Project summaries

Vaccines are the most effective way to prevent infectious diseases. The factors driving the decision to vaccinate are complex and stem from historical, political and socio-cultural influences. Public health and vaccine policies, health professionals, communications and media are also key influencers in this individual decision-making process. As researchers, we recognise the need to engage with the public and understand its perception about maternal and neonatal vaccination, and vaccine research as a whole.

In their project ‘Capturing and exchanging multi-national perceptions of maternal and neonatal immunisation,’ Marie Yang and her team collaborated with their partners at the Chulalongkorn University and the Malawi-Liverpool Wellcome Trust Programme. They recruited participants from three cities from different continents, i.e., Liverpool (UK), Blantyre (Malawi) and Bangkok (Thailand), and asked them, e.g., what a vaccine is, whether vaccines are safe, what informs their decision to vaccinate or what their opinions are on the newly introduced COVID-19 vaccines. Their responses were captured through pictures and videos and collated into a short film.

The short film portrays the beliefs and concerns of parents, grandparents, and professionals about vaccines, and also their conflicting journeys through social media and vaccine information material, and their understanding of risk-benefit ratios. The short film also informs on people’s health literacy in general.

Marie Yang and her colleagues hope that the short film will be used as a tool to engage communities around the world to start their own debate, overcome misinformation and break down the barriers to vaccine acceptance. They are keen to pursue this project through public outreach activities that will help further empower the public and build trust in maternal and neonatal vaccination, and vaccine research.

The UVRI-IAVI HIV Vaccine Program facilitated this public engagement project on maternal vaccines in fishing communities (FC) in Lake Victoria, Uganda. The project consisted of a baseline study to assess existing knowledge on maternal vaccines and a subsequent information campaign built on the study results in the targeted communities.

The study aimed to determine the level of knowledge, attitudes and practices regarding maternal vaccination and consecutively raise awareness on the topic. In addition, Village Health Teams (VHTs) and students were trained in assessing the vaccination status for maternal and childhood vaccines in the FCs.

Community entry meetings were conducted with 318 participants and 26 community leaders of the Kasenyi landing site to introduce the project to the communities. Targeted community meetings were conducted on Koome Island with 107 participants. During the study, both quantitative and qualitative approaches were applied by using questionnaires and in-depth interviews. The study participants were health workers, VHTs, students and women with children below five years. A total of 425 individuals were interviewed (317 female, 108 male).  While the community members had heard about immunisation in general, the majority was not aware of the different immunisable diseases (only 29.9% knew about BCG, 9.4% about hepatitis B, 1.6% about pneumonia, 1.2% about influenza, and 35.1% about tetanus). 85.4% of the participants knew polio and 74.4% measles. Only 28.6% had heard that women are vaccinated against tetanus, 22% against HPV and 28% did not know the types of vaccines given to women.

For raising awareness of maternal immunisation in the communities, banners with pictorial information and leaflets in local languages were distributed with the support of 50 VHTs, who also answered questions that emerged in the communities. In addition, two schools were provided with skits to educate community members and 40 students were engaged in sensitising community members on immunisation, together with two drama groups. Furthermore, audio messages were produced in Luganda and English and were broadcasted through local radio stations for a sustained sensitisation of the local population on maternal immunisation.

This project was implemented to promote changes in social norms and behaviours pertaining to vaccination during pregnancy and the neonatal period among tribal communities West Bengal, India, by proactively engaging the tribal women and girls. It focused on building their capacity in using community radio, podcasts, narrowcasts and videos produced by communities to bring about the desired changes. A series of training programmes were organised to capacitate propagators.

During the project audio content for community radio, web radio, podcasts, and social media (Facebook and WhatsApp) were produced by tribal women in Purulia District in tribal languages to promote their views and experiences in maternal and child health including vaccination. Videos produced by tribal women highlighted the importance of antenatal care (ANC), vaccination before pregnancy, institutional delivery, postnatal care (PNC), immunisation of infants, services availability at the local level (the place of ANC/PNC and vaccination service, health care facilities), benefits provided by the government (transport services, supplementary nutrition, allowances) and success stories. The personal anecdotes of tribal women as part of videos prepared by them reveal the increase of knowledge of services available, importance of vaccination and safe motherhood and favourable attitude towards health care services. This led to discussions within the tribal communities of the problems and solutions thereto in the village assemblies. This further resulted in an articulation of the demand for services by informing local health authorities and by persuading them to ensure the same and supply necessary space/room for health workers to provide care and propagate the health services availability.

While these videos were shown in the traditional village assemblies, the community radio listening centres which had been installed in the 51 tribal villages, were the hubs of lively discussions and spaces for feedback from the community members. Furthermore, audio messages (specially prepared for the WhatsApp messenger service) and videos on ANC, institutional delivery, postnatal care, and immunisation were produced for social media campaigns. In addition, regular live phone-in programmes were broadcast on maternal and child health including the importance of immunisation.

In total, approximately 250,000 people were reached with the project. The project has come up with audio and video content on maternal and child health in the tribal language Santali. This is especially relevant as there is hardly any production of similar material to generate awareness on maternal and child health including immunisation among tribal people in their own language by governmental or state authorities.

The project was successful in raising the issues of maternal and child health and vaccination in tribal village assemblies to resolve challenges and barriers related to antenatal and postnatal care, institutional delivery, neonatal health, and early immunisation. And for that, a strong partnership has been built with the ‘Council of the Five Elders’ Aatu-Marehar, a tribal decision-making body on the village level consisting of 5 individuals whose decisions are binding to the village population. It is hoped that the fruits of this partnership will be felt for years to come as the manifold issues relating to maternal and child health have been discussed with due importance and stress at various fora.

Maternal vaccination has proven to protect newborns from neonatal tetanus, which has a mortality rate of about 30% to 70% in developing countries. This project aimed to improve maternal vaccination services uptake in pregnant women and postnatal mothers in Tanzania.

The project was implemented in three steps: baseline assessment, training and evaluation. Participants included health care workers (HCWs), mothers and community members from 10 villages, who were selected on the basis of their interest in participating in the project and their availability. For assessing problems related to maternal vaccination experienced in the communities, in-depth interviews (IDIs) and focus group discussions (FGDs) were conducted with 58 HCWs, mothers and other community members. In the training phase, 10 HCWs were educated as “trainer of trainers” to teach community leaders, who in turn trained the communities including mothers during routine community meetings. In a third phase, FGDs and IDIs were conducted to evaluate the acquired knowledge among HCWs, mothers and other community members.

The baseline assessment revealed a shortage of human resources among HCWs, a shortage of tetanus vaccines, a lack of awareness of maternal vaccination among mothers, who were often not able to visit vaccination services due to being occupied with household responsibilities, and little interest in  antenatal care among their husbands. While the baseline findings helped to enrich training content, the results from the evaluation phase helped to assess the impact of the project. The data generated in the evaluation phase suggests that the project resulted in an increased vaccine awareness in the communities and that more mothers visited clinics for antenatal examinations at an earlier stage. Also more men supported their wives in receiving vaccination services.

It can be concluded that knowledge gaps and lack of awareness were the major reasons for inadequate use of vaccination services. The availability of service providers and proper timing of vaccination service provision are additional keys for the accessibility of vaccination services. The project demonstrated that vaccine awareness creation through community meetings is a low-cost measure for a sustainable promotion of maternal vaccination services.

This project aimed to train students as immunisation ambassadors and change agents able to engage, empower and link mothers and community members to maternal and neonatal immunisation services.

It consisted of a baseline survey using a questionnaire to assess existing knowledge and awareness on vaccines and maternal immunisation, followed by training on vaccines, leadership and communication skills. Training materials were provided to students aged 15-19 years from secondary schools in Entebbe.

Up to 506 students were trained and 329 (65.3%) of these were female. 462 (93.5%) of the students believed vaccines are safe, 475 (96.7%) thought it is necessary to vaccine communities against diseases, 353 (71.6%) would accept to be vaccinated with a new vaccine and 463 (93.2%) would encourage communities to vaccinate. 481 (97%) heard about immunisation while 334 (67.9%) heard about maternal immunization before the training.

Out of 390 responders, the following proportion of students knew about some of the vaccines used against the immunisable diseases: 304 (78%) for polio, 223 (57%) for BCG, 177 (45%) for measles, 129 (33%) for tetanus and 76 (19%) for COVID-19 (with some students mentioning AstraZeneca). Student knowledge or awareness of vaccines was low for HPV (8%) and yellow fever (1.28%). 1.54% and 2% of the students thought there are vaccines for HIV and malaria, respectively. 361 (74.1%) of the students agreed maternal immunisation is beneficial to both the mother and the newborn and 354 (73.1%) had heard about immunisation of mothers against tetanus. 433 (91.2%) of the students were happy to act as a link between parents and communities and maternal immunisation services.

The project produced the following outcomes and impact: Before the training, 33 (8%) of the students had poor general knowledge on vaccination and this reduced to 8 (2%) after the training. 86 (22%) of the students had poor general knowledge and awareness of maternal immunisation before the training and this reduced to 7 (1%) after the training. The students demonstrated enjoyment of the training exercise and were inspired by some of the presenters, most of whom are undertaking PhD or postdoctoral programs. The students were exposed to new knowledge such as herd immunity and basic immunology. The students showed interest in vaccines and how the immune system works, and they were curious about COVID-19 vaccines.

In this project, Ugochukwu Madubueze from the Federal University Teaching Hospital in Abakaliki, Nigeria, and her team created a video film on the benefits, myths and misperceptions of maternal vaccination.

The project was carried out between October 2019 and March 2020 in remote villages of Ebonyi State in Southeast Nigeria. The main project output is a short film depicting a stage drama, in which 21 role models and other people with influence in the villages educated over 600 women of reproductive age on the benefits, myths and misperceptions of maternal vaccination. In addition, they produced 3,000 pamphlets in the local dialect and distributed them to 600 women for sharing with their peers. The team trained 30 interviewers who monitored and evaluated the progress of the project using questionnaires and immunisation cards. Furthermore, through broadcasted radio and television jingles, approximately 10,000 women in Ebonyi State were sensitised to maternal vaccination in their local dialect.

Results from this project showed a significant increase in the awareness of maternal immunisation and willingness to vaccinate against vaccine preventable diseases among women of reproductive age in the rural areas of Ebonyi State. The team specifically reported an increase in the uptake of tetanus and hepatitis B vaccinations. In addition, the 21 women who acted in the movie were strengthened in their agency and ownership through participating in the play.

In conclusion, the project improved the awareness and understanding of maternal vaccination and increased risk perception, vaccine uptake and confidence to complete maternal vaccination as scheduled. All this was achieved through engaging knowledge transfer, communication, and educational methods.

There is a low uptake of tetanus vaccination in Kawempe division, Uganda, driven by a lack of awareness of the importance of maternal tetanus immunisation. A collaborative project between Makerere University Johns Hopkins University (MUJHU) Care Ltd/MUJHU Research Collaboration, Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit (MRC/UVRI & LSHTM), and St George’s University of London (SGUL) explored the understanding of potential barriers to delivery and uptake of maternal vaccines. It was found that women had limited knowledge of and concerns over the effectiveness and safety of vaccines to themselves and their unborn babies. The women indicated that husbands, peers, mothers and mothers-in-law are key influencers to the uptake of maternal immunisation.

Twenty community influencers were identified from 10 parishes surrounding Kawempe National Referral Hospital, a maternal and child health facility. These were trained on maternal vaccination using the Uganda Ministry of Health (MoH) Vaccination Handbook, after which they went on a door-to-door sensitisation campaign to raise awareness of maternal vaccination. Over 900 community members were approached in this way.

The community influencers also advised on scripts for a short film and radio spot messages on maternal vaccination. The MoH reviewed, advised and approved the scripts prior to roll-out. The film was shown during ten community engagement sessions to over 430 people mobilised by the community influencers, and discussion was held between project staff, community influencers and community members in attendance on maternal vaccination benefits, dispelling myths and answering questions. The radio-spot message was broadcast over three radio stations, two of which major in Luganda, the local language predominant in the area and the third majoring in English. Three radio talk shows were also held tackling the same topic.

The messages were well received and the involvement of men in the campaign was appreciated as pregnancy and maternal health are widely viewed as women’s issues. 63% of the community had heard the radio spot. It can be concluded that community mobilisation is a useful tool to increase vaccine awareness in Kampala.

Adequate immunization coverage in rural communities remains a challenge. Traditional birth attendants (TBAs) form an integral part of the social, cultural and religious fabric in most rural communities in Nigeria. Despite their limitations in handling the complications of childbirth, TBAs are widely accepted and patronized, especially in rural areas. The objective of the project was to empower TBAs through a public engagement platform using a workshop intervention to change their knowledge, attitude and willingness to promote immunization uptake.

Ninety TBAs from the three geopolitical zones of Imo State, Nigeria were selected and engaged through a culturally adapted audio-visual workshop. Data were collected pre and post workshop sessions using a pretested questionnaire and analysed.

More than half of the TBAs had at most, a secondary level of education (54·4 %). The average length of time they practiced as TBAs was 16 years with an average of ten birth deliveries per month. After the intervention, all the respondents (100%) reported a willingness to always promote immunization uptake and also, there was a statistically significant increase in Knowledge. Similarly, the level of knowledge in the post intervention period appeared to be significantly associated with the geopolitical zone the TBAs practiced in.

The workshop intervention empowered the TBAs by successfully improving their knowledge and their willingness to always promote immunization uptake. Consequently, the training of TBAs on immunization has the potential of improving vaccination coverage especially in the rural areas where TBAs are significantly patronized.

Misinformation about vaccines can lead to vaccine hesitancy and lack of acceptance. In this project, Hal Drakesmith from the MRC Weatherall Institute of Molecular Medicine at the University of Oxford and his team developed a free online role-playing game as an educational way to demonstrate the power of vaccines. They linked up with computational biologists and game developers, explained their concept, and going into winter 2019, a prototype of the game emerged.

Unfortunately, something else also emerged: SARS-CoV-2. As cases spread and vaccine research intensified, Drakesmith’s team was keen to improve and complete their project. They co-opted a coder from Goldsmiths University, London. He brought in maths based on epidemiological models of viral spread, but also streamlined the gameplay to improve the player’s experience. This balancing act of ‘reality’ with ‘playability’ took a long time to finesse and the emphasis was on the latter, to ensure uptake of the game.

As the game starts, a viral pandemic (a fictitious Influenza strain) has broken out. The player has limited doses of the vaccine per week and must decide where to deploy this vaccine to halt virus spreading across the 99 cities featured in the global network. Each week in the game lasts a minute in real time, and the vaccination campaign lasts a season: 13 weeks. There are also vaccine refusers, who aid the spread of the virus; a pop-up of Tips and Tricks to help players; and at the end of the game, the important report on how well the player did: how many people were protected from the virus by the use of the vaccine.

The game was released and has been played by about 1,000 people so far. Drakesmith’s team will be targeting secondary schools in the UK and overseas after the project runtime, using the game to spread vaccine awareness, at a time when it is most needed.

Patience Kiyuka and her team produced a play and a radio drama to address maternal vaccine hesitancy in rural Kenya.

Vaccination is one of the most effective public health interventions today. However, there is a growing number of people who perceive vaccines as unsafe and unnecessary. Vaccine hesitancy has mostly been attributed to decreasing vaccination coverage and increased risk of vaccine-preventable outbreaks. In her public engagement project ‘Building confidence on maternal vaccination by addressing risk perceptions using community theatre in rural Kilifi, Kenya,’ Patience Kiyuka and her team conducted a mixed-methods survey with men and women of reproductive age as well as focus group discussions with expectant mothers and discussions with key informants on maternal vaccine hesitancy within a rural setting of Kilifi County, Kenya. The information gathered was used to produce a play that was staged in open community spaces and to create a radio drama that was aired on two local radio stations.

Of the 104 people surveyed, 94% reported that they had heard of vaccines before; however, only 70% knew which vaccines expectant mothers receive. 27% stated that they knew people in their community who had refused or were hesitant to take a maternal vaccine. The main reasons given for refusals included religious beliefs and rumours that the maternal vaccine was a family planning method. The community play was produced to capture community concerns while addressing misinformation around vaccination. It was observed that the play offered an entertaining platform while educating community members on the importance of maternal vaccination. Producing and airing the radio drama on local radio stations offered an opportunity for listeners to call in and ask the researchers about different issues they needed to be clarified.

The availability of safe and effective maternal vaccines will only be beneficial if mothers choose to use them. The project has demonstrated that dissemination of accurate information and continuous engagement with the community members can build trust and confidence in vaccines.