Hesitancy around vaccination is a growing challenge across the world. Our most recent data from Africa shows 72% of individuals expressing hesitation about Covid-19 vaccines and 30% expressing hesitancy about routine immunization. A more recent demand survey in Afghanistan found 64% of respondents hesitant.

We believe hesitancy is increasing because of the growing penetration of social media, and the growing tendency to rely on social media when accessing information about vaccines. As an illustrative example, the table below shows the number of Facebook users in Nigeria:

This more than tripling of social media users over a five-year period is replicated in all of our countries, and represents a fundamental shift in the way people access information. This could be harnessed positively, but at present it primarily poses a challenge, since the available evidence suggests a high volume of rumors and misinformation circulating.

At the same time, much of the demand-generation activity is modeled on a 20th century model of information dissemination, and often includes messaging which is misaligned with actual concerns. While information campaigns generally focus on the benefits of immunization, our data shows that the number one reason for hesitancy is safety and security at vaccination sites (cited by 61% of those hesitant in urban areas and 78% of those hesitant in rural areas). Messaging is therefore not targeting the actual concerns, and more fundamentally, many programs are ‘flying blind’ by not using data to understand what those actual concerns are. Even where data is available it is often not being used to influence campaign messaging.

We have found in our own work that leaders are very receptive to new approaches and have been willing to collect data, reprogram messaging based on data and engage in strong demand activities. An example below is the Taliban leadership making videos to promote immunization as an Islamic duty.

We have also found that social media engagement with positive messages can increase rapidly when there is a dedicated effort to do so; in this case, from zero to eight million people in a period of three months.

There needs to be an urgent reorientation of demand-generation activities, led by a paradigm shift from traditional, paper-based, fact-focused, uninformed activities, to a modern marketing approach characterized by the use of evidence, multiple channels, and rigorous testing.

Specifically, the focus should be to ensure that demand generation activities are:

• Data-driven: based on accurate, regular data, showing what drives hesitancy and which messages work

• Technology-driven: to promote both the dissemination of messages but also to test different approaches to driving demand (e.g. a/b testing of different messages and approaches)

• Emotional and factual: almost all demand generation focuses on conveying ‘facts’ about immunization rather than emotional appeals (notable exceptions were Covid-19 vaccination campaigns in some developed countries which focused on a mixture of factual and emotional marketing)

• Centered on global public goods and knowledge about what works: at present, each country invents the wheel for itself; there is a strong opportunity to create global guidelines.

Making this shift quickly can help get demand generation programs back ahead of the game.