and low willingness to receive them, is a significant and growing risk to beating the pandemic globally.

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COUNTRIES
Countries of interest to drive vaccine confidence and uptake

These countries have been prioritized to understand the unique and diverse contexts of demand for COVID-19 vaccines and ensure equitable access.

Developing a safe and efficacious vaccine against COVID-19 in record time has been a success, but swift and comprehensive rollout of the vaccine has been marred by a number of challenges.

Project Outputs

Country-level Psycho-behavioral segmentation strategy

The segmentation strategy is a culmination of qualitative fieldwork to arrive at drivers of hesitancy and behavior profiles, which are then validated and sized through surveys of probability-based representative samples

 

Psycho-behavioral segmentation strategy:

  • Kenya

  • Burkina Faso

  • Cote D’ivoire

  • Pakistan

Country-level segment-targeted Design Blueprints & Solution Concepts

These design blueprints and concepts will articulate solutions for driving the COVID -19 vaccine uptake that can be locally adapted and implemented by governments and stakeholders. These design interventions will be co-developed with govts. IPls and stakeholders, and rapid tested with the community and frontline workers.

 

Segment-targeted design blueprints and concepts for localized solutions to drive vaccine uptake for:

  • Kenya

  • Burkina Faso

  • Cote D’ivoire

  • Pakistan

Guidance and Support tools

Tools will be designed to support implementers and public health authorities to comprehensively understand the segment profiles and solutions strategy, and to help them effectively adapt and deploy localized interventions to address the barriers to vaccine confidence and uptake in the dynamic COVID context

Consolidated Global Vaccine Hesitancy Output

The outputs from all focus geographies will be synthesized to build a consolidated framework of vaccine hesitancy segments and targeted solutioning strategy

Methodology

Research

Planning

1

Research

2

Design Research and Outputs

3

Dissemination and Support

4

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OCT - DEC 2021

Planning & Stakeholder Engagement

Engage with various stakeholders and partners to understand the context, needs, and gaps in knowledge. Build partnerships and alignment on problem-framing and field recruitment

DEC 2021 - MAR 2022

Formative Qualitative Research

Understand the COVID-19 context, vaccine mental models and decision drivers and barriers to COVID-19 vaccine uptake through in-depth interviews and context mapping with end users

Quantitative Research & Segmentation

Measure the prevalence, variations and clustering of decision drivers and barriers to COVID-19 vaccine uptake in the population

MAR- APR 2022

Strategy & Co-creation

Facilitate collaborative workshops with key stakeholders to align on focus segments. Co-create and prioritize solution concepts that will be further developed

Qualitative Design Research

Test usability with psycho-behavioral segments and health system stakeholders to gain feedback on solution design concepts and prototypes

Design Blueprints Creation

Synthesize findings of all research phases to identify pathways to vaccine confidence and willingness for different behavioral segments of the population

MAY 2022

Implementation Support

Embed project research learnings within public health systems to ensure effective deployment of solutions

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The “Improving Vaccine Uptake Project” is a collaborative effort that focuses on identifying and targeting the range of barriers and behavioral drivers that underlie vaccine hesitancy within different populations.

Vaccine Decision Journey

Our study indicates that COVID-19 vaccination decision is a journey progressing through a set of micro-decisions. The decision journey consists of decision stages with desired outcomes. Sewed together, all the desired outcomes collectively create a positive pathway for vaccine uptake action. But in this journey at the decision stages, evaluation also leads to unfavourable assessment of COVID-19 vaccine causing drop offs.

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In the vaccine decision journey there are enablers that facilitate a person to move forward in their COVID-19 vaccine uptake journey through the different decision stages. And there are barriers that impede the forward movement of a person through the decision stages resulting in either regression to previous stage(s) or lead them to drop out of their COVID-19 vaccine uptake journey. 

The journey framework exists within the larger dynamic COVID-19 context. There are triggers, arising within the context, which can result in non-linear and iterative movements within the journey, and they can:

  • Push an individual forward towards uptaking the COVID-19 vaccine (e.g., during a pandemic peak, the high case load leads to higher risk perception and a more favorable vaccine appraisal).

   

  • Move an individual back towards avoiding the COVID-19 vaccine (e.g., a lower case load leads to lower risk perception, or a high ‘“viral” vaccine adverse event leads to a higher vaccine risk).

   

  • Lead an individual to skip some stages and move directly to uptake (e.g., extreme symptoms). 

Journey to COVID Vaccince Uptake Framework

POSITIVE PATHWAY

POINTS OF DIVERGENCE

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Vaccine enters
consideration set

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Seeking Mitigation Strategies

How can I cope with the
COVID-19 risk?

More Details

Confidence in current mitigation measures

 

Vaccine decision avoidance

Perceived need for vaccine

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COVID-19 Vaccine Appraisal

How do I feel about the COVID-19 Vaccine?

More Details

Unfavorable vaccine appraisal and favorable status quo appraisal

 

Selective engagement with 

Acceptance of vaccine

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Coping with Vaccine Risk
 

How can I cope with vaccine risk?

More Details

Unfavorable vaccine and favorable status quo appraisal

 

Procrastination and reappraisal

Getting 1st 
vaccine jab

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Vaccination Uptake

How can I get this vaccine?

More Details

Ability/access gaps

 

Inaction and rationalization

Complete

COVID-19/boosters vaccine

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Vaccination Adherence

Should I get the second dose?

More Details

Lack of coping expectation discrepancy or poor intent

 

Second dose avoidance

Internalization of COVID-19 Risk

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COVID-19 Disease Appraisal

What do I feel about the COVID-19 disease?

More Details

Negligible 
COVID-19 risk

 

Vaccine information and decision avoidance

Qualitative Insights

Phase 1 of the study has been completed. The initial findings from the qualitative data confirm the presence of a number of behavioral enablers and barriers affecting vaccine confidence and thereby the uptake behavior surrounding COVID-19 vaccines. The behavioral complexity surrounding vaccinations involve factors such as vulnerabilities, contextual anchors, risk perception and information seeking. We identified the following themes contributing to the COVID-19 vaccination behavior:
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With the vaccine having been available for almost a year and 50% of the population in Pakistan already vaccinated, the ‘moveable middle’ is rapidly shrinking. Most people have already decided whether the vaccine is favorable or unfavorable.

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Low COVID-19 case burden leads to a feeling of low risk and the belief that COVID-19 disease is not relevant in Burkina Faso. In this context, vaccine is not considered as an active decision to be made.

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With less than 20% of the population vaccinated in African countries, the majority of the population in Kenya and Cote D'Ivoire is still contemplating the vaccination decision, creating a large movable middle who have not yet made their final decision.

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People are unable to make sense of inconsistent and contradictory information around vaccine, resulting in a pursuit of lived and heard experience from 'trusted' people around them.

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With radio, ‘community criers’ and community bodies as the dominant channels of information, together with low COVID-19 information seeking behaviour, limits their exposure to COVID-19 reporting and misinformation.

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Even though individuals may harbour favourable vaccine beliefs, lack of engagement on the topic of vaccines and COVID-19 within the community and low signalling of vaccination status by those who have been vaccinated does not create necessary social proof needed for vaccine action.

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For people who trust and engage with mainstream information channels and the health system, COVID-19 vaccination uptake is more likely. Those who remain on the margins of these institutions, in terms of access and trust, feel alienated from the vaccination process.

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European dynamics play a central role in influencing beliefs around COVID-19 disease and COVID-19 vaccine. Europe’s experience with the pandemic and vaccine provides points of comparison, often leading to negative COVID-19 vaccine intention. 

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There is deep rooted distrust towards any kind of external intervention due to colonial history. ‘Us’ vs ‘Them’ mental model is used to view the vaccines. 

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There is high trust in the health system to treat extreme symptoms and conditions. Hesitancy among HCWs with respect to COVID-19 disease and the perceived trivial nature of symptoms impedes trust in vaccination and health information seeking behavior.

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Experiences of living with other epidemics and endemic diseases (like HIV, Malaria, Yellow fever, Ebola, Meningitis) act as reference points to evaluate COVID-19 symptoms, severity, and the ability to cope with COVID-19.

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Vaccine mandates are a much needed push towards vaccination for some, and cause for concern and skepticism for others.

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While mandates can be the much needed push for the unvaccinated, mandates create a perception that those vaccinated have done so due to only the mandate overshadowing vaccine relevance and benefits.

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People will default to staying unvaccinated, unless a felt need and urgency for vaccines are created, as vaccination is seen as a disruption to their current ‘healthy’ state.

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Even though individuals may believe the vaccine is favorable, prolonged vaccine inaction due to various barriers leads to a disconnect between their beliefs and actions. This disconnect eventually leads to a belief that the vaccine is unfavorable.

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The ‘moveable middle’ considering vaccination but uncertain about adverse effects may procrastinate taking the vaccine.

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Women are at risk of remaining unvaccinated, given their limited decision autonomy, high fear from dominant misinformation themes regarding infertility, and limited exposure to information and mandates.

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People suffering from other illnesses and pre-conditions, fear the ‘strong’ vaccine and adverse effects therefore avoid vaccination altogether, alienating a critical high risk population.

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At the end of 2021 the number of confirmed COVID-19 cases in Kenya (population: 54 million) was in excess of 267,000, with a death toll of more than 5,300.

A total of 6.5 million people had received at least one dose of the vaccine, representing less than 12% of the total population. Only 6.5% of the total population has been fully vaccinated against COVID-19. The Government of Kenya plans to vaccinate 50% of all adults by the end of June 2022 in a phased approach, while maintaining a prioritization matrix, using vaccines procured through COVAX in March 2021.

54M

PEOPLE IN KENYA

267K

CASES OF COVID-19

12%

FULLY VACCINATED

5,300

DEATHS
AS OF 12/2021

Segment Overview

Due to lower overall vaccination uptake, we see 2 high uptake, 2 moderate uptake potential, 1 moderator-low uptake potential and 2 low uptake potential  segments. In an election year, individuals were exposed to multiple sources of information and multiple perspectives on the vaccine, and the decision got intertwined with other issues such as trust in institutions, resulting in a highly segmented population.

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Pakistan

Pakistan has seven approved vaccines being administered to the population. Around 30% of the population had been fully vaccinated by the end of 2021, and an additional 12% partially vaccinated. With the concerted efforts of the Government of Pakistan and international organizations, daily vaccination numbers increased from 400,000 doses in May 2021 to more than 1 million during December 2021.

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Cote d’Ivoire

Côte d’Ivoire was among the first countries in Africa to receive COVID-19 vaccines through UNICEF and COVAX facilities. Approximately 4.3% of the population has been fully vaccinated and an additional 5.5% partly vaccinated.​

A 15-country study by the Africa CDC found that in Côte d’Ivoire the reported willingness to accept a COVID-19 vaccine (71%) was lower than average across the countries (79%).

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Burkina Faso

Burkina Faso received its first batch of COVID-19 vaccines in May 2021. The country has received both AstraZeneca and Johnson & Johnson vaccines from the International Vaccine Alliance COVAX program. The vaccination campaign aims to inoculate over 15 million citizens, initially targeting healthcare workers. Current vaccination rates remain very low, with about 1.7% of the population either fully or partly vaccinated at the end of 2021.

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Kenya

A total of 6.5 million people had received at least one dose of the vaccine, representing less than 12% of the total population. Only 6.5% of the total population has been fully vaccinated against COVID-19. The Government of Kenya plans to vaccinate 50% of all adults by the end of June 2022 in a phased approach, while maintaining a prioritization matrix, using vaccines procured through COVAX in March 2021.

Kenya Workshop

Designing Segment-Targeted Interventions for Improving COVID 19 Vaccine Uptake
Nakuru Kenya January 30 - February 3

In collaboration with Kenya’s Ministry of Health, Final Mile organized a co-design workshop. Through a combination of theory, group discussions, activities and practical application, participants:

Learned a new way of understanding and decoding vaccine uptake through psycho-behavioral segmentation:

  • Built capacity with Human Centered Design (HCD) as a problem solving approach, both as a process and mindset, with a grounding in behavioral science

  • Applied HCD to develop segment targeted interventions for vaccine demand and uptake

  • Identified ways to apply segmentation and HCD to additional health system priority efforts beyond the COVID-19 pandemic

At the end of the five day workshop participants developed:

  • Segment-based, contextualized interventions to address COVID-19 vaccine uptake

  • A roadmap of activities for implementing the intervention and applying HCD

  • A plan for leveraging segmentation and HCD in health priorities beyond COVID-19

This workshop was possible through early investment and relationship building with government and agencies not only before the workshop but after as well. This collaboration led to active participation throughout the workshop with participants sharing experiences and making connections between their work and the concepts shared. Participants appreciated the rigour of the shared research findings as well as the workshop format that included discussions and activities to apply the content. While COVID-19 vaccination uptake is still a priority for those attending, it may not be much longer. Understanding this, we also discussed ways to leverage workshop learnings beyond COVID into areas such as addressing misinformation, rebuilding trust and routine immunization.

Participant quotes:

“This is a practical and effective approach to health care interventions”

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“I found the group discussions to be the most valuable part of the workshop, as they gave us the opportunity to exchange ideas and perspectives on the topics covered.”

“The design for learning / training was very engaging and is easy and relevant for replication in any training”

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“Training approach, handouts, relevance of the content and its great value add to our work. Data provided and evidence based research.”

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