Вересень 2010

ЄДНАЙМОСЯ ЗАРАДИ ДІТЕЙ

UKRAINE:Restoring public trust in immunization

Ukraine: vaccination crisis 2008 - 2010 2008:

• MoH prematurely launched MR campaign without proper roll out.• Newly vaccinated boy died: MR vaccine was incorrectly blamed.• MoH failed to articulate convincing arguments for vaccination led to media / political firestorm, fed by internet based anti-vaccine forces.

2009: • Gmvt postponed the campaign and eventually abandoned an attempt to immunise nine million people against MR • Anti-vaccine campaign continued: portraying immunisation as dangerous; feeding public distrust in system; demonizing WHO, UNICEF.

2010: • Gmvt disposed MR vaccines at a cost of $ 5 million to donors.• Immunization coverage dropped average up to 50% due to parents’ refusal and vaccine scarce/shortage.

Examples of covers in the Ukrainian press

Declining public trust: contextVaccination crisis - a time bomb that could happen elsewhere:

• Soviet legacy: obligatory vaccination - coverage up to 95 % even in the 1990s; no major outbreaks public at large would remember. • No new knowledge on immunisation is widespread among medical workers. • Media: contradictory information.• Now days parents have choice with no knowledge/ lack of convincing, easy-to-digest information; many of them are afraid of vaccine safety. •The anti-vaccine forces have capacity to disrupt public health interventions on a scale not seen before.• MoH: lack of capacity. A failing health care leads to people’s distrust to public health system.•Politicized governmental system combined with vaccine producers wars for the market

UNICEF has since 2008 been working closely with the MoH to rebuild public confidence in immunisation.

The project has developed key strategies :• situation analysis (KAPB, stakeholders, omnibus); • equipping medical workers (workshops, forums, materials); • building a pro-immunisation coalition; • developing an information platformto be followed by a campaign (Internet, IEC materials, video/radio);• educating media, religious leaders, civil society activists, other opinion makers.

UNICEF involvement:

It’s critical to strengthen immunization services in Ukraine in order to reduce and better handle adverse events following immunization through capacity building for health care workers:

•Components: crisis communication and training for key medical speakers; workshops on handling the media following adverse events; development of tools for improved surveillance of AEFI and training health professionals on using them; distribution of materials.

• Coverage: all oblasts of Ukraine, frontline workers, as well as health officials, press services staff.

UNICEF actions: medical community

UNICEF actions: medical communityOutcomes:

- 260 medical professionals from all regions of Ukraine improved their communication capacities on immunization & influenza issues

- 276 medical professionals from all regions of Ukraine improved their technical knowledge & communication on AEFI

- 2,160 doctors improved their knowledge on vaccines safety and efficacy

Outcomes (accord. to the assessment of the trainings effectiveness):• 98% of participants think that all information received is useful and was needed • 100% of participants do share and disseminate new information and knowledge received during the trainings (via conferences, seminars, briefing with staff) • 92% of participants improved their work with media following the trainings

MoH capacity and partner collaboration:

• observing MoH low capacity both at the central and regional levels: • enjoying strong cooperation with WHO at the CO level:• exploring USAID, SDC, WB support, including funding;• involving business, civil society, opinion-leaders.

RESULTED in: UNICEF in Ukraine is a catalyst of all pro-immunization efforts, well-recognized by MoH, donors and local partners.

Awareness raising campaigns on immunization and influenza

•Coverage: national; all medical facilities, kindergartens, pharmacies, (all together about 35,000 facilities) railway, subway

•Components: outdoor, media appearances, internet, video, IEC materials (brochure for parents, posters), PSA, documentaries, viral videos

UNICEF actions: general public

Campaign outcomes:- Outdoor campaign outreach: over 40 cities (all regions);- over 70 % of people have seen the ads;- 101 420 376 – Number of times citizens have contacted with the outdoor (only immunization) advertising-

UNICEF actions: general public

• 68% of population liked the adds • 43% absolutely influenced opinion on immunization• 85% of them are positively influenced

Unexpected result: 34% said they have seen the ads on TV (we invested only in outdoor campaign

• Coalition building – i.e. Donors’ letter to President resulted in his public response in media requesting Prime Minister to address the problem

• Educating: Trainings and briefings for media, religious leaders, NGOs, other opinion-multipliers

• EIC materials: press kit on immunization, advocacy video, international pro-vaccination films in Ukr, brochures, photo/video database

UNICEF actions: opinion-makers

AND:Monitoring (daily press monitoring shared with MoH); strong coordination (MoH, WHO); proactive in crisis (quicklines, Q&A, crisis communication plan)

UNICEF actions: Internet outreach

•Web-based resource on immunization for parents, doctors, media

• New media – i.e. infographics

• Partisan video; virus web-site

•Bloggers

UNICEF actions: impact

Negative attitude to immunization in Ukraine:

2008 year 2010 year 32% 22%

In Kiev:2008 year 2010 year 64% 24,5%

Market price of the campaign (both immunization and influenza) about 1 mln USD

What are the challenges:

• Unstable political environment (3 ministers of health and 4 chief sanitary doctors changed)• Numerous scattered anti-vaccination activists, no one major opponent to appeal• Evaluating intervention’s effectiveness (i.e. new media, bloggers) • Ukraine 46 mln country (9 mln children; 500,000 born annually)- challenging to outreach all parents, public at large, especially resources wise.

What works well:• Innovative approaches (i.e. Pool of advertising agencies developed creative concepts pro bono)• Free of charge placement of outdoor (MoU with Ukrainian outdoor association)• Playing with the topics that are priority political agenda (i.e. Ukraine&EURO 2012 argument in the donors’ letter to President)• Humanizing UNICEF language (real lives stories) & new approaches (virus video) to deliver the message • Crisis creates opportunities (fruitful partnership with MoH)

Lessons learned: • Using international media to influence decision-makers • New media : virus video, promo Internet campaigns, infographs• Keep an eye on media environment/reporting to be proactive not reactive • Practical outputs and measurable results.• Crisis Communication Plan including major sensitive aspects to be in place• Anti-immunisation groups use politicians and lay activists to communicate predominantly emotional messages• Our arguments to be well-adopted to your country context• Be prepared for being alone at the beginning: allies to join once your efforts bring results

Campaign outcomes:- over 70% enjoyed the adds- Over 60 % were motivated to change their behaviour (follow the messages)

Unexpected outcomes:- outdoor operators printed and placed additional amount on their own $.- got in social media: “Got sick? Tweet from home!”

UNICEF actions: general publicInfluenza

Health for All, asukhodolska@unicef.org

ДЯКУЮ!