When working to cancel out the mistrust to secure willingness to get vaccinated we should also consider limitations in the access to vaccines. Image: unknown author under CC license.

Lorena Moscovich Head of experimentation AccLabUNDPArgentina @LMoscovich

 

When a crisis hits, it doesn't hit everyone equally. Its effect depends on the existing situation of those most affected. Without a doubt, this is the case with COVID-19. An urgent problem is the convergence of persisting inequalities with the whole new set of problems that arose and deepened, by COVID-19. Let us consider the health emergency sparked by the pandemic and the enormous economic consequences of the general financial collapse, a byproduct of “non-pharmacological” measures—such as school and business closures and quarantines.

Undoubtedly, those most affected are people who have fewer possibilities of staying home, those who lack access to running water to meet basic sanitary standards, those with no formal employment, women, who work longer days when along with working away from home they also take care of both household duties and children, the disadvantaged people who, when they have formal jobs, work in riskier jobs that other people refuse to do, among other examples.

One thing to keep in mind is how will these groups in vulnerable situation be equipped when the pandemic stops, because we do expect it to stop, at some point. The only sustainable solution to the COVID-19 crisis is the identification and roll-out of an effective vaccine keeping in mind that the low-income segment of the population is both more vulnerable to COVID-19  and also has more uneven access to health facilities.

At the same time among certain segments of the population, there is significant skepticism regarding vaccines. For instance, 12% of people without primary education believe vaccines are not effective. This figure is only 4% of those with incomplete tertiary studies. According to the Vaccines confidence and Access index of the Bunge y Born Foundation, mistrust is more generalized within this segment of the population.

In sum, we see that the long-lasting inequalities that hamper the access to vaccines due to barriers such as distance or lack of time to go to health facilities are now met by a new trend of emerging mistrust in vaccines. With the Accelerator Lab from UNDP Argentina, the Co_Lab, we started working on a hypothesis. It is related to the origins and the nature of the information that can encourage people to continue going to the vaccines centers: If we work on positive messages that counteract misinformation on vaccines we will increase the confidence in immunization so as to foster the willingness to attend vaccines centers.

Through two qualitative studies and a large survey experiment in partnership with the Bunge y Born Foundation, we aim to have a better understanding of the Argentine misinformation scenario regarding vaccines and also how it coexists with other barriers to vaccines. The qualitative study will complement the information the Foundation already produces.  The foundation is responsible for the Argentine chapter of the Vaccines confidence and Access index. They also monitor public discourse on immunization by mapping these issues on social media.  With the results of our qualitative study together with the Foundation, we are going to conduct a survey experiment to test messages effective at countervailing misleading information on immunization. The work will complement the UNDP country office on-going efforts on the health area and the rapid response for the recovery of the crisis of the COVID-19.

When working to cancel out the mistrust to secure willingness to get vaccinated we should also consider limitations in the access to vaccines. In Argentina, the state provides several vaccines universally and enforces their mandatory use. However: a question arises: do people have ample access to health facilities?  Is there public transportation? Are vaccine centers open during hours that allow working parents to go? Can single mothers leave some children home to take siblings to vaccines centers?  We will have to consider the crucial problem of access and assess limitations in all its dimensions.

So in addition to understanding the long-lasting barriers to access, we aim to identify the scope and sources of mistrust of vaccines in the low-income population, which is the most affected during COVID-19. We also aim to identify specific contents and sources (social media, WhatsApp, acquaintances, brochures, television, etc) of misconceptions and misinformation on vaccines behind the mistrust of groups in vulnerable situations.

To assess the demographics of both mistrust and its behavioral effects, seeing how both are distributed across families and young people regarding vaccination compliance (willingness to get vaccinated by young people and the intention and willingness of mothers to have children vaccinated).A related problem is how proper information is received and if people understand the messages on good practices in health care and immunization. In this regard, other goal will be to amplify the influence of credible information, sources on vaccines by identifying role models at the neighborhood level. And lastly to understand and develop messages that potentially can cancel out misinformation and misconceptions behind mistrust of vaccines that can be inputs for the governments' strategies to broaden health care coverage amidst the COVID-19 crisis.

Particularly, we will focus on two groups: mothers because they are responsible for the vaccination of children. This task is overwhelmingly in charge of women. The second group is young people ages 15-20 because the Vaccine Confidence and Access Index of 2019 shows they hold higher rates of mistrust. Also, because their compliance with vaccines many times is beyond the scope of their families, meaning they may no longer follow their families' advice, but they are still vulnerable to diseases such as HPV.

In a nut shell, we face a twofold challenge, to keep on overcoming the barriers that limit the access to vaccines and also how these barriers now interact with an emergence challenge: misinformation. What we learn from these two groups will provide crucial lessons for the preparedness of the population for the reception of a vaccine against COVID-19.

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