Building Confidence in the COVID-19 Vaccine in India: Insights for Impact

In an effort to understand trends in vaccine hesitancy in India, Facebook's Data for Good team analysed thousands of public posts about the topic on Facebook. The research team also included insights on hesitancy from Facebook's COVID-19 Trends and Impact Survey (CTIS), which tracks information on vaccine acceptance at a local level in over 200 countries and territories worldwide. At the time of analysis, the survey found that almost 77% of respondents in India indicated they would like to receive the vaccine. Qualitative assessment of the public posts confirmed these generally positive feelings about COVID-19 vaccine in India, though many people had questions about their availability, potential side effects, and when/how they would be eligible to receive their first dose.

Drawing on these insights, the Yale Institute for Global Health, UNICEF, and Facebook developed eight social media campaigns - four in English and four in Hindi. With content designed by the Public Good Projects, the campaigns linked to the Government of India's COWIN website, which provided more information on vaccines, registration for appointments, and vaccination certificates. Campaigns included:

1. Filling Information Gaps with Emphasis on Safety and Efficacy: This campaign focused on vaccine safety by outlining the rigorous testing by scientists and promoted efficacy by outlining that vaccines are the best way to limit the spread of COVID-19.
2. Countering the "Wait and See" Approach: This campaign used fact-based messaging to highlight the urgency of vaccination through messages like, "Every day you wait to get vaccinated is another day you could be spreading COVID-19 in your family and community." This campaign aimed to reassure people, despite the perceived rush to develop and distribute vaccines, that the time for them to be vaccinated is now.
3. National Pride: This campaign sought to capitalise on the social approval expressed in public posts, as well as the national pride that people were expressing at India's ability to develop its own vaccine and to share with other countries - deploying messages like, "Make India #1 in COVID-19 vaccination" and "Don't let India down; get vaccinated against COVID-19." This messaging positioned India as a leader in the global fight against COVID-19 and motivated Indians to join the fight by getting vaccinated.
4. Testimonials/Messengers: Leveraging insights from the analysis of public posts, this campaign shared personal stories of successful vaccination through trusted peers, family members, and healthcare workers. The content stressed the vaccine's minimal side effects and reinforced people's desire - and ability, thanks to vaccination - to return to normal, pre-pandemic life.

The eight campaigns reached over 98 million people in India. UNICEF, Yale, and Facebook tested the effectiveness of these four campaigns, in both languages, over a three-week period in July-August 2021. Viewers of each ad set were randomly divided into two groups: those who saw the ads and those who did not. A statistically significant lift was observed in ad recall for four of the eight campaigns, three of which were in English. Overall, the most successful campaign was the "National Pride" campaign, which attained a statistically significant lift for four out of the five awareness and attitude questions posted by researchers, for both English and Hindi campaigns. This campaign was particularly effective in increasing the likelihood that Hindi-speakers would advise a close friend or relative to get vaccinated against COVID-19. In short: Campaigns emphasising social norms such as national momentum and content depicting testimonials with diverse messengers including health care workers and parents achieved the greatest lift in attitudes.

COVID-19, Immunisation and Vaccines

UNICEF is a partner in the COVAX Facility along with the World Health Organization (WHO), the Global Alliance for Vaccines and Immunizations (GAVI), and the Coalition for Epidemic Preparedness Innovations (CEPI). By late November 2021, COVAX had secured more than 5 billion vaccine doses; of these, UNICEF had shipped over 236 million doses to 138 countries. However, not only does vaccine hesitancy continue to grow around the world, but the pandemic has disrupted routine vaccination services that are critical for protecting children against preventable diseases in more than 70 countries.

As of late November 2021, the number of COVID-19 tests conducted per capita in India remained low, and only 30% of the eligible population had been vaccinated against COVID-19. Alongside the operational challenges in delivering vaccines to a country of 1.38 billion people, vaccine hesitancy remains a barrier, with health workers facing resistance from people who believe that vaccines aren't effective and that they cause serious side effects. The above-described initiative is part of an effort to address these issues.

Yale and UNICEF plan to leverage the insights from the project in a number of additional countries to increase vaccine acceptance. Some of the lessons they will apply include:

• Leverage national momentum to vaccinate.
• Use trusted messengers and testimonials.
• Share practical information and answer common questions.
• Consider content in local and/or multiple languages.