PAPER: Key findings from the discussions on “Building and sustaining trust in vaccines and vaccination in Roma communities”

The analysis of the results of the discussions held on the topic in June 2022 show that there are no comprehensive solutions at this stage to increase vaccination preparedness against Covid-19 and to conduct similar campaigns in the future. The experts participating in the discussions offer many valuable ideas, the basis of which always have prerequisites that are not currently available. The typical precondition is the expectation of certain behaviour by important actors or institutions, which is not present and there is no clarity on how the expected behaviour or actions can be triggered.  

At this stage there are no guaranteed effective tools to counter propaganda, disinformation, and misinformation.

What makes health mediators good communicators in Roma communities is the same thing that makes them vulnerable to the misinformation and disinformation that is circulating in their community.

There are big differences from place to place. Some differences seem regional, others are at the level of specific communities. Some of the differences boil down to the fact that in certain places or in certain territorial units, a particular issue of public interest does not exist or does not manifest itself. For example, in certain places, fake news and propaganda on a particular topic have not penetrated because of circumstances that most often remain unexplained. In such a case, the answer is relatively simple – there is no need to act in such places. Often, however, the situation is more complex – in different places the problem manifests itself differently. In such cases something has to be done everywhere, but the measures/actions cannot be the same. They have to be tailored to local specificities. Who are the actors that can design and implement locally specific measures? Are there similar local actors everywhere? Are there actors who are not local, but who can nevertheless cover all places, taking into account local specificity? From the discussions, it appears that the answer to both questions is “no”. The examples given are always for (a small number of) specific locations, which are far from covering the whole country. 1) The examples are usually partial – in the opinion of the experts themselves who give them they cover only part of the necessary activities; 2) The examples are not always successful – among them there are obviously or demonstrably unsuccessful cases or at least cases whose success is in doubt (not conclusively confirmed/proven).

  1. Providing examples of successful practice based on own experience. Successful practices cited are of different nature and scale. Some are part of a concerted effort to increase vaccination coverage and vaccination readiness against Covid-19. Others are isolated events that occurred in the context of an activity that was not directly aimed at increasing vaccination readiness against Covid-19 or was not part of a systematic effort in that direction.
  2. Conduct local examples of successful vaccination. Examples are usually related to some local specificity or circumstance that can be assumed with high probability or is quite certain to have led to a successful outcome – high vaccination coverage.  At least some of these circumstances are pre-existing and not part of a deliberate effort that can be described and replicated elsewhere. For example, strong commitment to the vaccination cause, personal initiative, and community activism by a General Practitioner /GP/ assisted by a health mediator led in a particular place to unusually high, almost complete vaccination coverage against Covid-19. The mechanism by which General Practitioners /GPs/ with similar beliefs and activity are formed and motivated remains unknown. In this case, the given GP and her/his work with the health mediator appear to be an externality without prescription how it can be replicated elsewhere.
  3. Pointing out deficits in state policies especially related to central and local authorities and institutions.
  4. Pointing out problems caused by the behaviour, including the speech, of political leaders or famous and influential public figures.
  5. Indication of complete solutions or systems of cause-effect relationships to a similar problem. The expectation is that the vaccination problem has a similar structure and therefore it is possible that the processes that led to the solution of the other problem can be projected onto the vaccination problems.

When we don’t know for sure what the intermediate links in the causal chain are, we weld the relevant cause directly to one of the two main effects – creating additional positive information about vaccines and increasing vaccine readiness.

It is possible, when new information becomes available, to go into detail about some causal links.

The impact of medical doctors’ negative attitudes towards vaccines is very strong – it can make even those willing to vaccinate opt out.

Figure 1. Overall pattern of causal relationships from discussions of vaccines and vaccination at RPL.
Figure 2. Overall pattern of causal relationships from discussions of vaccines and vaccination in RPL. The individual groups of categories mentioned by a particular participant are separated into distinct classes, indicated by separate colors. Categories mentioned by more than one participant are separated into separate classes.

Despite the large amount of ideas presented for possible actions to increase vaccination against Covid-19, the overall model for action that emerged from the aggregate suggestions of the participants cannot solve the vaccination problem, but it does provide guidance: 1) which are the problem areas; 2) for which activities there is no appropriate initiator and therefore, although theoretically necessary, they cannot be implemented or it is currently unknown how they can be initiated; 3) for which activities recommendations have been made to specific actors, but they have shown no willingness or initiative to implement them and it is currently unknown who can prompt them to do so.

Not all mentioned categories were explained by the relevant expert in terms of how they affect vaccination. Similar categories are also included in the general model. On the one hand, they can be thought of as how they would be affected by others or how they would affect other categories present in the model mentioned by the same or other experts.

The full report is available in Bulgarian langage.

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