As the world grapples with the COVID-19 pandemic, the delivery of health services, including routine vaccinations, have been disrupted – including in Africa’s largest economy and most populous country, Nigeria.
Nigeria has less than 2.5 per cent of the world’s population. And yet, it accounts for 10 per cent of the global burden of infant, child and maternal mortality.
More than 2,300 Nigerian children die every day from diseases that can easily be treated or prevented.
One of the reasons is the low rate of child immunization. At the moment, only 23 per cent of Nigerian children are fully immunized. That figure was 22 per cent in 1995. Nigeria is clearly struggling to keep up with its population growth when it comes to health interventions – and children are one of the biggest casualties.
Clearly much remains to be done and the challenges are enormous – including disruptions due to COVID-19, and vaccine hesitancy. One big factor in saving children’s lives in Nigeria is helping parents, caregivers and communities to understand the critical importance of ensuring children receive their full, age-appropriate immunizations, so that they can both survive and thrive into a healthy future.
Organizations like UNICEF are working to ensure that there is continued uptake of routine immunizations for children, despite the pandemic.
To help drive this work and better understand how to engage parents and communities, UNICEF Nigeria partnered with Facebook through the ‘Insights for Impact Project’ to amplify and test the effectiveness of vaccine messages on its Facebook platform, via an information campaign. The campaign had three main objectives:
Promote the message that vaccines are safe
Communicate that vaccines are effective in protecting children from vaccine-preventable diseases, like polio and measles
Remind caregivers and communities that it is important to continue routine immunization amidst the COVID-19 pandemic
The outcomes of the information campaign were analyzed through a survey comparing people who saw the ads (the test group) with an audience of people who did not see the ads (the control group). If, in comparing both groups, we saw that vaccine acceptance is higher in the test group, then we would know that the ads were effective in promoting the importance of childhood immunization.
The campaign used three different types of messages to persuade communities of the importance of immunization. The three types were: 1) emotional 2) authoritative and 3) informative.
The campaign reached over 16.5 million Nigerians. At the end of the campaign, we asked people in the test and control groups whether they had remembered seeing an ad from UNICEF (ad recall). Overall, the results of the survey revealed that the authoritative campaign was the most memorable, followed by the emotional campaign. Both these messages yielded statistically significant ad recall.
To understand the campaign’s effect on attitudes about vaccine effectiveness, we asked “How effective do you think routine vaccines are in protecting children from devastating childhood diseases?”. We found the authoritative ads worked best, as people who saw the authoritative ads were +1.4 percentage points more likely to say that vaccines were ‘very’ or ‘somewhat’ effective, when compared to users who had not seen the ads. For this question, we did not see strong results for the emotional and informative messages.
To understand the campaign’s effect on vaccine safety, we asked “How safe do you think routine vaccines are for children?”. Once again, authoritative messages performed the best, as people who saw the authoritative messages were +1.2 percentage points more likely to indicate that vaccines were safe, when compared to people who had not seen the ads. However, we did not observe a significant difference for people who saw the emotional or informative messages.
We also surveyed people on the importance of continuing routine vaccinations during COVID-19. However, none of the three messages were effective in driving this objective.
There are no guarantees that a campaign will resonate with people and yield strong outcomes, however, authoritative messages were able to achieve statistically significant results for improving perceptions of vaccine effectiveness and safety.
“At this critical time in the COVID-19 pandemic, the results of this study have been an eye-opener. With this information, we now know how to adjust our digital vaccine campaigns in a way that will address people’s concerns, especially now that the COVID-19 vaccine has become available in Nigeria. The impact of this campaign has not only been useful for our Facebook platform, but for other social media platforms as well – and the learnings will help us define our approach to be most effective with our audiences,” said Eliana Drakopoulos, Chief of Communication, UNICEF Nigeria.
“Having worked on immunization campaigns across several countries, I know that finding the right message to inform communities about the importance of immunizations can be challenging, so it was noteworthy that we identified a successful strategy for building confidence in routine immunization in Nigeria and managed to reach over 16 million people” said Kadeem Khan, Associate Research Manager, Facebook Data for Good. “The results for the authoritative messages in particular, demonstrate the efficacy of digital communication in shifting perceptions of vaccination safety and effectiveness.”
The findings highlight an opportunity to further use authoritative messages to drive immunization outcomes. Altogether, the findings of this campaign may inform wider vaccine-messaging in the region, including the COVID-19 vaccine.