Effects of local faith-actor engagement in the uptake and coverage of immunization in low- and middle-income countries: A literature review

Abstract

Introduction: Religious leaders are universally recognized as having an influence on immunization uptake and coverage in low- and middle-income countries (LMICs). Despite this, there is limited understanding of three questions: 1) how do religious leaders impact the uptake and coverage of immunization in LMICs? 2) what successful strategies exist for working with local faith actors to improve immunization acceptance? and 3) what evidence gaps exist in relation to faith engagement and immunization?
 Methods: In January 2021, we searched PubMed and Google Scholar databases covering the period from January 1, 2011, to January 15, 2021, with key search terms related to faith engagement and immunization in peer-reviewed literature and conducted a gray literature review to answer these three questions. We excluded articles covering faith engagement and immunization in high-income countries, news articles, online blogs, social media postings, and articles in languages outside of English. Data were coded to guide thematic analysis.
 Results: We found extensive evidence supporting the value of religious engagement for immunization promotion and acceptance in LMICs across faiths. However, there was limited rigorous evidence and examples of specific approaches for engaging local faith actors to strengthen immunization uptake in LMICs. As a result, there is a lack of widely shared knowledge of what works (or doesn’t) and successful models for engaging local faith actors. Additional current evidence gaps include: few rigorous study designs; a lack of vaccine hesitancy studies outside of Nigeria and Pakistan; and limited exploration of faith engagement and immunization in religions other than Islam and Christianity.
 Conclusions: Our review findings reinforce the powerful role local faith actors play in diverse communities within LMICs in both promoting and inhibiting immunization uptake. The literature review comes at a critical time, given the urgent need to expand access to COVID-19 vaccination in LMICs. Findings from this review will advance understanding on how to more effectively engage local faith actors in promoting immunization campaigns and addressing vaccine hesitancy, which is more complex than expected. Further study is needed to understand how to most effectively counter vaccine hesitancy in different geographic, linguistic, and socio-cultural contexts.

The impact of Muslim and Christian religious leaders responding to COVID-19 in Israel

“…Particularly in relation to COVID-19 vaccination, the importance of collaboration with religious leaders and multi-sectoral partnerships is important in reducing hesitancy and work toward the shared goal of building public trust in vaccines ( 37 ). A systematic review published in May 2022 found mixed evidence that religious leaders can both promote vaccination and inhibit vaccination, suggesting the need to engage religious leaders more effectively ( 38 ). Another study in 22 countries across Europe showed that in countries where the majority religious group had a leader who publicly and consistently supported vaccination against COVID-19, religiosity was positively related to vaccination rates.…”

The state’s attitude towards religious communities in a health crisis: pursuing toward new interpretative approaches?

“…Yendell, O. Hidalgo, C. Hillenbrand 2021: 100 ff.]. Faith actor engagement can become a gamechanger in the fight for immunization in low-income countries [Melillo et al, 2021]. Interreligious dialogue can give a powerful contribution in strengthening cooperation and combating discrimination in "fragile contexts" (Holden 2021).…”

Faith-based organisations and their role in supporting vaccine confidence and uptake: a scoping review protocol

“…Traditionally, reviews on PHA-FBO partnerships to increase vaccine confidence and uptake have focused on interventions in LMICs 28–31. Olivier and colleagues from the Joint Learning Initiative on Faith and Local Communities published a comprehensive report and a journal publication looking at 43 examples of faith community participation in immunisation programmes in LMICs 29 30.…”

“…Another review conducted by the Faith Engagement Team of the US Agency for International Development’s MOMENTUM Country and Global Leadership programme, collected 110 studies on evidence of local faith actors’ influence on community vaccine hesitancy28. Its most recent review described PHA-FBO partnership strategies that may improve COVID-19 vaccine confidence in 4 sub-Saharan countries 31. Besides written reviews, conferences and panel sessions hosted by the WHO, UNICEF and Global Alliance for Vaccines and Immunisation (GAVI) offered collaborative opportunities for FBOs to share how PHA-FBO partnerships increase vaccine confidence and uptake in the context of LMICs; and open dialogues on issues of governance in equitable distribution 32–34…”