When the first surge of COVID-19 hit Uganda in the early months of 2020, there was a lot of information about it, and it was quite difficult to tell what was true and what was false. The disease itself was new and anything could pass. Social media platforms were loaded with, especially scary information. What was clear was that it was deadly. Although the Ministry of Health, quickly developed Standard Operation Procedures (SOPs), by the time these were disseminated the first scary but convincing messages about the corona virus and COVID-19 had taken deep root in the minds of many, making compliance to SOPs difficult. 
The MoH designed its messages around three main actions to prevent the spread of the corona virus:
Wear a maskWash hands regularlyKeep social distanceIn March 2021 a fourth action, vaccination against COVID-19, was added to the list. 
Working with the Ministry of Health, the USAID/Regional Health Integrated to Enhance Services in East Central (RHITES-EC) project oriented and deployed risk communication agents to conduct interpersonal communication activities, disseminated COVID-19 Health communication materials to trigger discussions on accurate information and demystify rumours, conducted mentorships with cultural and religious leaders on facts about COVID-19, held support supervision meetings with key stakeholders purposely to offer timely and appropriate information on COVID-19 vaccines. At the end of all this, by February 13, 2022, the EC region attained average vaccination consumption of 70% across the 12 districts.

The Sabin Vaccine Institute's 2020-2021 Social and Behavioral Grants Program partners concluded their year-long research projects in December 2021. Five multidisciplinary teams in four countries (Sierra Leone, Kenya, Pakistan and India) were awarded funding to explore the drivers of COVID-19 misinformation and its impact on both routine immunization and COVID-19 vaccine acceptance. Research teams and communities co-designed interventions employing a range of social listening and communication dissemination strategies, including the use of digital and social media, to increase vaccine literacy and willingness to vaccinate. Community-based participatory research equipped and empowered community influencers in both traditional and non-traditional leadership roles to dispel rumors and misinformation and support health knowledge translation and trust between patients and providers, which increased vaccine acceptance.


Evidence-based strategies remain an imperative to combat the global COVID-19 infodemic and health mis- and disinformation circulating both online and offline to increase vaccine acceptance and vaccination uptake. Given the diversity of cultures and communities across and within countries, these strategies require tailoring to the localized context but with a design approach that is scalable and replicable in other settings to optimize reach and impact. Through synthesis of five successful grant partner project methodological approaches, community-tailored interventions and findings, Sabin and its partners are providing an initial blueprint for replicable and scalable social and behavioral science-based communications strategies which increase vaccine confidence and acceptance within low- and middle-income country communities and offer transferrable approaches for various settings and health domains.

Covid-19-related movement restrictions impeded planned in-person home visits and community events. Suaahara II, a 10+ year multi-sector nutrition program funded by USAID, swiftly transitioned to remote approaches, including telephone-based counseling, SMS messages, and social media, to provide crucial health and nutrition as well as Covid-19 information to the households. As a large nutrition project implemented at scale across 42 of Nepal's 77 districts, Suaahara's transition was enormously challenging. However, Suaahara II established a system for telephone counseling and follow-ups within a week of the lockdown. Over a period of two years, Suaahara II frontline workers have made nearly three million calls to two million households, linked nearly 40,000 food insecure families to the government relief package, and referred 15,000 people with Covid-19 symptoms for testing. From our experience, we have myriad lessons learned to share social and behavior change communication (SBCC) practitioners on how the program achieved the transition with speed, effectiveness, and quality. In this presentation, will discuss the enabling factors for this transition, including the information system and database where Suaahara had information of almost all households in its target areas, swift and distance capacity building of the staff, and frontline staff's pre-acquaintance with these systems This presentation will also focus on the challenges of this adaptation and mitigating measures Suaahara II adopted to overcome these challenges.

SBC has often created and allowed room for development of a range of innovative and legitimate approaches to foster sustainable adoption of desired outcomes. Social listening is a powerful societal tool that is associated with a range of uncontrollable, yet very powerful features informally accepted by both old and modern culture as well as tradition. Identifying and sampling the different sources of social listening information could offer a deeper look into infordemics associated with COVID-19 vaccine acceptance.
The goal of this approach was to develop a model that could provide an evidence-based mechanism of addressing societal behavior towards the introduction and roll out of COVID-19 vaccines as a preventive measure against the pandemic. This would ultimately save time and other resources in debunking rumours, misinformation and subsequently increasing vaccine acceptance and demand in Botswana. The approach routinely collected data from different sources online, in communities, media and feedback mechanisms such as call centres to comprehensively analyse emerging rumours, misinformation and misconceptions and develop bi-weekly response plan.
Through this approach Botswana managed to timely and accurately respond to emerging issues thereby intercepting content that might have otherwise became viral, the effectiveness of this approach resulted in high vaccine acceptance rates, 78% among youth (18-35 years) and most young people,53%, trusted information given by health workers about COVID-19 vaccine. Ultimately Botswana managed to vaccinate 43% of population by December 2021, surpassing the WHO set target of 40%.

Combatting online harms and mis and disinformation are central not just to defending democracy but as key communications strategies when confronted with a pandemic or infodemic.  Outside of fact checking we wanted a means to empower the public to play a key role in mitigating mis and disinformation.  Not only would doing so provide an element of agency in a battle that may seem overwhelming but it also contribute to positive behaviour in engaging more critically with content and helping to raise awareness with peers.  Media Monitoring Africa developed a public complaints platform, where online harms can be reported, assessed according to standardised local rights based principles and action can be taken by platforms. The Real411 system offered unique information to national efforts aimed at dealing with the COVID pandemic, and it also provided data for university partners to carry out research.  

The "Sponsor a child" initiative was implemented as a pilot project in 8 districts of Aden, Shabwah and Dhale Governorates in the south of Yemen through a partnership with Social Services Center – a community-based partner. The aim was to provide a platform through which children who had completed their full dosage of immunization would encourage other children and adolescents sponsor other children to complete their vaccination dosages. 
500 children and adolescents (300 girls and 200 boys) from the age 10 to 17 years were trained on the project mechanism, phases and basic information about the immunization dosages that should be given to children. Training was done to empower the selected children within the community to complement the reach of adult community mobilizers who also mobilize the community to ensure that more children start and finish their vaccinations.  The sponsoring children were linked to the adult community mobilizers who supported to provide guidance and support to the children. The children were provided the list of children who were not fully vaccinated in their communities and accordingly visited their care givers to remind them to take their children to health facility to be vaccinated. The constant follow ups by the sponsoring children led to getting more children fully vaccinated. Over a 18 month period, an additional 4,620 children were fully vaccinated. In 18 months cycle when the sponsoring children began their engagement with other children, on average, each sponsoring child supported 9 other children to start and complete their vaccinations.

Social listening on digital platforms is becoming an integral part of health preparedness and response planning. This work analyses online conversations about COVID-19 vaccines in Eastern and Southern Africa region, using a taxonomy developed in collaboration with social and behaviour change (SBC) teams to identify infodemic signals and inform risk communication and community engagement.  The analysis shows how conversations about access and availability of vaccines represented the largest share of engagement over the course of 2021. Conversations about vaccine effectiveness and safety represented the second and third largest share of engagement. Insights from social listening, particularly detection of rumours, concerns and misinformation/disinformation, were shared with regional and country-level partners to inform risk communication and community engagement.   

With funding from the John Templeton Foundation, World Relief (WR) implemented a couples-focused Family Planning (FP) intervention in Burundi (2019-2022). The population is more than 98% Christian, and religion shapes couples' interactions, motivations, coordinated action, and FP outcomes. Common barriers for uptake of FP methods include misinformation, religious belief, fear of side effects, and mistrust that prevents couples deciding together about contraceptive use. Working with couples, church leaders, and CHWs, WR's goal was to empower values-based joint decisions around FP. 


Through formative research, major barriers and enablers for FP were identified and integrated into a story-based curriculum for couples, job aids for faith leaders, and training sessions for CHWs.  WR recruited and trained more than 1300 couples to facilitate couples' groups and worked with faith leaders to integrate FP messaging into couples' counseling, sermons, and existing group meetings through their faith communities. 


Monthly dialogue groups informed CHWs of the community SBCC efforts, linked the faith leaders' efforts to the couples' intervention, and created a stronger two-way referral system between the SBCC intervention and CHW's FP commodity distribution. The program adapted messaging for the couples' intervention, faith leaders, and CHWs based on emerging understanding of misinformation in communities. New layers of misinformation emerged as community members gained trust over time and shared more openly their taboos and concerns. The feedback loops created by the monthly dialogues provided a critical, timely channel for targeting specific barriers to FP. 

It is often assumed that behavior reflects belief; in order for behavior to change, stubborn negative beliefs about it must be shifted. This would be particularly challenging to achieve in areas of widespread misinformation about the COVID-19 vaccine where trust in public authorities may be low or motivations are questioned. Yet evidence from behavioral science research raises questions about this assumption and our own formative work suggests that normative influences may be sufficiently powerful to prompt vaccination, with or without actually changing underlying negative beliefs. Through in-depth interviews with health providers, community leaders, religious leaders, community members, and other local stakeholders in vaccine roll-out in both Cameroon and Cote d'Ivoire, one strongly emerging insight is that seeing someone you know or can identify with get safely vaccinated can be a powerful driver towards vaccination. Based on our observations we hypothesize that a normative intervention may directly shift negative beliefs but also may nudge some segment of the population towards vaccination without necessarily shifting underlying negative attitudes or beliefs. In either case, this suggests normative interventions will have a critical role to play in vaccination efforts, and also underscores the importance of making vaccines easily accessible to those already motivated to receive it as their actions may have downstream impact on their peer network. We hope to have more insights related to the influence of norms and potential for applications beyond COVID-19 to share from testing and implementation of new behavioral solutions later this year.

The spread of misinformation on social media has generated confusion and uncertainty about how to behave with respect to protective actions during the COVID-19 pandemic, such as mask wearing, social distancing, and getting vaccinated. Pennycook et al. (2020) found that asking people to think about the accuracy of a single headline (i.e., accuracy nudge) improved their discernment in sharing true versus false information related to COVID-19. This study sought to replicate the work of Pennycook et al. (2020) and test the generalizability of their findings to three different countries: Kyrgyzstan, India, and the United States. This study also explores whether findings extend to information related to COVID-19 vaccine acceptance, a timely and important topic at the time of data collection. The accuracy nudge's effect did not replicate in the Kyrgyzstan sample (n=1,049). Results were mixed in India (n=703) and the US (n=829); the nudge decreased willingness to share some false information (misinformation) but it did not significantly increase willingness to share true information.  We discuss potential explanations for these findings and practical implications for those working to combat the spread of misinformation online.

Routine immunization rates have been steadily decreasing in Kyrgyzstan and were adversely impacted by COVID-19. In addition, vaccine hesitancy has been increasing, yet a gap exists in understanding locally specific reasons for vaccine hesitancy and how SBCC might be leveraged as a solution. This presentation will share findings from a behavioural insights (BI) project designed to answer: Why do adults in Kyrgyzstan decide not to vaccinate their children (or themselves) and what trusted communication sources might be tapped to decrease vaccine hesitancy and increase vaccination rates? This qualitative project was conducted from 2021-2022 with a series of focus group discussions (FGDs) in urban and rural areas with vaccine hesitant men and women 18+. Larson et al.'s (2015) vaccine hesitancy tool determined eligibility. FGD items were pretested, including tools from the literature on routine immunization and COVID-19 vaccination, and tested messages to gauge reactions and potential for future SBCC interventions. COVID-19 protocols were followed, and participants received a card with the nearest location to obtain the COVID-19 vaccine. The FGDs were conducted in Kyrgyz and Russian, audio recorded, transcribed into English for analysis, and analyzed by multiple coders, including assistance from local team members on cultural interpretation and confirmation of findings. Full results will be shared, with a focus on culturally specific reasons for vaccine hesitancy and implications for SBCC practice, research, and theory. This presentation will add to the growing interest in BI as an approach for addressing routine immunization and COVID-19 vaccination.

Trust, clear communication, and understanding between communities and research institutes is essential for effective community participation in research aimed at improving health outcomes. 


The critical role of research fieldworkers or community-based health workers engaging within communities on behalf of research institutes as 'connectors' to build trust and understanding with potential research participants, is widely recognized (Molyneux, S. et al, 2013). They take on this 'ambassador' role while collecting research data and disseminating health information to community members. 


The arising ethical challenges and dilemmas of their bridging roles, the impacts on their capacity to effectively communicate and execute their responsibilities, as well as the benefits of their specific roles to research institutes have increasingly been explored and documented (Kingori, P, 2013). 


Recognising the unique role of this cohort of research professionals, and building on more than a decade of research exploring the ethical dilemmas, engagement challenges and benefits of this role as 'connectors', two Global South research institutes (the Oxford University Clinical Research Unit Vietnam/OUCRU and Kenya Medical Research Institute -Wellcome unit/ KEMRI-Wellcome collaborated with The Global Health Network (TGHN) to develop an online portal called 'CONNECT'. This accessible online resource aims to provide an inclusive space which both professionally recognizes these research roles and supports supervisors/managers who directly resource research field workers and community-based health workers. It aims to make resources freely and easily available to support more equitable access to professional support.