Vaccines save millions of lives every year, but recent outbreaks demonstrate the tenuous nature of this achievement. The Sabin Vaccine Institute (Sabin) is launching a research program to better understand the factors leading some to accept vaccination and others to delay or refuse it. Research partnerships supported by Sabin will conduct pilot studies that harness local insights to design and evaluate appropriate social and behavioral interventions. By giving local institutions the resources they need to address their specific challenges, these projects will not only serve these communities, but will inform future approaches to improve vaccination acceptance globally.

Dr. Dorothy Peprah, director of vaccine acceptance at Sabin, emphasized the value of this initiative for improving acceptance of vaccines in low- and middle-income countries. “There is no better time to embark on this program than in a year when the World Health Organization declared vaccine hesitancy as one of the top threats to global health,” said Peprah. “Local insight into the social and behavioral aspects of vaccine acceptance can help countries build trust from the ground up, and we expect these findings to serve as a foundation for communities to improve confidence in vaccines.”

The Social and Behavioral Interventions for Vaccination Acceptance Small Grants Program aims to support interdisciplinary problem solving while also building collaborative relationships between immunization program managers working at the country level and academic researchers involved in social and behavioral research. Over a period of eight months, research teams in Uganda, India and Sierra Leone will implement and evaluate locally-designed interventions to improve vaccination acceptance. The research studies are diverse in their research methodology and goals.

Doreen Tuhebwe, a research associate from the Makerere University School of Public Health in Kampala, Uganda, will lead a team to analyze the effectiveness of peer group participation models to improve human papillomavirus (HPV) vaccine uptake in poor urban settings. Set to take place in Kisenyi Slum in Kampala, the study will empower adolescent girls who have received the HPV vaccine by offering them training to advocate effectively with their vaccine-hesitant counterparts. “With funding support from Sabin’s Small Grants Program, this study will inform us on how to design social-behavioral interventions to overcome vaccine hesitancy in order to contribute to achieving universal health coverage in Uganda and beyond,” said Tuhebwe.

In India, Dr. Gagandeep Kang and team will assess the level of vaccine hesitancy in Nuh district of Haryana where immunization coverage is known to be far below the national average. Levels of hesitancy will be assessed in association with perceptions about vaccines among health workers. The findings will subsequently inform the development of tailored interventions aimed at improving vaccine confidence and knowledge of government health workers. “For health workers to believe in vaccines is really important and through this project, what we are hoping to do is to understand what frontline health workers think about vaccinations, what their belief systems are, so that we can make sure that we can devise interventions that improve confidence in vaccines across all aspects of health systems,” said Kang.

The Kambia District Health Management Team in Sierra Leone and University of Bath’s Dr. Luisa Enria will study barriers and opportunities to vaccine access and acceptance among rural populations situated along the borderlands of Sierra Leone and Guinea, an area that presented engagement and containment challenges during the 2014-2016 West African Ebola outbreak. Using proven social science methods and tools, the researchers will train and deploy a team of community health workers and social mobilizers. “This project will allow us to listen to the voices of communities in hard-to-reach borderlands, to really understand what the barriers to immunization are, so that we can design immunization and engagement campaigns that reflect their realities and expectations,” said Enria, who is a lecturer at the U.K. university. The data will inform the development of a community engagement strategy in Kambia District.

Sabin’s Small Grants program will culminate in funded opportunities for grantees to share their results with government, international non-governmental organizations and local health stakeholders including health workers, healthcare professionals and key target groups.

About the Uganda Research Team

Doreen Tuhebwe, M.P.H., is a research associate and field coordinator at Makerere University School of Public Health in Kampala, Uganda. She participates and leads in teaching, examination, research and community service at the university’s Department of Health Policy Planning and Management. The study’s co-researchers include Christine Adyedo, National EPI Supervisor at the National Expanded Program on Immunisation associated with Ministry of Health in Kampala, and Steven Ssendagire, resident mentor of the public health program at Makerere University.

About the India Research Team

Gagandeep Kang, M.D., Ph.D., is executive director of Translational Health Science and Technology Institute in Faridabad, India. Kang is a clinician scientist and is known for her work on understanding transmission, development and prevention of enteric infections and their sequelae. Her research team members are Roma Solomon, M.B.B.S., Director, CORE Group Polio Project India (CGPP India); Manojkumar Choudhary, Monitoring and Evaluation Specialist, CGPP India; Jitendra Awale, Deputy Director, CGPP India; Rina Dey, Communications Advisor, CGPP India; and Siuli Mitra, who is a scientific communications and public relations expert at Translational Health Science and Technology Institute.

About the Sierra Leone Research Team

Colleagues with the Kambia District Health Management Team (DHMT), namely Hassan Kanu, District Social Mobilization Coordinator; Joseph Kalokoh, District Operations Officer, EPI Manager at DHMT; and Raymond Konjor-Wright, DHMT Finance Officer, are working with Luisa Enria, Ph.D., a lecturer in international development at the University of Bath in the U.K., on this project. Since 2015, Enria has collaborated with the DHMT on the Ebola Vaccine Trials in the district, during and after the West African epidemic. This collaboration continued through an ongoing project on the Anthropology of Vaccine Deployment.