Get to Know Three of Our 2021 Social and Behavioral Research Grant Partners

By: Deeva Agravat, MSc; Abigail Quinn, BA; Kate Hopkins, PhD, MPH

The Sabin Vaccine Institute’s Vaccine Acceptance & Demand initiative is proud to provide funding to 10 grant partners awarded through the 2021 Social and Behavioral Research Grants Program. This blog is the first in a series examining the selected research projects based on one of three themes: vaccine equity, marginalized communities, social media/messaging.

The COVID-19 pandemic has served as a stark reminder of the long-standing inequities in vaccine access and its compounding consequences, which have further widened the gap amongst countries of different socioeconomic status. Despite the launch of COVAX by the World Health Organization (WHO) to ensure a dilatory, equitable and accessible deployment of COVID-19 vaccines to lower- and middle-income countries (LMICs), vaccine nationalism amongst upper-income countries significantly diminished their financial support of bilateral and multilateral efforts to supply the Global South. A report released by the WHO estimates “more than 700 million vaccine doses have been administered globally, richer countries have received more than 87 percent, and low-income countries just 0.2 percent.”

The 76th UN General Assembly and the Global COVID-19 Summit provided platforms for high-level commitments from prominent world leaders, organizations, academics and practitioners to urgently address issues of vaccine equity, universal access, and the trajectory of a global action plan for future health crises. Solutions proposed included ramping up vaccine manufacturing, addressing bottle necks in the supply chain and investing in domestically homegrown innovations. Participating countries and organizations announced their role in donating high quality vaccines and financial support to strengthening health systems worldwide.

Leaders from the G20 summit addressed disparities among LMICs and prioritization of administering vaccinations. But at the same time upper-income countries recently procured COVID-19 vaccines to inoculate children and provide booster vaccinations to the adult population, whereas LMICs have been left with incapacitated health systems struggling to access an initial supply of vaccines. The pandemic has further impacted upon routine immunizations due to global service disruptions.

With the ongoing mission to support vaccine equity globally, Sabin’s projects are located in Nairobi & Kiambu Counties, Kenya; Kathmandu and Sarlahi District, Nepal; and the Indian states of Uttar Pradesh and Bihar. The research will explore narratives, interventions, and experiences prioritizing vaccine equity in LMICs. Associated research findings will further contextualize the multi-faceted barriers to achieving vaccine equity in order to improve vaccine access, demand and uptake in rural and resource deprived populations.

Meet Our Project Teams Focused on Vaccine Equity

Effect of COVID-19 Pandemic on Routine Childhood Vaccination in Kenya

The Regents of the University of California, Los Angeles (UCLA) in partnership with the National Health Research Institute in Kenya (KEMRI) and Innovations for Poverty Action (IPA) will explore the impact of the COVID-19 pandemic on routine childhood immunization.

“We are honored to have been selected for this award. This is an exciting opportunity to leverage our ongoing collaborative research in Kenya, in order to generate policy- and program-relevant insights for ‘catch-up’ strategies to ensure that all babies born during the COVID-19 pandemic will be fully immunized.” said Dr. Corrina Moucheraud, an associate professor of health policy and management and associate director at the Center for Health Policy Research at UCLA.

This study will re-engage an existing cohort of over 1,000 Kenyan women who gave birth between March and November 2020 and leverage data collected from in-person surveys and in-depth interviews to better understand the correlation between the pandemic and under- or delayed-vaccination. Using the WHO’s Behavioral and Social Drivers of Vaccination (BeSD) Increasing Vaccination Model, the research teams at UCLA, KEMRI, and IPA will investigate modifiable multi-level factors that influence vaccination:

• Individual influences (beliefs, attitudes, knowledge, and trust)
• Group influences (social norms)
• Contextual influences (leaders’ support, policies and programs affecting access, exposure to information and demographics)
• Vaccine specific issues (availability, affordability, accessibility and attitudes of healthcare workers)

Findings will inform tailored implementation strategies—co-created with key stakeholders—to overcome barriers to coverage and uptake.

Implementation Research on COVID-19 Vaccine Trust, Inequities, and Hesitancy in Nepal

In Kathmandu and Sarlahi District, Nepal, a population broadly representative of rural northern Indian, Pakistan and Bangladesh will be involved in a study conducted collaboratively between Johns Hopkins University (JHU), Bloomberg School of Public Health and the Nepal Nutrition Intervention Project. This implementation research study includes the following activities:

• Assessing national health systems readiness for COVID-19 rollout with focus on demand generation and communication
• Understanding rural health provider readiness and COVID-19 vaccine knowledge/attitudes
• Describing trust in health authorities, COVID-19 vaccine hesitancy, and associations with social inequities among the public in rural Nepal

The study’s methodology includes in-depth interviews with approximately 10 government officials and 10 civil society stakeholders at the national level. Using an interview guide with adapted questions from the WHO’s COVID-19 Vaccine Country Readiness Assessment Tool, activities will include interviews with mixed-method components amongst 20 facility-level providers in public and private settings and a household survey of 300 adults in rural Sarlahi District, Nepal.

Global and regional COVID-19 vaccine shortages and related misinformation have negatively impacted rural Nepalese populations’ vaccine-related attitudes, perceptions, and behaviors. The Principal Investigators, Dr. Daniel Erchick, an epidemiologist, and faculty member at the Department of International Health at JHU, and Dr. Subarna Khatry, director of Nepal Nutrition Intervention Project-Sarlahi, are hoping to rapidly generate practical evidence and recommendations to support the government of Nepal’s vaccination demand initiatives and communication efforts.

“Understanding the determinants of COVID-19 vaccine hesitancy is critical to the development of evidence-based communications approaches to achieve equitable access and high demand for these life-saving vaccines. Our implementation research study will investigate how public trust and social inequities are related to attitudes towards COVID-19 vaccination among rural communities in Nepal,” Dr. Erchick and Dr. Khatry said in a joint statement.

COVID-19 Vaccine Hesitancy in Rural India

Based in the states of Uttar Pradesh and Bihar, India, this study seeks to further understand the attitudes towards COVID-19 vaccines, intention to vaccinate, and barriers experienced by individuals and communities on the ground. The project will be undertaken by the Centre for Social and Behaviour Change (CSBC), Ashoka University, India; which is the technical partner to the National Institute for Transforming India (NITI Aayog), Uttar Pradesh and Bihar State governments and has embedded Behavioral Insights Units in NITI Aayog and Uttar Pradesh. The Principal Investigator Dr. Sharon Barnhardt, director of CSBC, along with the research team, will implement a large-scale, quasi-representative, in-person survey in rural Uttar Pradesh to empirically estimate demand for the vaccine, the determinants and barriers of this demand, and challenges regarding vaccine supply.

This research will address the gap of quantitative evidence used to establish the levels of hesitancy within the context of rural India.

“Vaccine hesitancy is under-studied in the Indian context, and while there has been measurement during the COVID-19 pandemic, the focus has largely been on urban, digital populations,” Dr. Barnhardt explained. “The Sabin Vaccine Institute’s grant will allow us to deepen our understanding towards the COVID-19 vaccine in rural Uttar Pradesh and Bihar and enable us to design interventions that could potentially decrease hesitancy.”

This study will cover a proportional sample of 6,000 individuals from 28 districts in Uttar Pradesh and 20 districts in Bihar. Filling crucial knowledge gaps, findings will help construct strategies for the final mile and design communication strategies for the vaccination program to be implemented by central and state government stakeholders.