From barriers to breakthroughs: innovation in immunisation communication

Extensive research has examined the proliferation of mis- and disinformation on social media. A review identified 756 relevant publications between 2014 – 2022, with significant interest during the COVID-19 pandemic, particularly around vaccine information on social media. Less is known about the effectiveness of using social media proactively, for engaging in pro-vaccine advocacy through a public health lens. In this paper, we ask whether such advocacy can be effectively promoted through social media and, if so, whether such efforts improve vaccine intentions. 
Through a WhatsApp-based field trial in Varanasi, India's slum areas, the Happy Baby Program promoted vaccine information, facilitated vaccine uptake, and congratulated those who received the required doses. Through these efforts, the program sought to improve caregivers' vaccine advocacy. The question explored in this study is whether, after improving one's advocacy for a topic (in this case, vaccination), one's own behavior toward that topic (vaccination intentions) also improves. 
A quasi-experiment was run in Varanasi's slum areas, with longitudinal data collected from three study arms: Control Arm, a Vaccine Arm that disseminated information on only vaccines, and a Wellness Arm that disseminated information on vaccines, breastfeeding, handwashing, and nutrition. Those in the two treatment arms significantly improved their advocacy behaviors, which, in turn, improved their own vaccination intentions. Important implications arise from this study, including in how "stealth marketing" could be run, when the targeted behavior (vaccination) is not explicitly promoted, but is assumed to improve because of improvements in other adjacent behaviors (advocacy).

In Cameroon's most zero-dose-affected district, an innovative SBC intervention moved from behavioral insight to measurable impact using a fully co-created, community-led approach. Following formative research guided by the WHO BeSD framework and AI-supported sentiment analysis, caregivers in Nkolndongo District co-designed a tailored social and behavior change strategy to improve childhood immunization uptake.
Interventions were grounded in local narratives and delivered through Parent Champions, trusted community members trained using an abbreviated version of the Make Me a Change Agent materials. These champions conducted household visits and public dialogues, using locally produced SBC videos to address vaccine hesitancy, misinformation, and social norms. Videos featured real caregivers, health workers, and community leaders, and were designed with emotional resonance and visual storytelling in mind.
The pilot engaged 20 Parent Champions and reached over 2,000 households. Within three weeks, 728 previously zero-dose children were vaccinated, and 92.5% of referred families successfully completed immunizations. Caregivers reported increased trust, peer connection, and self-efficacy in making health decisions.
This presentation highlights how behavioral personas, participatory design, and peer-led communication can translate insights into action. It shares lessons on how to localize content, shift community norms, and center caregivers as change agents, offering a scalable model for SBC programming in other equity-critical settings.

Summary
Zero-dose children-those who have not received DPT containing vaccines-remain highly concentrated in India's urban slums, where structural, social, and behavioral barriers intersect. Conventional SBCC approaches have largely relied on top-down programmatic design, often overlooking the contextual realities of highly mobile, underserved communities. The Zero Dose Learning Agenda (ZDLA) reimagines SBCC as a locally led, participatory process, embedding behavioral science and gender sensitivity at its core.

Through a "3D" approach-Define, Design, Deliver-ZDLA engaged caregivers, community health workers, local influencers, and government officials to co-create and test solutions addressing barriers to immunization. Insights from mixed-methods assessments informed the development of behavioral prototypes, including the Vaccine Cost - Chequebook, Mobilizer Flip Flyer, and Fathers' Engagement Meetings. Each tool was iteratively refined through After-Action Reviews (AARs) and field testing.

Early results showed promising uptake, with approximately one in three zero-dose children vaccinated as a result of these interventions. Beyond outcomes, the participatory approach strengthened trust, ownership, and adaptive learning among community and government actors.

 ZDLA demonstrates that when communities lead in defining and designing solutions, SBCC shifts from information dissemination to co-created change. By embedding localization, gender, and behavioral insights, ZDLA offers a scalable, equity-focused model for reaching last-mile populations-transforming how SBCC drives immunization and social inclusion.

Reaching Pakistan's zero-dose children-those who have never received a single vaccine remains one of the country's most persistent immunization challenges. Between October 2024 and March 2025, UNICEF Pakistan, together with the Expanded Programme on Immunization (EPI) and community partners, applied Human Centered Design (HCD) research across 16 districts to codesign and test eight practical, community-driven solutions. Developed with direct input from caregivers, frontline workers (FLWs), and local leaders, these approaches aimed to respond to deep-rooted barriers such as mistrust, constrained access, cultural constraints, and limited motivation.
Eight prototypes were tested across 16 diverse districts. These included mobile vaccination vans, women-only hubs, migrant-friendly navigators, quick-care clinics, community champions, redesigned child-friendly clinics, Child Wellness Days, and Community Recognition Programme for vaccinators. Over 1,142 prototype days, teams engaged nearly 19,000 caregivers, Influencers, gathered operational and uptake data, documented frontline worker perspectives. Guided by behavioral science, each prototype was iteratively refined through direct community feedback to ensure cultural alignment, operational practicality, and sustainable implementation.
Low-cost models such as Community Immunization Champions Network and Women-only Health hubs were particularly effective among underserved groups, offering approachable touchpoints. Mobile vans and migrant navigators addressed barriers of distance, mobility, and trust, providing families with reliable and culturally sensitive access to vaccination. Child Wellness Days and redesigned clinics reframed vaccination as a positive family experience, reducing anxiety while encouraging consistent participation.
Overall, the combination of behavioural science and community insights produced practical, adaptable, scalable models that can strengthen immunization systems across diverse contexts.