Empowering community leaders to advocate for COVID-19 vaccines through the vaccine champions programme

In this week’s episode, we bring you a panel discussion on how the vaccine champions programme has empowered community leaders to advocate for COVID-19 vaccines in Australia, Vietnam, and Fiji. 

You will hear from three vaccination experts and leaders who are all involved in an innovative behavioural change programme known as Vaccine Champions, which was developed in Victoria, Australia and has recently been rolled out in Fiji and Vietnam.

On the panel:

• Sr Litiana Volavola, National Program Manager for the Expanded Program on Immunization (EPI) and Supply Chain and Fiji COVID-19 Vaccination Team Lead
• Professor Thu Anh Nguyen from the Woolcock Institute of Medical Research in Vietnam
• Professor Margie Danchin, Group Leader, Vaccine Uptake, Murdoch Children’s Research Institute

In this episode we discuss the results from the implementation of the vaccine champions programme in Australia and how it has been rolled out in Vietnam and Fiji, including:  

• An overview of the vaccine champions programme and what it means to be a vaccine champion. 
• The challenges and barriers to achieving high vaccine coverage in the community such as access and acceptance. 
• Learnings from recent trainings in Vietnam and Fiji and how the programme is supporting community leaders to advocate for COVID-19 vaccines in their communities. 

We encourage you to join the conversation at @CentreHealthSec. You also access the paper Vaccine Champions Training Program: Empowering Community Leaders to Advocate for COVID-19 Vaccines here: https://www.mdpi.com/2076-393X/10/11/1893

Transcript

Please note: We provide transcripts for information purposes only. Anyone accessing our transcripts undertake responsibility for assessing the relevance and accuracy of the content. Before using the material contained in a transcript, the permission of the relevant presenter should be obtained.   

The views presented in this podcast are the views of the host and guests. They do not necessarily represent the views or the official position of the Australian Government.  

Andrew Everett 00:27

Welcome to Contain This. I'm Andrew Everett, an adviser from the Indo Pacific Centre for Health Security. I'd like to acknowledge the Traditional Owners and Custodians of Country throughout Australia and the region. We recognise the continuing connection to land, waters, and community and pay our respects to Elders past and present. 

Today, we're hearing from three exceptional people who are all involved in an innovative behavioural change programme known as the vaccine champions. This programme was developed first in Victoria, Australia, and has since been rolled out in Fiji and Vietnam. Earlier this year, I had the opportunity to talk with Sister Litiana Volavola, the national programme manager of the expanded programme of immunization and supply chain within Fiji's Ministry of Health and Medical Services. Sister Liti has a decorated career managing countless vaccine preventable disease programme areas and leads many elements of pages COVID-19 vaccine rollout. I also met with Professor Thu Anh, who was head of the Woolcock Institute of Medical Research in Vietnam, who also holds an honorary position as a senior clinical lecturer at the University of Sydney and is also an epidemiologist and social scientist by training with more than 20 years of experience. And finally, the lead of this project Professor Margie Danchin Margie is the paediatrician at the Royal Children's Hospital and group leader of the vaccine uptake group at the Murdoch Children's Research Institute and is also a clinical scientist at the University of Melbourne. She's an immunisation expert who leads a programme of research on vaccine demand at uptake in Australia and across the Indo Pacific region. She is also deputy chair of the Australian regional immunisation Alliance, or ARIA for short. I hope you enjoy the conversation. 

Thank you all for joining me. Let's jump in. I'm sure that most people listening, haven't heard of a vaccine champion before. Margie, what is a vaccine champion? 

Professor Margie Danchin 02:49

Absolutely. The core essence of a vaccine champion is anyone a trusted member of their community. And really importantly, they don't have to have a health background. They just need to be able to advocate and talk about and answer questions about all types of vaccines. Of course, more recently, that has been COVID vaccines, but it's about the routine EPI vaccines and any new vaccine being introduced into a community. And what a vaccine champion really can do is talk about their own personal experiences. They can tell stories and normalise vaccination, and also guide people to trustworthy information. So, you know, a vaccine champion can come from just such a broad section across the community.

Andrew Everett 03:33 

I think I'm warming up to the idea of calling myself a vaccine champion, Margie. We'll see how we go by the end of this podcast. 

Professor Margie Danchin 03:44

Yeah, I was gonna say absolutely. I mean, honestly, the key really is around, you know, a champion, being able to build trust and to really address misinformation. And that's done by people we know. And that's people from our own communities, because that those are the people that we trust, and we listen to not necessarily, you know, an expert on the radio or the TV or reading information on a website.

Andrew Everett 04:07

So why is there a need for vaccine champions then, Margie?

Professor Margie Danchin 04:13

Well, if you think about you know, the challenges we've had around achieving very high in vaccine coverage in the community, we always think about, well, what are the barriers to vaccination and in general that falls into two main categories there. There are barriers around people actually being able to access vaccines, you know, such as having a big family and not being able to get public transport, or the clinics closed or any number of access issues. And then there's acceptance issues. And that's, you know, really around the confidence of vaccines, people feeling that they can have their questions answered around vaccine safety or how well vaccines work. And this is where the champions fit into addressing those acceptance barriers, because what we're really talking about here is really effective and strong communication around vaccines, and bringing communities together, community engagement. And so that's exactly what the vaccine champions programme does. And the core, of course, is that it has to be locally adapted to whatever setting that the programme has been delivered in so that it can reach those harder to reach or priority groups to really build confidence in vaccines. And that's exactly where we started with this programme at the start of the COVID rollout in Australia. We wouldn't be here today if the vaccine champions programme in Victoria wasn't a success. 

Andrew Everett 05:27

Margie, could you explain to listeners how this programme that was effective in the Australian context that works at the Australian community level, how could that be transposed into the Fijian context?

Professor Margie Danchin 05:47

I think you know, that's exactly what happened. We were so delighted with how well the programme had gone in Australia, that, you know, through ARIA, or the Australian Regional Immunisation Alliance, I really sought some funding and resources to design the programme to initially be codesigned and adapted to countries in the Pacific. And fortunately, you know, Fiji was the first country that we approached, and you know, you'll hear from Sister Liti in a minute. But just to give you a brief little summary of the programme, as I said, we did train 35 vaccine champions, and two thirds of them went to run on run their own community sessions, and just under half of them have a health background. So again, broad representation from the community and what was so exciting was, you know, representatives, particularly from Fiji, rugby, and cricket, who were just fantastic vaccine champions, as well as young people and faith leaders, and, you know, the village head men and so on, that really got that broad representation across the community. And then what was super exciting was that they went on to run nearly 55 community sessions, which reached over 1,000 community members. So, you know, for Fiji I think it was an extraordinary example of what true partnership and codesign looks like.

Andrew Everett 07:11

1,000 community members, that is quite a high number. Sister Liti, I'd like to bring you into the conversation. Given your role as Fiji's national EPI programme manager. Do you have any reflections on this collaborative design process, or how this vaccine champions programme built from existing MHMS endeavors?

Sister Litiana Volavola 07:35

Thank you, Andrew. First before going to get on to start with how I came to know about vaccine champions and vaccine, the vaccine communication programme we were introduced through UNICEF and I think that again through an undertaking by RBIs, how Margie had mentioned through this rapid formative assessment, and they had finding some information on COVID-19 acceptances and uptake. But what caught me at them and made me excited was part of the finding was in the studies that they found, saying that risk communication and community engagement activities needed to be convened to engage families and friends and church leaders, influencers in the in the community will build a partnership and support citizens to be positive voices for their families and communities. So I said, yes, at the same time, because we were running the risk comps, community engagement training, we were asked whether this was anything otherwise, I said, no, we'll just complement each other. And that left us to know that we were on the right track. So for me, I was super excited to advise those are leaders who say yes bring the vaccine champion, across and we conduct the training to get to reach our population that are still not reached with vaccination, because our overarching goal is to vaccinate everybody in Fiji. 

Andrew Everett 09:25

Fantastic, it's wonderful to hear the themes of similar modalities of the training programme. I want to ask sister Liti, about the connection between the vaccine champions programme and the connection to vaccination services, given your role within the Fijian government, you are able to connect in vaccine champions into vaccination services to make sure that if there's a cohort of people that they've successfully been able to talk about intentions to vaccinate, where to from there are they able to be directed and supported into actually following through and getting a vaccination in Fiji? 

Sister Litiana Volavola 10:20

It's supported COVID vaccination service and that's again, based on Dr. Frawley’s findings most of the time when the nurses do not have enough time when they go to the communities they planned places to visit to places for vaccinations and the nurses did not have time to talk about the vaccine or address concerns on any advice and so the nurse would just conduct the vaccination or would leave the community and say that they would come back another time which we do not do most of the time. So the vaccine champions were there on the ground to take this up. And so, to those who are being convinced they want to be advised to come to the nearest health centre, so, that position to us to have the supplies as nearest as the it can be to be the community at the same time to build on that we trained them on not just on COVID vaccines, not just on booster, but because paediatric vaccination was you know, it was on the horizon for us. 

Andrew Everett 11:40

Thanks, Sister Liti, it sounds like thanks to your connections and your embeddedness and your leadership within the Ministry of Health and Medical Services, you are able to position the vaccine champions programme so that it was able to address both the barriers to access, i.e., bringing the vaccine supply to the community, as well as working with the vaccine champions to work on vaccine acceptance. So that sounds pretty impressive and comprehensive. I'd like to bring in Professor Thu Anh Nguyen the head of the Woodcock Institute into the conversation. Thu Anh there really seemed to be a considered two-step process in Vietnam, yourself and others drafted. One that didn't assume vaccine champions to be the solution. Can you explain how the communications desk review and a communication plan that was conducted informed the future vaccine champions programme in Vietnam? 

Professor Thu Anh Nguyen 12:39

Andrew, the situation in Vietnam is quite different from many other countries. But I believe the high vaccination coverage is not across all population. In some specific population, the coverage is pretty low. For example, among elderly with comorbidities or children under 18 years old. At the time we started the programme as a nation coverage is very low. And we decided to conduct a desk review to understand who are they? Who are the people who haven't got the vaccine yet? Where are they? Why they do not go for vaccination? And what drive the other group, though, who already accept to have vaccine came for vaccine? And how could we approach those who refuse to come for a vaccine. So we conducted a desk review together with the partners in the country, such as UNICEF, Ministry of Health and lecturer active and medical university, to collect to compile evidences to provide answer to the question. And from the results of the test, we identify targeted audiences for the COVID-19 vaccination programme. we identify approach to reach them and what messages to address their concern to prevent them to go for vaccination. And from that process to develop, we found that broad communication which lasts group of population however, in Vietnam, there's a specific group of population who refuse to have vaccine, and we need to find ways to reach them and to send them the right message. And the only way the most effective way is to have a champions to have a network of vaccine champion at the community level to help us to reach to the consumer. 

Andrew Everett 14:41

And so the identification of key population groups and specific subpopulations, was that a real priority for the Ministry of Health, was that their driving force behind the creation of this programme of work? 

Professor Thu Anh Nguyen14:56

Yes, it is a priority for the Ministry of Health as well as for the Government of Vietnam. Before we conducted this work, there was a lot of discussion between DFAT, NC, Murdoch Institute and Woolcock Institute with the Ministry of Health to identify the areas that we can provide technical assistance in the most fruitful and effective way. And the Ministry of Health would like to learn who do not came for the vaccine, and how we can reach them and what message we should send them and how to send the message to the people so that the vaccination coverage in Vietnam could reach to much higher level. 

Andrew Everett 15:41

As DFAT’s programme manager for this work, it is so excellent to hear that there is such close alignment with UNICEF, and that UNICEF along with DFAT are financially supporting this incredible programme. Margie, I know that you're working quite close to this Vietnam expansion. Did you have anything you want to add?  

Professor Margie Danchin 16:01

Yeah, thanks, Andrew, and great to hear Thu Ahn talk so, you know, in such detail about the programme, I think what I would say at this point is, you know, I think we feel incredibly proud, as I said, of the partnership and of the initial success in terms of being able to work so closely with the Ministry of Health, engaging our six master trainers who've been able to, you know, translate the, the programme and deliver it to the provincial trainers. You know, in the first part of the programme, we had nearly 100 provincial health care workers that that received the training, and are now going on to conduct their own sessions, to train community vaccine champions who will then deliver their own sessions. So I think that's, you know, really exciting. And as we see the expansion, now, we're going to go back and update the training for those existing provincial health care workers and champions. And now of course, expand to the different provinces, as you said, but also, it's really important, I think that we're that this work is underpinned by very clear evaluation framework. So that we can really understand the reach of the programme in terms of you know, the numbers of champions trained and how many sessions they go on to deliver. The effectiveness is really critical in terms of vaccine uptake, doses delivered changes in vaccine coverage. And then of course, ultimately, the intention is that you decrease vaccine preventable diseases in the community. So there's a lot that we need to do to measure the success and the impact of the programme. 

Andrew Everett 17:39

Thanks, Margie. Globally, there must be many eyes on this programme if it is an effective and accepted way for community champions to go in and directly contribute to increased immunisation rates and key population groups. To close, I want to ask a question to Sister Liti, drawing on your experience within Fiji's MHMS, and Thu Ahn with your experience within Vietnam's health systems. As Margie alluded to just now, in order for the vaccine champions programme to continue to achieve meaningful immunisation uptake outcomes into the future, it needs to have a sustainable programme endpoints and be appropriately embedded within Fijis MHMS and Vietnam's Ministry of Health respects respectively, what measures are in place? Or do you think should be put in place to ensure positively changed attitudes to immunizations are sustained going forward? I'll ask Sister Liti if you could respond first. 

Sister Litiana Volavola 18:41

We build trust, which is very important, trusting the message that we both talk to, to our people, our community members, and not just to trust the message but trust the messenger or, and that that's one of the things that come up very strongly on the ground as we continue to conduct a responsible community engagement training. That's number one. Number two is to have as a strong partnership of response community engagement training to community health workers and vaccine champion training to the 35 members of a community that was selected as participants, and these are our champions on the ground. We also collaborate in taking our booster doses to the expected outcome right now our goal is to achieve 70% with booster dose in Fiji right now a third dose of Pfizer booster is sitting at 54.6%. And it's been sitting on that coverage for quite some time even though the vaccination uptake on the ground continues to come like two per day or five in a week. So as it takes for people to come forward and talk on radios and other mediums. The team has placed its continued partnership and capacity building, just tailoring the package to suit Fiji and our contexts with an aim to continue to build two things which are very important for us the skills and the confidence to address miss information or anything of that sort. So right now it still affects uptake still causes a little bit of hesitancy. So we the vaccine champion you know, a team conducting training or those two things, it would be conversations on the ground, or within that, at the same time move towards other vaccine initiatives in the future. Vinaka.

Andrew Everett 20:57

Thank you, Sister Liti. And the same question for you Thu Anh. And what measures are in place, or do you think should be in place to ensure positively changed attitudes towards immunisation are sustained in Vietnam going forward following the vaccine champions programme? 

Professor Thu Anh Nguyen21:15

In Vietnam, we are working on, and we hope to be able to continue, supporting the Ministry of Health and the expanded programme on immunisation to strengthen the capacity of the system, the second thing that we need to do. First of all, we need to develop a programme of capacity building on vaccine communication, using the local budget and integrating into the existing activities of the EPI programme to make it sustain. Number two, we need to support Ministry of Health to review and redesign the database for the EPI programme in order to help the government to identify the gaps in the programme implementation so that they can act fast and act effectively. Number three we discussed with the EPI programme and in the future, we need to provide support for the EPI programme to improve capacity the national immunisation technical advisory group, the NITA which already exists in Vietnam, but hasn't got sufficient funding and capacity to run in a more effective way. And finally, we hope that in the coming months we'll be able to help the local organisation to develop a platform to share evidence-based information on vaccine for the community. Delivering in their own language in the way that they will prefer to reveal whenever they had question or concern about vaccine.

Andrew Everett 23:07

I'd like to thank Sister Liti, Professor Thu Anh, and Professor Margie Danchin. Thank you so much for your time today and for joining the joining me on Contain This.  

You’ve been listening to Sister Litiana Volavola, the national programme manager for the expanded programme of immunization and supply chain, who was also the Fiji COVID-19 vaccination team lead working within Fiji's Ministry of Health and Medical Services. Professor Thu Anh who is head of the Woolcock Institute of Medical Research in Vietnam, who also holds an honorary position as a senior clinical lecturer at the University of Sydney. And Professor Margie Danchin, a pediatrician at the Royal Children's Hospital group leader of the vaccine uptake group at the Murdoch Children's Research Institute, and a clinical scientist at the University of Melbourne. I hope you've enjoyed listening thank you for tuning in to Contain This.

Contain This is produced by the Indo Pacific Centre for Health Security. We acknowledge the Traditional Owners and Custodians of Country throughout Australia and the Indo Pacific region. We recognise their continuing connection to land, waters, and community and pay our respects to Elders past and present. You can follow us on Twitter @CenterHealthSec.