A pushback against vaccine hesitancy
In far-western Nepal, intensive social behaviour change interventions supported by GAVI and UNICEF are seeking to build trust in and demand for immunization in vaccine-hesitant pockets of the population
Kailali, Nepal: Priya Baral says that despite having been trained to expect it, she was still taken aback by the lack of awareness about vaccines among certain families she met in the course of working in Dhangadhi Sub-Metropolitan City (SMC) in Kailali District in far-western Nepal.
“We found children who had never been vaccinated all their lives,” she says. “Not a single vaccine.”
Priya is a volunteer with local organization BAS Nepal, mobilized as part of an initiative by GAVI and UNICEF to support the Government of Nepal to increase vaccine uptake during the nationwide measles and rubella (MR) campaign in March 2024. She is among 25 young volunteers who were trained and deployed in select locations to engage with vaccine-hesitant communities, search for and identify children who had either received no vaccines or had missed out on any of the vaccines listed in the national immunization schedule.
To start with, the volunteers were provided an orientation session together with female community health volunteers (FCHVs) to guide them in their interactions with communities.
“After the orientation, we headed into the community together with the FCHV didis,” Priya explains. “We went from door-to-door, talking to parents and caregivers to collect data on the vaccination status of children.”
Based on these conversations and insights – particularly on the factors that were preventing these families from vaccinating their children – the volunteers and FCHVs then counselled the caregivers. They talked about the benefits of vaccines, discussed and dispelled various misconceptions around vaccination, as well as emphasizing the dangers that awaited children who did not get vaccinated.
Finally, when the caregivers seemed convinced and willing to take their children to receive the vaccines, the volunteers would make sure they knew where the nearest vaccine centre was, and in some cases, even accompany them all the way.
The mobilization of volunteers like Priya is just one of the tools that GAVI and UNICEF are employing in the effort to target vaccine-hesitant pockets within the overall population and inspire visible changes in behaviour.
Other tools include engagement with existing community groups such as mothers’ groups, as well as working with religious leaders, teachers, youth clubs to ensure their ownership in the campaign and leverage their influence to promote vaccination.
“Nepal has seen a lot of successes when it comes to the coverage of the national immunization programme,” says Kali Pun, Health Officer at UNICEF Nepal.“However, there continue to be some persistent pockets of hesitancy and lack of awareness around the country that need to be tackled if we want to make sure no child in Nepal is deprived of vaccines.”
And that is precisely where the intensive social behaviour change (SBC) approach come in, with a focus on connecting with individual families and seeking to understanding the cultural, social and religious drivers that may be influencing people’s perceptions of vaccines. Such an understanding ensures that subsequent messages and interventions can be tailored to fit particular contexts, thereby fostering more sustainable changes in both attitudes and practice.
Father of two Alim Shefi, currently residing in Dhangadhi, can bear witness to this. Alim’s young son had missed out on getting several vaccines, partly because of how the family has had to frequently move across the Nepal-India border for work, and partly because they did not think vaccines were important. But following interactions with local FCHV Sabina Banu and volunteer Purnima Singh, Alim and wife Sanniya was able to understand the risks of incomplete vaccination, eventually resolving to visit the vaccine center the very next day.
Alim says, after two-year-old Usman receives the MR vaccine for the first time: “And I’m going to return to the hospital to make sure both of them get all the needed vaccines.”
UNICEF Nepal/2024/RUpadhayay
“I feel confident now that my child will be safe.”
