The COVID-19 vaccination campaign has been underway in the country and elsewhere in the world for the past few weeks. Although there are still challenges in terms of vaccine supply, decision-makers are also facing the challenge of communicating to the public about their vaccination plans, and the safety and effectiveness of vaccines. This is particularly challenging in a context where new information (and misinformation) about COVID-19 vaccines is emerging on a daily basis. This can exacerbate vaccine hesitancy or confidence among the public, which may interfere with the achievement of vaccination targets. Indeed, it is estimated that 60-80% of the world’s population must be vaccinated to achieve “herd immunity” for COVID-19.(1, 2) According to the Mayo Clinic, herd immunity (sometimes referred as community immunity) occurs when a large portion of a community (the herd) becomes immune to a disease, which makes the spread of the disease from person to person unlikely.

To help Canadian decision-makers as they respond to unprecedented challenges related to the pandemic, the COVID-19 Evidence Network to support Decision-making (COVID-END) has reviewed what is known about the COVID-19 vaccine roll-out.(3) This blog post is the third in a series which examine evidence and experiences from Canada and other countries about the COVID-19 vaccine roll-out. It focuses on the set of challenges facing decision-makers when communicating vaccine-allocation plans and the safety and effectiveness of vaccines.

What the research tells us

Decision-makers are facing many challenges related to communicating to the public about their vaccination plans, and the safety and effectiveness of vaccines.(3) They must plan carefully for the following:

Who should be the target of the communication plans?
- the general public
- high-risk groups (for example, health workers, older and frail adults, those with chronic conditions, essential workers)
- individuals who are hesitant about (or opposed to) vaccination 

How should they communicate with them?
- who should communicate the information (for example, healthcare workers, research experts, teachers, business leaders, government leaders, community leaders, or the media)
- how often should we communicate with them (for example, every day or week)
- for how long
- what method should they use to communicate (for example, social media platforms, text messages, emails, telephone calls, radio, television, face-to-face by video, face-to-face in person) 

What information should be communicated to them?
- data and evidence about safety and effectiveness in terms of both protection against COVID-19 (including duration of protection) and protection against transmission (and other factors that may contribute to vaccine acceptance and hesitancy)
- information about new types of vaccines, current vaccine options (for example, the number of vaccines available in the country, number of doses required of any given vaccine) and prioritized populations
- information (for health workers) about vaccine-administration protocols
- information to address myths and misinformation about vaccines
- information about the anticipated timing of when all those who want a vaccine will have been vaccinated 

Research evidence shows that vaccine hesitancy is universal across countries. A medium-quality rapid review revealed that such hesitancy typically manifested in the preference to wait to be vaccinated or to reject vaccination altogether. The most cited reasons for vaccine hesitancy or refusal included fear of side effects, safety, and effectiveness, as well as the expedited development of the COVID-19 vaccines, perceived political interference, and misinformation.

But many organizations have produced evidence-informed guidelines to help decision-makers in their communication efforts. For instance, the World Health Organization (WHO) produced a guideline providing insights about factors that may help vaccine acceptance and uptake. This guideline is based on behavioural research (the types of research examining when and why individuals behave as they do) that has shown that vaccine acceptance and uptake can be increased by using three types of strategies:

- creating an enabling environment – making vaccination easy, quick and affordable

- harnessing social influences – especially from people who are particularly trusted by and identified with members of relevant communities

- increasing motivation – through open and transparent communication about uncertainty and risks, as well as the safety and benefits of vaccination

The WHO guideline also emphasized that communication interventions should be tailored to mitigate inequalities, particularly to Black, Asian and minority ethnic groups who have higher rates of infection, morbidity and mortality, as well as unvaccinated or under-vaccinated populations.

A medium-quality rapid review also indicated that communication of reliable, frequent, and tailored information about vaccines should be shared with community members through multiple platforms (for example, social media, traditional media, and providers). The review also highlighted that providers must be educated about vaccines and provided with appropriate training to increase provider vaccine recommendations to patients.

Moving forward

As the pandemic evolves, communication plans may be adapted to respond to new events (for example, new variants, new data and evidence about the effectiveness of vaccines against new variants, or possible cases of adverse events following vaccination). In the fourth part of our series, we will examine the challenges of administering COVID-19 vaccines in ways that optimize timely uptake.