Vaccination and Trust: How Concerns Arise and the Role of Communication in Mitigating Crises

When situations occur in which unwanted events are (rightly or wrongly) connected with vaccination, they may erode confidence in vaccines and the authorities delivering them. This document defines and describes the key concepts and theoretical elements pertaining to communication and building confidence in vaccines and vaccination, both in ongoing work and during a crisis. It provides a foundation and knowledge base to prepare communication strategies and crisis plans, or to plan and conduct training workshops.

Specifically, this background document presents the scientific evidence behind the World Health Organization (WHO)'s recommendations on building and restoring confidence in vaccines and vaccination, both in ongoing work and during crises. Created in response to a call from WHO Member States for technical support and guidance, its development was guided by lessons learned in countries and with the active engagement of national immunisation managers and partners, primarily through subregional workshops held across the WHO European Region.

The purpose of the document is to provide a knowledge base for stakeholders who develop communication strategies or facilitate workshops on communication and trust-building activities in relation to vaccines and immunisation, such as immunization programme units, ministries of health, public relations and health promotion units, vaccine safety communication trainers, and immunisation advisory bodies.

Drawing on laboratory research and fieldwork within psychology and communication, it examines:

• How people make decisions about vaccination (e.g., how their decisions are affected by their attitudes, social norms, and culture);
• Why some people are hesitant about vaccination and how this may increase the risk of a crisis; and
• The factors that drive a crisis, covering how building trust, listening to and understanding people, building relations, communicating risk, and shaping messages to the audiences may mitigate crises.

A brief overview of WHO guidance and recommendations on communication and confidence-building in relation to vaccines and vaccination is presented in Figures 1 and 2 on pages 4-5 of the document. In brief, WHO recommends that Member States should:

• build population resilience against vaccine rumours and scares through ongoing activities;
• ensure a strong programme, well prepared to respond to any event that may potentially erode confidence;
• respond immediately to any such event with appropriate actions based on an assessment of the situation.

Steps include: Gather your inner circle; understand the problem; liase with key stakeholders; and communicate externally ("Honest and open communication is crucial for maintaining and building trust").

This document contains frequent references to relevant supporting documents in the Vaccination and trust library, which includes a series of support documents with practical guidance for specific situations. See Related Summaries, below.