Community connections:building trust - SBCC strategies for immunisation

The Community Reorientation of Women Network (CRoWN) addresses persistent gaps in child immunization and maternal health in Nigeria and Chad, where significant unvaccinated populations remain due to gender inequities and socio-cultural barriers. The concept co-created with known community health advocates (polio vaccinators) utilizes a network of community-based women volunteers to promote demand for key family health services across the family cycle, by focusing on expectant mothers in need of prenatal care, childbirth and ultimately ensuring that all children under 5 receive the full range of recommended immunizations and are subsequently enrolled in formal education. This mixed-methods study engaged 669 volunteers in Nigeria and 89 in Chad, who were trained and deployed as CRoWN Ambassadors to connect households with health services using a name-based tracking system. Results from 39 wards in Nigeria showed immunization of 64% of zero-dose children and referral of 78% of pregnant women for antenatal care. In Chad, 90% of zero-dose children were vaccinated, with 100% of referred women utilizing antenatal care. CRoWN facilitates household counseling, peer-support groups, and savings schemes promoting both health service uptake and community empowerment. The model outperforms many paid initiatives by sustaining impact beyond funding cycles through trusted, community-led efforts. Building on early success, CRoWN is expanding to six more Nigerian states, where over 16,000 women are waiting to be trained in order to lead interventions that enhance immunization, primary healthcare, and address wider development challenges, fostering lasting, multi-sectoral change in underserved communities.

India has made remarkable strides in running the world's largest immunization program, yet millions of children remain either unvaccinated. Conventional explanations often reduce this gap to awareness deficits. Findings from this formative study, conducted across six districts in India, suggest a more nuanced reality: most caregivers are not denying, but are navigating risks- balancing uncertainty, fear of side-effects and even the influence of social norms.
This abstract draws on findings from the formative study conducted by BIAS and WPP Media to understand why parents of zero-dose and partially vaccinated children do not complete immunization. Written through the lens of translational sciences, it bridges the world of research and strategy, translating evidence of caregiver decision-making into actionable approaches for SBCC design. 
Zero-dose and missed dose households are not opposite of full-dose families; they exist along a fragile continuum of trust. Zero-dose caregivers lean heavily on family and peer networks. Their trust resides in anecdotes and stories where immediate experiences of vaccine side effects outweigh prevention benefits. Distrust, competing priorities, and systemic inadequacies slowed partial-dose caregivers. For full-dose caregivers, vaccination functions as a normative action reinforced by family consensus, front-line-worker (FLW) support and reinforced by doctors.
The study offers a key strategic pathway cultivating trust as infrastructure tiered across caregiver journeys and responsive to critical decision. In practice this requires, support relationship building, balancing narratives (fear with care), and matching messengers to moments- frontline for reassurance, doctors for credibility and peers for proof.

High vaccine hesitancy, driven by misinformation and access barriers, is acute in General Tinio, Nueva Ecija, Philippines, classified as a Geographically Isolated and Disadvantaged Area (GIDA). Its 2023 Fully Immunized Children (FIC) coverage was 53.34%, far below the 95% national target. The study assessed the specific Behavioral and Social Drivers (BeSD) of vaccine hesitancy toward Routine Immunization (RI) to guide local policy and strategies for the Immunization 2030 goal. 
A two-phase, mixed-methods approach utilized the WHO BeSD framework. Phase 1 involved a baseline quantitative KAP survey, Focus Group Discussions (FGDs), and Key Informant Interviews (KIIs). Phase 2 focused on co-designing culturally resonant SBCC materials (explainer videos/ and Instructional flipcharts) and providing Interpersonal Communication (IPC) training for Barangay Health Workers (BHWs). 
Findings from the KAP survey showed that caregiver confidence was the only significant behavioral driver directly influencing vaccine intention, acting as the key link between positive beliefs and intent. Qualitative analysis, however, revealed persistent misconceptions and significant access barriers (logistical inconvenience, difficulties reaching Indigenous People communities). The co-design process was critical, demonstrating the value of close BHW/local influencer collaboration and fostering community ownership. 
The study concludes that full RI coverage is hindered by misconceptions and logistical barriers in the Philippine GIDA context. The primary contribution is a locally-tailored, community-informed SBCC campaign, which the team is advocating to institutionalize by advocating for Municipal Ordinance. This demonstrates a vital, scalable pathway for translating research into local policy, strengthening immunization campaigns toward the Immunization 2030 goal. 

Ethiopia has made progress in its immunization system yet faces a high burden of zero-dose children. According to WHO estimates, Ethiopia has about 3.9 million zero-dose children as of 2025 with National vaccination coverage for many basic vaccines remaining under 80 percent. Research shows that this is driven by multiple factors including zero dose children being concentrated in rural, pastoralist, and conflict-affected areas where access to routine services remains limited. The drivers of zero-dose status are multifaceted and a combination of geography, fragile health infrastructure, sociocultural barriers, and limited trust in health systems which all contribute to missed opportunities for vaccination.