Social mobilisation, consent and acceptability: a review of human papillomavirus vaccination procedures in low and middle-income countries

Abstract

BackgroundSocial mobilisation during new vaccine introductions encourages acceptance, uptake and adherence to multi-dose schedules. Effective communication is considered especially important for human papillomavirus (HPV) vaccine, which targets girls of an often-novel age group. This study synthesised experiences and lessons learnt around social mobilisation, consent, and acceptability during 55 HPV vaccine demonstration projects and 8 national programmes in 37 low and middle-income countries (LMICs) between January 2007 and January 2015.MethodsA qualitative study design included: (i) a systematic review, in which 1,301 abstracts from five databases were screened and 41 publications included; (ii) soliciting 124 unpublished documents from governments and partner institutions; and (iii) conducting 27 key informant interviews. Data were extracted and analysed thematically. Additionally, first-dose coverage rates were categorised as above 90 %, 90–70 %, and below 70 %, and cross-tabulated with mobilisation timing, message content, materials and methods of delivery, and consent procedures.ResultsAll but one delivery experience achieved over 70 % first-dose coverage; 60 % achieved over 90 %. Key informants emphasized the benefits of starting social mobilisation early and actively addressing rumours as they emerged. Interactive communication with parents appeared to achieve higher first-dose coverage than non-interactive messaging. Written parental consent (i.e., opt-in), though frequently used, resulted in lower reported coverage than implied consent (i.e., opt-out). Protection against cervical cancer was the primary reason for vaccine acceptability, whereas fear of adverse effects, exposure to rumours, lack of project/programme awareness, and schoolgirl absenteeism were major reasons for non-vaccination.ConclusionsDespite some challenges in obtaining parental consent and addressing rumours, experiences indicated effective social mobilisation and high HPV vaccine acceptability in LMICs. Social mobilisation, consent, and acceptability lessons were consistent across world regions and HPV vaccination projects/programmes. These can be used to guide HPV vaccination communication strategies without additional formative research.

Introducing new vaccines in low- and middle-income countries: challenges and approaches

“…rotavirus and pneumococcal vaccines) that can only prevent a proportion of all clinical cases of diarrhea and pneumonia, the message may be more complex, so as to explain how these signs and symptoms are caused by many different diseases. Community engagement is key to any communication strategy and may involve credible influencers (leaders and celebrities) at national and local level [62,82]. For example, in Burkina Faso, for the introduction of meningococcal A conjugate vaccine a comprehensive communication plan was developed at the time of vaccine introduction planning [65].…”

Progress in HPV vaccination in low‐ and lower‐middle‐income countries

“…A consistent learning from the past 10 years of HPV vaccine delivery in LLMICs is that poor planning negatively impacts programs. Examples of poor groundwork include not coordinating with the education sector for school‐based vaccinations; not allowing sufficient time for the planning process itself; and not adequately sensitizing national level stakeholders, community leaders, and parents of eligible girls . Confusion in the eligibility criteria and application of those criteria during vaccinations was also noted as a challenge .…”

“…LLMICsisthatpoorplanningnegativelyimpactsprograms.Examples of poor groundwork include not coordinating with the education sector for school-based vaccinations [39][40][41] ; not allowing sufficient time for the planning process itself; and not adequately sensitizing nationallevelstakeholders,communityleaders,andparentsofeligible girls. 39,62 Confusionintheeligibilitycriteriaandapplicationofthose criteriaduringvaccinationswasalsonotedasachallenge. 39 Guidance from WHO suggests countries need to consider 6-9months as the minimaltimetoplanaqualityHPVvaccinationprogram.…”

The investment case for cervical cancer elimination

“…Raising awareness and engaging communities has a long way to go, although the introduction of HPV vaccines in demonstration projects in more than 20 LMICs in recent years has laid some groundwork by introducing information about the burden of cervical cancer and the possibility of preventing it. At least the key messages and appropriate terminology are now much better understood …”

“…Castle et al 14 and appropriate terminology are now much be er understood. 18 Scaling up all these ac vi es to na onal programs with coverage reaching even the most marginalized popula ons is the ul mate goal, if we are to achieve elimina on of cervical cancer. As Holme et al 19 report, there is both good news and bad news on this front.…”