Integrated Communication Strategy for Distribution of H1N1 Vaccine

This 43-page document proposes a communications plan that countries can use to inform the public and at-risk groups about the H1N1 vaccine. It was developed by the World Health Organization (WHO)/H1N1 Communications Team and Societal and Individual Measures Team, and draws on input from colleagues in WHO Regions and personnel from the Academy for Educational Development (AED) and United Nations Children's Fund (UNICEF) who work with the media and risk communications, as well as on behaviour modification and societal interventions.

In late 2009, the estimated global manufacturing capacity for pandemic vaccines was at most 3 billion doses per year. It was expected that demand for these vaccines would initially outstrip supply and access to the vaccine would vary among countries. In the context of this limited supply and concern over H1N1 and the vaccine, WHO contends that it will be important for recipient countries to be able to communicate clearly about both the virus and the vaccine.

The guide identifies and describes some of the communications challenges faced by these countries, including:

1. Explaining a new virus and its risks to a wide audience;
2. Explaining the vaccine and assuring the public that it is safe;
3. Communicating when and where vaccine is available, and to whom;
4. Managing over-demand and under-demand for the vaccine;
5. Addressing healthcare workers' concerns;
6. Addressing concerns from other target groups - that is, groups that will be first in line, or priority, for receiving the vaccine - in particular, pregnant women;
7. Managing adverse events; and
8. Managing trust in institutions.

The guide also articulates a suggested strategy for approaching these challenges. The strategy is informed by an integrated approach to vaccination campaign communication. According to WHO, while information and mass media campaigns play a crucial role in informing different stakeholders about pandemic (H1N1) 2009 influenza and about the vaccine and its benefits, ensuring the successful distribution and uptake of the vaccine among priority groups requires more. The integrated strategy described here includes elements of both risk communications (often done through the media) and social mobilisation (using multiple communications means and methods to convince individuals and groups to take action). The central focus is on influencing human behaviour so that people carry out appropriate actions to protect themselves from becoming infected and from infecting others.

Below is a summary of the actions that are described in detail within the resource.

Stage 1 - Before the arrival of the vaccines: planning

Goal: Prepare the public with information, using this opportunity to remind the public of how they can protect themselves from the flu and how to care for themselves if they are ill.

• Create a communications plan: Use the specific suggestions in the attached full document or sample documents from other countries to help speed up the process.
• Clearly define what the general public and members of priority groups need to do, and decide how to communicate this information.
• Develop, define, share, and make widely available an H1N1 vaccine policy that clearly explains the specific priority groups and explains why they were chosen.
• Survey and assess the feeling of both priority and non-priority groups toward the vaccine and develop/adapt communication materials in response.
• Draft core communications material, such as media releases, press information packages, briefing papers, web materials, and talking points.
• Perform rapid pre-tests on developed messages to ensure acceptability by meeting with small groups of priority populations (e.g. pregnant women) and guide them through a discussion.
• Identify and meet with all partners - other government departments, regional and municipal government, professional associations (doctors, nurses, midwives), religious associations, religious leaders, non-governmental organisations (NGOs), and/or United Nations (UN) partners.
• Seek "champions/advocates" - national celebrities, religious leaders, traditional leaders, political leaders - who are trusted and to whom the vaccination groups would most likely turn for information.
• Establish a mechanism for responding and answering of queries about H1N1 and the vaccine - e.g. a telephone hotline - and train the phone operators to answer the most common questions.
• Organise a system for monitoring adverse events.
• Designate spokespeople and appropriate staff who can develop communication materials; include these personnel in meetings and allow them access to top leaders.
• Create a plan for responding to a communications emergency or sudden upsurge in media queries. This can be a list of people who could be available; one should meet with them to give them background, determine where the operations centre will be, and ensure that support staff will be available.
• Where the web and internet connectivity allow, the Ministry of Health should coordinate its web posting with WHO. WHO can also help to ensure that the entire UN system in the country carries additional information on its websites and can also help organise communications support - working, for example, with UNICEF and with NGOs.
• Ensure good availability of the Minister of Health and other key officials to respond to interview requests and speaking engagements around H1N1 and the vaccine. Use all channels: meetings, newspaper, radio, TV.
• Launch a campaign to inform healthcare workers about the vaccine and to provide them with tools for encouraging the other priority groups to get the vaccines. According to WHO, the mass media is not the right tool for this kind of campaign. Rather, it is best run by directly addressing healthcare workers through their workplaces and specialised publications.
• Share materials with local health care facilities that they can easily prepare and distribute at low cost. Encourage healthcare facilities to hold meetings with their staff to explain H1N1 and the vaccine.
• Hold discussions with public security officials to decide if security will be needed at vaccine clinics in order to control crowds. If this is the case, plan to have civilian officials on-site to give information to the public and explain why the vaccine is not available to all.
• Conduct a series of workshops or meetings with specific groups: the media, key staff that will be responding to media queries, key stakeholders/partners, and healthcare workers.

Stage 2 - Distribution of the vaccine: implementing the plan

Goal: keep the public informed about how the campaign is progressing, and ensure that priority groups are fully informed about where to access vaccine. For members of the public are not in priority groups, clarify why the vaccine will not be available to them, and what they can to do protect themselves against the disease.

• When the campaign starts, the Minister of Health or the responsible authority should hold a press conference to announce the beginning and explain the basics to the population (see details in the box within the document entitled "Launch of the campaign: Holding a press conference").
• Through targeted messages in workplaces and meeting places, ensure that health staff and other priority groups know where and when the vaccines are available - inform staff through meetings, memos, phone calls, etc.
• Continue discussions with healthcare workers and priority groups. Check if they have any concerns, if the messages are clear, and/or if any changes need to be made to the campaign. This can also provide an opportunity to improve healthcare workers' knowledge of H1N1 in general.
• For the wider public, continue to promote non-vaccine measures to prevent infection/spread of disease and publicise where the public can seek out further information.
• Monitor public reaction through media monitoring, consulting logs from phone lines, and meeting with partners and professional associations.
• Monitor for "adverse events" (side effects of the vaccine), remembering to look for these events in adults as well. Share the information with the relevant bodies within the country, and with the appropriate WHO focal point. Be prepared to be open about adverse events and investigate immediately - informing the public as early as possible.
  

Stage 3 - After campaign: monitoring and evaluation

Goal: ensure that what needs correcting is corrected, and that plans are in place for the next delivery of vaccine, or the next emergency.

• Announce results of vaccination campaign (numbers vaccinated, adverse events, overall impact).
• With partners from all sectors involved, review what went well and what didn't.
• With public, determine attitudes about what happened. Are there any misconceptions that need to be addressed?
• Evaluate what went well and what didn't. Were the right messages delivered to the right people? Did they change their behaviour accordingly?
• Develop lessons learned and share with partners.
• Modify procedures or regulations where necessary to better prepare for next time, or for the next delivery of the vaccine.
• Formalise the emergency plan for next time.
  

WHO stresses that each country needs to develop a communication strategy which reflects the priorities of its government and the needs of its population; even within countries, different groups will have different concerns. "Messages should only be adopted and used by countries after being tested for relevance and effectiveness with the people they are aimed at. In the same way, the suggested approach must fit in with the resources available to the country, as well as the time available before delivery of the vaccine." Templates, tools, and resources in the final portions of the resource are designed to facilitate adaptation of the strategy for country use.

Click here to access the full document in PDF format.