Factors affecting the implementation of childhood vaccination communication strategies in Nigeria
Globally, vaccination is recognized as a cost-effective public health measure for decreasing childhood mortality and morbidity [1]. Strategies which improve the uptake of vaccination include ‘supply-side’ interventions, such as ensuring a constant supply of potent vaccines, strong health systems to ensure delivery of these vaccines and sufficient health personnel to administer vaccines [2]; and ‘demand-side’ components which focus on individual and household determinants of health-seeking behaviours, such as building the knowledge base of individuals to utilise vaccination programmes to their advantage. Addressing vaccine hesitancy linked to parental knowledge, understanding, attitudes, beliefs, and behaviours is an important example of a demand-side component [3–9].
Poor communication, if not addressed, can undermine several components of vaccination delivery, including vaccine acceptance [3]. Improving vaccination communication delivery is therefore crucial to achieving better vaccination outcomes [10, 11] as well as the greater goal of knowledgeable caregivers and communities – important contributors to improving child health in many settings [12–14]. Effective communication could improve uptake of childhood vaccination, address incomplete vaccination or missed children, further strengthen routine immunization programmes, and encourage the use of new and underused vaccines. Although communication is an invaluable tool in routine and campaign childhood vaccination activities, as well as in other health programmes, it is rarely addressed in a systematic way compared with other components of vaccination programmes [3]. Ideally, vaccination communication efforts should complement and boost other immunization components, such as service provision, quality of care, capacity-building and the skills of health personnel, and disease notification and surveillance [15].
In Nigeria, where this study was based, routine vaccination coverage for all recommended vaccines has remained poor though there has been a gradual rise in vaccination coverage from 21% of eligible children (0–11 months of age) in 2003 to 25% a decade later [16]. Factors seen to have contributed to poor routine immunization performance include ineffective supply chains, poor delivery of services, scarce human resources, low demand for health services, funding gaps, accountability issues and weak governance, and poor data quality [17]. Furthermore, vaccine hesitancy – defined as “a delay in the acceptance or refusal of vaccines despite the availability of vaccine services” [18] – may also play an important role. Vaccine-hesitant individuals are a mixed group: individuals may delay receiving vaccines, or may agree to vaccines but be unsure of doing so, or may decline some vaccines but agree to others, as commonly observed in some parts of northern Nigeria in the context of oral polio vaccine mass campaigns [13]. For example, studies have shown that the increased number of polio campaigns in Nigeria were seen as suspicious by some populations [19, 20].
Communication interventions have made significant contributions to the polio eradication programme in Nigeria [21]. Numerous communication interventions have been implemented, particularly in high-risk states for polio, with the aim of increasing acceptance of routine immunization and breaking the transmission of wild poliovirus. However, implementing these communication interventions has been challenging. This paper aims to explore factors affecting the delivery of vaccination communication in Nigeria. An understanding of such factors can inform policy makers during the planning of communication interventions and when adapting these to suit local contexts. This study forms part of the ‘Communicate to vaccinate’ (COMMVAC) research project which focuses on building research evidence to improve communication about childhood vaccinations with parents, caregivers and communities in LMICs. In this study, communication interventions refer to all interventions which are purposeful, structured, repeatable and adaptable strategies aimed at informing and influencing individual and community decisions on personal and public health participation, disease prevention and promotion, policy making, service improvement and research [12, 22].
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