The Drivers of Low Vaccination Utilization in Niger.

Vaccination adherence involves the expected benefit of a vaccine and the perceived risk of the disease. To develop an evidence-based communication strategy aimed at improving vaccination coverage in Niger, we conducted a mixed socio-anthropological study of the perceptions among the population on the benefit and the risk of the childhood (Expanded Program on Immunization) and the COVID-19 vaccines. Our results show that negative rumors are not a significant driver of vaccine refusal. The insufficient level of fully vaccinated, compared with partially vaccinated, children might be explained by misunderstandings around the side effects of vaccines and the necessity for full vaccination. Approximately one-fourth of the population is vaccinated against COVID-19, whereas 73.3% think that vaccines against the disease are a "good thing," and 83% of those who have heard messages promoting the vaccination approve of them. This apparent contradiction is explained by a low perception of the risks of COVID-19. More than half of the population surveyed believe that the disease is not present in the country. A large majority believe that only ill people can transmit the disease, whereas only 12.8% think they know anybody who has ever been sick with COVID-19. Three-fourths of the interviewees have seen images from around the world of persons sick or deceased from COVID-19; the same proportion has not seen any such images of affected patients in Niger. Communication to improve COVID-19 uptake should focus on the reality of the disease presence and its transmission and not on rumors surrounding the vaccines.

Vaccine Refusal: A Major, Underestimated Obstacle for the Poliomyelitis Eradication Initiative.

In 1988, the WHO launched the Global Poliomyelitis Eradication Initiative with the goal of eradication by 2000. Not only has this goal, which has been repeatedly postponed, still not been achieved, but while the wild polio virus is still endemic in two Asian countries, a new epidemic caused by a vaccine-derived virus is spreading and is now affecting numerous developing and industrialized countries, including the United Kingdom and the United States. In addition to biological explanations for the failure of eradication, vaccination refusal by communities in mainly two regions of Africa and Asia has prevented mass vaccination campaigns from achieving their immunization coverage targets. The way these campaigns have been deployed has contributed to mistrust and hostility. The negative reactions of some communities, expressed from the first vaccination campaigns, were belatedly considered, which gave time for rumors to flourish and settle permanently. This failure underscores the importance of taking into account, before any vaccination campaign begins, the "health culture" of target populations-meaning their representations of the vaccines and the health authorities that promote vaccination, as well as their knowledge, fears, and hopes.

[Failure of poliomyelitis eradication campaign with oral vaccine: there's no vaccination without adherence]. / Échec de la campagne d'éradication de la poliomyélite avec le vaccin oral: on ne vaccine pas sans adhésion.

Thirty-five years after its launch, the Global Polio Eradication Initiative has yet to reach its original goal of 2000. Not only is the wild type 1 polio virus still endemic in two countries, but a new outbreak due to viruses derived from the live attenuated virus used for the oral vaccine has been spreading since 2016. The National Immunization Days (NID), during which teams go door-to-door and attract children to be vaccinated, have provoked violent opposition particularly in Northern Nigeria and in the area of India, Pakistan, Afghanistan. In both regions, the same rumor has developed that the vaccine contains sterilizing products, in order to limit the Muslim population. The organizers of the campaign multiplied in vain the NIDs to overcome the resistance, but pockets of insufficiently vaccinated population have persisted. This has allowed the wild virus to remain endemic and the new outbreak of vaccine-derived viruses to progress. We can wonder what the campaign would have become if its organizers had taken the time to reflect and reorient their strategy to rely on the routine vaccination of the Expanded Program on Immunization that does not arouse such opposition.

[For a communication addressing populations' health literacy]. / Pour une communication basée sur la culture en santé (health literacy) des populations.

The concept of "health literacy" has been widely used in English-speaking countries for about 20 years. However, its meaning has evolved since its first definition as "cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health", to be most often centered on the narrower meaning of "functional health literacy", which is the ability to read and understand written medical documents. This narrow definition excludes illiterate populations and don't take into consideration the social skills. Moreover, it doesn't take into consideration the barriers erected by the culture. Working in the field of health communication, we propose the broadest concept of "health culture", which encompasses health literacy as well as all the representations that influence people decisions about their health. The health culture approach makes it possible to base strategies, messages and communication tools on the representations of the target populations, in order to sensitize them to the behavioral changes promoted by this communication. We show some examples of its application in public health programs in sub-Saharan Africa: breastfeeding, pregnancy support, Ebola virus disease, HIV testing, tuberculosis, and COVID-19.

Public Perceptions, More Than Misinformation, Explain Poor Adherence to Proven COVID-19 Control Measures.

Since the beginning of the COVID-19 pandemic, there has been a profusion of studies and webinars on the infodemic (the rapid diffusion of information on the internet). The infodemic is often cited as a key factor in the lack of adherence to COVID-19 preventive measures, including vaccination. A study we conducted in West Africa questions the reality of this impact: the majority of people who do not adhere to the preventive measures draw their opinion from their own experience, not from what they have viewed or read on social networks. Historically, resistance to public health messages and interventions, including vaccination, existed before the advent of the Internet. Studying the perceptions of the population and not only the circulation of information is necessary to fully understand the lack of adherence to the COVID-19 preventive measures and to build an effective communication strategy.

Revisiting COVID-19 Communication in Western Africa: A Health Literacy-based Approach to Health Communication.

Adherence to protective measures is a major component of COVID-19 epidemic control. COVID-19 health literacy is a major driver of this adherence, and the evaluation of health literacy levels is the basis for designing an effective communication strategy. We conducted a quantitative socio-anthropological study of the knowledge of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and perception of the prevention messages in Burkina Faso, Cabo Verde, Guinea-Bissau, Ivory Coast, and Sierra Leone. There are widespread erroneous ideas regarding the transmission of and the protection against COVID-19. The majority of people are unaware that asymptomatic individuals can transmit the virus. Knowledge of the risk factors for severe disease is not sufficient, and the majority of individuals fear contracting COVID-19 by visiting a health center. Our study also shows the achievements of communication campaigns on several aspects: almost everybody has heard of the virus and heard or read the messages on the protective measures and a large majority of people think that these measures are effective against COVID-19. Based on these results, we propose a communication strategy that will emphasize that asymptomatic individuals can transmit the virus, emphasize the risk factors, reassure individuals regarding the safety of frequenting health centers, and design specific messages targeting young populations.

Les enjeux de la communication sur la tuberculose en Côte d'Ivoire.

OBJECTIVE: The objective of this socio-anthropological study was to establish a foundation for communication recommendations with the potential to increase the demand for tuberculosis (TB) screening in Ivory Coast. The study therefore focused on perceptions of TB likely to be influenced via communication campaigns. METHOD: The study design included a qualitative approach, with semi-structured interviews of 54 persons and 28 focus groups each comprised of 8 persons, as well as a quantitative approach, with a questionnaire distributed to 400 respondents. The study was undertaken in Abidjan, Bouaké, Korhogo and San Pédro, Ivory Coast. RESULTS: Amongst the results, this study showed that the population has a robust understanding of the existence and severity of TB and a good understanding of TB symptoms. There is little confidence in traditional medicine to treat TB and there is an awareness that TB can be treated by modern medicine and medications. On the other hand, only half of the population knew that TB treatment is free-of-charge, which could be a contributing factor to patients not seeking treatment. For the vast majority of respondents, there is an association between TB and HIV or AIDS. Fears related to this association are likely to present a significant obstacle to seeking treatment in cases of presumed TB. CONCLUSION: Based on these findings, we think it is essential to reinforce communication around the availability of free treatment for TB, and to disassociate TB from HIV in communication and awareness-raising tools both for TB and for HIV.

Erroneous Communication Messages on COVID-19 in Africa.

Adherence of the population to COVID-19 prevention recommendations is crucial to control the epidemic. However, a study of communication messages around COVID-19 in 15 West African countries showed a number of unfounded messages, as well as a lack of communication on critical information to understand the prevention measures being promoted. Incidents of violence that have taken place recently suggest that general mistrust and hostility could grow, similar to the events that occurred during the previous Ebola epidemics. It is therefore urgent to review and revise the COVID-19 communication messages currently used in sub-Saharan Africa.