Community engagement as key to Covid-19 vaccine uptake: Lessons from Eswatini

According to the Africa Centres for Disease Control and Prevention, slightly more than 28% of Eswatini's population has been fully vaccinated against Covid-19 -- a statistic that the Ministry of Health (MOH) aims to improve to reach the World Health Organization target of fully vaccinating 70% of the population of all countries by mid-2022. To increase the uptake of Covid-19 vaccination in Eswatini, the MOH and its partners have sought to understand community-level factors that influence vaccine acceptance. As a contribution to this effort, Pact recently completed a community-based assessment of perceptions of the vaccine and willingness to get vaccinated.  

Pact and its local partners in the Triple R project (Ready, Resourceful, Risk-Aware) supported by USAID, undertook this study to support the MOH's Covid-19 Risk Communication and Community Engagement team. The Triple R project works to improve the health and resilience of HIV-affected vulnerable children, adolescents, youth and caregivers through comprehensive HIV interventions delivered in the community and at home. To carry out this study, Pact Eswatini leveraged its trusted relationships with community leaders, community members and health care workers to facilitate focus groups in 14 tinkhundla, on their perspectives, attitudes and reactions to the Covid-19 vaccine. In collecting this in-depth qualitative data, the assessment identified challenges to vaccine uptake and collected valuable information to enhance community education and vaccine demand creation efforts.  

Assessment findings – lingering misinformation and fears 

Findings showed a high level of community awareness about Covid-19, its virus transmission, and prevention. However, there are still myths and misconceptions, especially around vaccination. Misconceptions have led to fear about vaccine safety, exacerbated by conspiracy theories obtained from social media, especially Facebook, which is reportedly the primary information source. In addition, communities expressed concerns that their fears have not been allayed by government vaccine rollout campaigns and feel they don't have a voice in the process. The assessment team heard many comments such as “It is a man-made disease.”

Health care workers expressed a need for updates and scientifically accurate information on the Covid-19 virus and vaccines to inform the community and their patients. As frontline workers, having up-to-date information is crucial to garnering public acceptance of the vaccines. In addition to misconceptions, barriers to vaccine uptake included a lack of physical and financial access. For example, respondents noted that vaccination centers were far and many had no money for transport or food to go for vaccination. 

Improved vaccine uptake will require a concerted effort to promote correct information on the benefit of Covid-19 vaccines through community engagement. There is a need to bring services closer to people at highly frequented sites such as schools, churches and sports fields. Community-based programs, such as Triple R, can fill this role – with local partners supporting national and local governments to address misconceptions, meeting the need for vaccine demand creation.  

The importance of community-level partnerships

Community engagement in these efforts cannot be over-emphasized. Using community champions to raise awareness and create demand as community health workers bring services closer to people will go a long way in improving vaccine uptake.  

Pact found strong support among assessment participants for expanding vaccine delivery via community structures. Community leaders said that "Health facilities are too far, not ideal for placing vaccines there," and emphasized their preference for vaccines to be available via schools and imiphakatsi, chiefdoms that serve as administrative structures.  

Civil society organizations and faith- and community-based groups regularly collaborate with key community stakeholders, which is needed to ensure the success of vaccination efforts. These partnerships will be critical for crafting and delivering culturally effective messages that consider the effects of traditional and religious beliefs in engendering community trust in vaccines and the expansion of MOH vaccination campaigns. The assessment results show that these messages and improved access to vaccine sites will need to reach young men and women, especially unemployed youth who may not prioritize getting vaccinated due to travel costs. 

Community-based solutions

The MOH's Covid-19 response program is using these assessment results to strengthen vaccine promotion, including community-level peer-to-peer mobilization and door-to-door communication. Given the study's success and the usefulness of the results, USAID is including activities to promote Covid-19 vaccine uptake under the Triple R project as part of the Agency's rollout of the Initiative for Global Vaccine Access (Global VAX).  

Leveraging its existing platform, Pact is working with partners in local government, traditional leadership, and faith communities to expand community dialogue and educational sessions, continue to identify vaccine concerns and address information gaps. The assessment is also helping to further tailor information and messages on the WhatsApp based "Health Alert" App that Pact developed in partnership with the Praekelt Foundation to better serve communities during the Covid-19 pandemic. 

Coordination efforts with credible stakeholders will help expand vaccine coverage through community-based services. Through ongoing community engagement, Pact understands how the communities it serves prefer to be reached and, with its trusted partners, can increase Covid-19 vaccination coverage at the community level. 

For more on how Pact has been building trust to mitigate vaccine hesitancy against Covid-19, listen to this podcast.