Co-created Messages & Trusted Messengers for COVID-19 Vaccine Acceptance in Northern Nigeria
Evaluating
the
use
of
co-
created
messages
and
trusted
messengers
to
improve
COVID-
19
vaccine
acceptance
in
Northern
Nigeria
Dr.
Chizoba
Wonodi
Associate
Scientist,
Johns
Hopkins
University
–
International
Vaccine
Access
Centre
(IVAC)
National
Convener,
Women
Advocates
for
Vaccine
Access
(WAVA)
Advisor,
Targeted
Messaging
for
COVID-
19
Vaccine
Acceptance
(TM-
COVAC),
Funded
by
Sabin
Vaccine
Institute
Situation
overview
Problem
statement
12
The
Problem
•
Although
COVID-
19
vaccines
are
now
in
adequate
supply,
Nigeria,
like
the
rest
of
Africa
continues
to
report
low
COVID-
19
vaccine
coverage.
•
Less
than
20%
of
the
population
have
been
fully
vaccinated
in
Nigeria,
in
contrast
to
67%
in
the
US
•
V
a
c
c
i
n
e
h
e
s
i
t
a
n
c
y
(
V
H
)
r
a
t
e
s
a
r
e
h
i
g
h
a
m
o
n
g
a
d
u
l
t
s
a
n
d
h
e
a
l
t
h
c
a
r
e
w
o
r
k
e
r
s
(
H
C
W
s
)
i
n
N
i
g
e
r
i
a
•
R
e
a
s
o
n
s
f
o
r
h
e
s
i
t
a
n
c
y
w
e
r
e
c
o
n
s
p
i
r
a
c
y
t
h
e
o
r
i
e
s
a
r
o
u
n
d
t
h
e
v
i
r
u
s
,
t
h
e
p
a
n
d
e
m
i
c
r
e
s
p
o
n
s
e
,
a
n
d
t
h
e
C
O
V
I
D
-
1
9
v
a
c
c
i
n
e
.
C
o
n
c
e
r
n
s
a
b
o
u
t
C
O
V
I
D
-
1
9
v
a
c
c
i
n
e
s
a
f
e
t
y
a
n
d
e
f
f
e
c
t
i
v
e
n
e
s
s
a
l
s
o
f
u
e
l
h
e
s
i
t
a
n
c
y
,
a
n
d
V
H
w
a
s
h
i
g
h
e
r
i
n
N
o
r
t
h
C
e
n
t
r
a
l
a
n
d
S
o
u
t
h
-
E
a
s
t
r
e
g
i
o
n
s
1
.
•
The
GoN
through
the
NHPCDA
is
driving
communication
efforts
to
promote
vaccine
uptake.
However,
most
of
these
efforts
are
centralized,
producing
modest
effect
on
vaccine
uptake.
•
There
is
a
need
for
effective
approaches
to
inform
and
influence
communities
to
increase
their
demand
for,
and
uptake
of
COVID-
19
vaccines.
•
Having
trusted
messengers
deliver
targeted
messages
that
respond
to
community
concerns,
holds
promise
for
achieving
the
behavioral
shifts
that
are
needed
to
raise
COVID-
19
vaccine
coverage
in
Nigeria
1
Wonodi
C,
Obi-
Jeff
C,
Adewumi
F,
Keluo-
Udeke
SC,
Gur-
Arie
R,
Krubiner
C,
Jaffe
EF,
Bamiduro
T,
Karron
R,
Faden
F.
Conspiracy
theories
andmisinformation
about
COVID-
19
in
Nigeria:
implications
for
vaccine
demand
generationcommunications.
Vaccine.
2022
13
TM-COVAC:
is
a
before-and-after
study
that
aims
to
use
the
human-centered
design
(HCD)
approaches
to
co-
design
and
co-
disseminate
targeted
messages
to
improve
the
COVID-
19
vaccine
uptake
among
hesitant
HCWs
and
adults
.
The
study
is
set
in
all
10
wards
in
Gwagwalada
Area
council
of
FCT,
Nigeria.
March
–
April
2022
April
2022
May
–
June
2022
July-
October 2022
Nov
-
Dec
2022
Mixed-
methods.
Measurements
ground
on
the
behavioral
and
social
drivers
(BeSD)
framework
•
Household
surveys
of
1,515
eligible
adults
18years
and
above using
a
two-stage
sampling
approach
•
Survey
of
139
HCWs
selected
convenience
sampling
•
Qualitative
interviews
with
74
purposively
selected
HCWs,
eligible
adults,
community
leaders
and
program
managers
at
all
levels.
KII(1),
FGDs
(8),
and IDIs
(13)
•
Framework
analysis
approach
for
qualitative
interviews
and
descriptive,
bivariate
and
multivariate
analysis
of
survey
using
R
analysis
software
FGD
with
HCWs
in
primary
health
facility
(rural
area),
March
21,
2022
Of
the
849
unvaccinated
adults,
34%
were
hesitant
or
unsure
(VH).
Overall
hesitancy/undecided
rate
among
adult sample
was
~1
9
%
14
Overall
vaccination
rate
was
higher
in
HCWs
compared
to
the
adults,
however,
among
the
unvaccinated
HCWs
and
adults,
vaccine
hesitancy
(VH)
rate
was
similar
at
34%
83%
(N=115)
17%
(N=24)
34%
VH
rate
among
unvaccinated
HCWs
Of
the
24
unvaccinated
HCWs,
34%
were
hesitant
or
unsure
(VH).
Overall
hesitancy/undecided
rate
among
sample
of
HCW
was
5%
44%
(N=666)
56%
(849)
34%
VH
rate
among
unvaccinated
adults
Baseline
survey
results
15
M
a
j
o
r
r
e
a
s
o
n
s
w
e
r
e
c
o
n
c
e
r
n
s
a
b
o
u
t
t
h
e
v
a
c
c
i
n
e
’
s
s
a
f
e
t
y
(
3
1
%
)
a
n
d
s
i
d
e
e
f
f
e
c
t
s
(
2
8
%
)
,
a
n
d
o
t
h
e
r
.
Major
reasons
for
vaccine
hesitancy
were:
•
practical
issues-
lack
of
knowledge
on
where
to
get
vaccinated
(49%),
vaccine
not
offered
yet
(44%),
vaccine
unavailability
(31%),
inability
to
access
vaccines
(27%),
far
vaccination
site
(14%);
•
Thoughts
and
feeling
issues-
concerns
about
COVID-
19
vaccine
safety
(31%),
side
effects
(29%),
and
efficacy
(28%)
;
and
•
Social
processes
issues-
distrust
in
government
(11%)
.
Multiple
responses
were
allowed
COVID
vaccination
rate
(%)
among
adults by
key
demographic
characteristics
Baseline
survey
results
COVID
vaccination
rate
(%)
among
HCWs
by key
demographic
characteristics
Qualitative
interview
findings
Most
cited
socio-
behavioral
drivers
of
COVID-
19
vaccine
hesitancy
from
the
qualitative
interviews
6
Baseline
qualitative
results
•
I
n
v
o
l
v
i
n
g
t
r
u
s
t
e
d
c
o
m
m
u
n
i
t
y
m
e
m
b
e
r
s
a
n
d
v
a
c
c
i
n
e
h
e
s
i
t
a
n
t
e
l
i
g
i
b
l
e
a
d
u
l
t
s
w
a
s
f
e
a
s
i
b
l
e
i
n
d
e
v
e
l
o
p
i
n
g
a
r
e
p
o
s
i
t
o
r
y
o
f
e
v
i
d
e
n
c
e
-
b
a
s
e
d
t
a
r
g
e
t
e
d
m
e
s
s
a
g
e
s
a
n
d
c
o
m
m
u
n
i
c
a
t
i
o
n
s
t
r
a
t
e
g
i
e
s
t
o
a
d
d
r
e
s
s
C
O
V
I
D
-
1
9
v
a
c
c
i
n
e
h
e
s
i
t
a
n
c
y
•
L
e
v
e
r
a
g
i
n
g
e
x
i
s
t
i
n
g
c
o
m
m
u
n
i
t
y
s
t
r
u
c
t
u
r
e
s
a
n
d
p
l
a
t
f
o
r
m
s
t
o
c
o
-
d
e
v
e
l
o
p
a
n
d
c
o
-
d
i
s
s
e
m
i
n
a
t
e
t
a
r
g
e
t
e
d
m
e
s
s
a
g
e
s
i
s
e
s
s
e
n
t
i
a
l
f
o
r
s
u
s
t
a
i
n
a
b
i
l
i
t
y
•
A
b
o
t
t
o
m
-
u
p
a
p
p
r
o
a
c
h
a
n
d
i
n
v
o
l
v
e
m
e
n
t
o
f
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r
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s
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e
d
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o
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u
n
i
t
y
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e
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h
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s
e
l
v
e
s
i
s
h
i
g
h
l
y
e
n
c
o
u
r
a
g
e
d
,
a
n
d
e
n
g
e
n
d
e
r
s
c
o
m
m
u
n
i
t
y
p
a
r
t
i
c
i
p
a
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i
o
n
a
n
d
o
w
n
e
r
s
h
i
p
•
I
n
v
o
l
v
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p
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i
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v
a
c
c
i
n
a
t
i
o
n
s
•
R
e
c
r
u
i
t
i
n
g
v
a
c
c
i
n
e
h
e
s
i
t
a
n
t
H
C
W
s
w
a
s
c
h
a
l
l
e
n
g
i
n
g
d
u
e
t
o
f
e
a
r
o
f
l
o
s
i
n
g
t
h
e
i
r
j
o
b
s
a
n
d
s
t
i
g
m
a
t
i
z
a
t
i
o
n
.
HCD
co-
creation
sessionand
message
testing
with
trusted
COVID-
19
vaccine
messengers,
May
25,
2022
7
Key
Learnings
T
H
A
N
K
Y
O
U
A
project
by
WAVA
in
collaboration
with
Direct
Consulting
and
Logistics
(DCL)
Nigeria
We
are
grateful
for
the
funding
support
from
the
Sabin
Vaccine
Institute
Dr. Chizoba Wonodi is evaluating the use of co-created messages and trusted messengers to improve COVID-19 vaccine acceptance in Northern Nigeria. Vaccine hesitancy due to conspiracy theories and safety concerns remains a challenge. TM-COVAC study aims to design targeted messages using human-centered approaches to increase vaccine uptake among hesitant individuals. Baseline survey results show a high vaccination rate among healthcare workers but significant hesitancy among unvaccinated adults. Effective communication strategies are crucial for boosting vaccine coverage in Nigeria.
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Evaluating the use of co-created messages and trusted messengers to improve COVID-19 vaccine acceptance in Northern Nigeria Dr. Chizoba Wonodi Associate Scientist, Johns Hopkins University International Vaccine Access Centre (IVAC) National Convener, Women Advocates for Vaccine Access (WAVA) Advisor, Targeted Messaging for COVID-19 Vaccine Acceptance (TM-COVAC), Funded by Sabin Vaccine Institute
Reasons for hesitancy were conspiracy theories around the virus, the pandemic response, and the COVID-19 vaccine. Concerns about COVID-19 vaccine safety and effectiveness The Problem also fuel Although COVID-19 vaccines are now in adequate Problemstatement hesitancy, and VH was higher in North Central and South-East regions1. Situationoverview supply, Nigeria, like the rest of Africa continues to report low COVID-19 vaccine coverage. Less than 20% of the population have been fully vaccinated in Nigeria, in contrast to 67% in the US Vaccine hesitancy (VH) rates are high among adults and health care workers (HCWs) in Nigeria The communication efforts to promote vaccine uptake. However, most of these efforts are centralized, producing modest effect on vaccine uptake. GoN through the NHPCDA is driving There is a need for effective approaches to inform and influence communities to increase their demand for, and uptake of COVID-19 vaccines. Having messages that respond to community concerns, holds promise for achieving the behavioral shifts that are needed to raise COVID-19 vaccine coverage in Nigeria trusted messengers deliver targeted 1WonodiC,Obi-JeffC,Adewumi F,Keluo-UdekeSC,Gur-ArieR,KrubinerC,JaffeEF,BamiduroT, KarronR,Faden F.ConspiracytheoriesandmisinformationaboutCOVID-19 inNigeria: implications for vaccinedemandgenerationcommunications.Vaccine. 2022 https://doi.org/10.1016/j.vaccine.2022.02.005 12
TM-COVAC: is a before-and-afterstudythataimsto use the human-centered design (HCD) approaches to co-design and co-disseminate targeted messages to improve theCOVID-19 vaccine uptake amonghesitantHCWsand adults.Thestudyis set in all 10 wards in Gwagwalada Area councilof FCT, Nigeria. March April2022 May June2022 April 2022 July-October 2022 Nov- Dec2022 FGDwithHCWs inprimaryhealthfacility (ruralarea),March 21,2022 Mixed-methods.Measurementsgroundonthebehavioraland social drivers(BeSD)framework Householdsurveysof1,515 eligible adults 18years andabove usinga two-stagesamplingapproach Surveyof139HCWsselected convenience sampling Qualitative interviewswith74 purposively selectedHCWs,eligible adults,communityleaders andprogram managersat alllevels.KII(1), FGDs(8), and IDIs (13) Frameworkanalysis approach forqualitativeinterviewsand descriptive,bivariate and multivariate analysis of surveyusingR analysis software 13
Baseline survey results Overallvaccination ratewashigher in HCWscompared totheadults, however,among the unvaccinated HCWs andadults, vaccine hesitancy (VH)ratewassimilar at34% 83% (N=115) 56% (849) 44% (N=666) 34% VH rate amongunvaccinated adults 17% (N=24) 34% VH rate amongunvaccinated HCWs Of the 24 unvaccinatedHCWs,34% were hesitantor unsure(VH). Overall hesitancy/undecided rateamong sampleof HCW was 5% Of the 849 unvaccinatedadults,34% were hesitantorunsure(VH). Overall hesitancy/undecidedrate amongadult sample was ~19%14
Baseline surveyresults COVID vaccination rate(%) among HCWsby keydemographic characteristics COVID vaccination rate(%)among adults bykeydemographic characteristics Majorreasonsforvaccinehesitancywere: practicalissues- lackofknowledgeonwheretogetvaccinated(49%), vaccinenotofferedyet(44%),vaccineunavailability(31%),inabilityto accessvaccines(27%),farvaccinationsite(14%); Thoughtsand feeling issues- concernsaboutCOVID-19vaccinesafety (31%), sideeffects(29%),andefficacy(28%);and Socialprocessesissues- distrustingovernment(11%). Majorreasons were concernsaboutthe vaccine s safety (31%) andside effects (28%), andother. 15 Multiple responseswereallowed
Baseline qualitativeresults Qualitativeinterview findings Mostcited socio-behavioral driversofCOVID-19vaccinehesitancyfromthequalitative interviews 6
KeyLearnings Involving trusted community members and vaccine hesitant eligible adults was feasible in developing a repository of evidence-based targeted communication strategies to hesitancy messages COVID-19 and address vaccine Leveraging existing community structures and platforms to co-develop and co-disseminate targeted messages is essential forsustainability A community members in diagnosing and solving their issues themselves is highly encouraged, and engenders community participationandownership bottom-up approach and involvement of trusted Involving program managers in the HCD process also built their skills on how to use an HCD approach to design context- specific solutions to improve interventions including vaccinations community acceptance of Recruiting vaccine hesitant HCWs was challenging due to fear of losing theirjobs and stigmatization. HCDco-creationsessionand messagetestingwithtrusted COVID-19vaccinemessengers,May 25,2022 7
A project by WAVA in collaboration with Direct Consulting and Logistics (DCL) Nigeria We are gratefulfor the funding support from the Sabin Vaccine Institute THANK YOU
