Response actors can be resourceful, relevant and supportive during the vaccine roll-out by integrating activities across vaccine roll-out initiatives, health care services and prevention programmes .
Invest in health systems strengthening and the protection of healthcare workers
Support healthcare workers and health facilities with access to and use of WASH infrastructure, hygiene consumables and Personal Protective Equipment (PPE).
Provide training on vaccine communications and building vaccine confidence, Infection Protection & Control (IPC) training and PPE for all healthcare workers – cleaners, guards, traditional healers, and other stakeholders where relevant.
Provide hygiene consumables both at the workplace and at home to protect staff, patients and family members.
Health care workers and vaccine programme staff should support community outreach to solicit trust, confidence and uptake in the vaccine roll-out.
Continue with disease surveillance
Coordinate and integrate disease surveillance efforts for COVID-19 and other diseases between health and WASH stakeholders. Keep sight of other health issues and impacts, alongside the COVID-19 vaccine roll-out and routine immunisation.
Aligning communication approaches and programming.
Build communication networks across different types of response actors and leverage those that have already been established. For example, Risk Communication and Community Engagement networks often combine government and non-governmental actors from a variety of sectors and expertise. These groups meet regularly and can be a good starting point for finding out who is doing what in a country or region. Encouraging partners to share information about community perceptions, communication and programmes that are being delivered or that are being planned can avoid duplication or confusion in communication. Ongoing sharing on what is working well, as well as common challenges, can help improve programme quality. Where possible work together to develop a strategy for risk communication and community engagement that covers prevention behaviours and vaccine promotion.
Trusted and established communication systems which have already been utilised to share information about COVID-19 prevention behaviours are well-placed to support the vaccine roll-out as well.
Many countries’ populations are facing other crises, such as conflict, drought, other disease burdens, food insecurity and livelihood constraints. These broader concerns are likely to affect vaccine-related perceptions. By collaborating with other sectors you may be able to develop programming that is more holistic, which acknowledges these competing concerns and which is ultimately more relevant to communities.
Use vaccine delivery sites as opportunities to continue promoting prevention behaviours
Conduct capacity strengthening activities to support the work of health workers and frontline response so that they have sufficient information about vaccines and prevention behaviours and so that they are able to effectively listen to populations. This may include skills to understand the secondary impacts of the pandemic or other health and livelihood concerns and to communicate about vaccine side effects.
Consider using vaccine centres as locations for the promotion of COVID-19 prevention behaviours and the promotion of other health behaviours and services. This could include distributing COVID-19 prevention or hygiene kits, informing people about other health services (e.g. routine vaccinations) or promoting the uptake of other health behaviours (e.g. use of mosquito nets)
Key takeaways:
Create an enabling environment with products, information, services and infrastructure.
The pandemic necessitates response actors to be empathetic, have robust listening and analytical skills.
Utilise vaccination centres as opportunities to promote preventative behaviours.
One size does not fit all – we need adaptive programming for each and every context.
Is there experience in integrating preventative hygiene programmes into vaccine roll-out?
There is unfortunately limited information on the effectiveness of integrating hygiene programming into vaccine programmes. A few examples include:
A cluster randomised control trial in Bangladesh demonstrates the impact of adding handwashing and water disinfection promotion in conjunction with oral cholera vaccination on diarrhoea-associated hospitalisation in Dhaka, Bangladesh. They trialled targeted interventions to provide handwashing hardware and hygiene promotion at both the household and compound level in conjunction with cholera vaccination programmes. Two years after the interventions, 45% of households receiving hygiene promotion sessions had a functioning handwashing station compared to 22% of households receiving the vaccination alone.
In Kenya, hygiene kits (including supplies for household water treatment and soap for handwashing) were combined with hygiene promotion and distributed to carers during infant vaccine campaigns. While data on water treatment were mixed, reported practices and demonstration of correct handwashing technique increased almost two-fold compared to households not receiving the intervention.
In Nepal, WaterAid and the Government of Nepal’s Ministry of Health decided to maximise having a ‘captive audience’ of thousands of caregivers who visited immunisation clinics at least five times in the first nine months of their child’s life. Outcomes from formative research created a hygiene intervention package (with the theme of ‘Clean family, Happy family’) which was later delivered through hygiene awareness sessions at vaccination centres. Rotavirus immunisation brought hygiene and public health sectors together and helped avoid miscommunication about the rotavirus vaccine being a ‘diarrhoea vaccine’ and highlighted the need for a comprehensive strategy rather than an individual approach to control diarrhoeal diseases. The programme continues to be delivered at scale.
Despite limited data, there are compelling arguments that support efforts to integrate hygiene promotion into vaccination programmes. Immunisation programmes reach many people and serve as a critical entry point to integrate WASH, with a particular emphasis on hygiene behaviour change interventions. Strategically, such collaborations provide an opportunity for efficient utilisation of resources and to communicate that there are multiple routes contributing to disease and therefore multiple prevention strategies needed at an individual or household level.
Want to learn more about integrating vaccine promotion into COVID-19 prevention work:
Editor Notes:
Written by: Jenny Lamb
Reviewed by: Lizzie McKee, Tom Heath, Victoria Maskell, Genevieve Hutchinson, Sarah Malycha, Rupali J. Limaye, Sian White, Daniel Korbel
Last update: 30.06.2021