South and SOUTHEAST Asia
Reimagining the vaccination guidebook
The Challenge
Can we show, rather than tell, local leaders how to design people-centered strategies?
The Context
In nearly all countries, the most effective immunization plans are designed closest to communities. But throughout these planning exercises, strategies that look at increasing caregivers’ demand for immunization can be afterthoughts. UNICEF’s Regional Office for South Asia called on us to help reverse this trend. Their goal was ambitious: help us make demand strategies the norm, rather than the exception, in two regions of the world. Their proposal? A manual to help immunization managers design demand strategies.
At least 6 million children are unvaccinated or undervaccinated in the 8 highest risk countries in South and Southeast Asia.
In the Philippines, the Dengvaxia vaccine was recalled in 2017, causing a major loss of trust in all routine vaccination that has still not been recovered.
Infecting people with dis- and misinformation is a rising phenomenon globally, and in Pakistan.
In Peshawar, Pakistan, misinformation videos about a 2019 polio campaign spread on Whatsapp, and led to nearly 1 million caregivers refusing OPV for their children.
In India most people know about immunization, but they don’t understand how many vaccines are “enough” to be fully immunized.
In Indonesia, a 2018 Measles vaccination campaign targeting 70 million children, was derailed by religious groups withdrawing their support. Measles vaccination rates fell to 6% in some parts of the country.
In Nepal measles vaccination rates have dropped from 90% to 70% because the message about the second dose has not been communicated effectively.
What We Heard
We started by talking to UNICEF, WHO and Government sub-national immunisation and behavioural managers across South and Southeast Asia. Over and over again, we heard the same thing: “not another manual!”, “help us understand how to build demand,” but “no theory, please.” They wanted practical tools that would help them understand complex human behaviour, and show them how to take quick, effective action to solve their urgent people problems.
Next, we dug into the data to understand the reasons for low uptake of vaccination in the region. Although each context had its own nuances, there were common patterns across countries and regions. Most existing strategies assumed caregivers wanted more information, and focused nearly all demand-generating resources on building knowledge. But most caregivers would gladly immunize their children if really practical barriers were removed: knowing where to go and when, not being fearful of being scolded for losing an immunization card, understanding what to expect after immunization, and how to mitigate adverse effects.
Our Solution
We put ourselves in the shoes of the tireless, resource-strapped immunization managers who know that building demand is important, but are overwhelmed by the process. We also considered what caregivers and health workers needed, and how we could best support managers to match the right solutions for their barriers to people’s needs. Through iteration, field testing, and feedback, we designed a human-centered experience that would be as easy as it was enjoyable and informative to go through. Our Demand Strategy Builder is a full package that takes managers through four key moments to designing a behavioral strategy.
Throughout each moment, users are provided with visual guidance, as little text as possible, guided visits to communities, and gamification through cards and role play. The end result? A crop of local level managers who are applying their deep knowledge of their communities to design behavioral solutions. A human centered research phase in the middle of the process makes sure assumptions are challenged, and human connections are made.
