| Research activities |
Greater involvement of African countries in basic research surrounding the science of infectious diseases and participation in clinical trials is important going forward to help inform the public, building on key activities initially surrounding COVID-19, including genomic sequencing and the local manufacture of ventilators to address shortages [15,174]. This also builds on current research activities among African countries to develop and test vaccines [204]. Improving pharmacovigilance (PV) activities is also crucial for the future to rapidly capture and convey accurate information regarding the effectiveness and safety of current and future vaccines in the real world to address misinformation, especially misinformation promulgated via various social media platforms [120]. This builds on initiatives, including a Pan-African clinical trial registry [205], as well as strengthening current PV activities [206]. Assessing the potential for using performance-based financing and incentives for HCWs, including HCPs, to improve vaccination coverage where there are concerns. Qualitative, context-specific social and behavioural research to complement quantitative surveys to enhance the understanding of perceptions and reasons for vaccine hesitancy in order to help develop future pertinent interventions that build trust and confidence in vaccines and vaccination. Development of context-specific vaccine hesitancy measurement tools to measure the impact of interventions, including those designed for various social media platforms, on vaccine confidence and acceptance and their overall cost-effectiveness, to provide future guidance.
|
|
Education
|
|
| Healthcare professionals (HCPs) |
Improving HCPs’ education regarding the science behind vaccines and the importance of the vaccinations for themselves and the general population. This includes addressing key concerns regarding COVID-19 vaccines during university education, as well as continuous professional development post-qualification given current concerns among a number of HCPs. Through educational programmes, community pharmacists, and other HCPs, people can be empowered with additional knowledge and skills to play a key role in addressing misinformation and reducing hesitancy [207,208,209,210]. Such programmes can be part of e-learning approaches, with hybrid learning approaches growing post the current pandemic [10]. Expand on the training of trainers (TOT) approach for capacity development to help address concerns among HCPs, given their increasing role with addressing misinformation and hesitancy and restoring trust [120,175,211,212].
|
| Medical journalists and other key influencers |
Governments need to work closely with medical journalists and other key influencers to promote key issues regarding the effectiveness and safety of vaccines to help counter misinformation. This is especially the case for misinformation spread via social media platforms, given their increasing influence and role in promulgating misinformation regarding COVID-19 [120].
|
| General Public |
Ensure programmes are in place, including those via pertinent social media platforms, to convey the benefits of vaccines. As a result, enhance uptake as well as address possible areas of misinformation co-ordinated by key national government and regional groups, as well as involve groups such as religious leaders and elders [120,213]. This should also include educational programmes in schools. Social media platforms are considered a key focus area given the rapidity with which misinformation can spread with its subsequent impact on accelerating the inappropriate use of medicines alongside increasing vaccine hesitancy [20,40,120,214,215]. This can also include government educational posters in major sites across countries conveying the benefits of vaccines during the current and future pandemics. Such posters/campaigns need to be in native languages and sensitive to local cultures. Governments need to introduce or enhance online data management systems with key information regarding the effectiveness and safety of vaccines, as well as their availability and uptake, to incentivise people to come forward and be vaccinated. This includes robust systems to capture possible side-effects.
|
| Communication strategies |
Context-specific and comprehensive communication strategies for vaccines, aimed at disseminating accurate and transparent information and in a timely manner, are essential going forward. In addition, so is ensuring communication through appropriate social media channels [120,215]. Content of any communication and messaging should be evidence-based, given the level of misinformation seen to date surrounding COVID-19, its prevention with vaccines, and treatment [16,20,28,120]. Collaboration between government, regulatory authorities, civil society, and academia to coordinate the content of communication and speak as one co-ordinated voice. Similar engagement with pharmaceutical companies where there are concerns with the level of misinformation regarding current vaccines and the potential negative impact. Continuous and structured social and community listening to inform communication strategies and interventions to enhance vaccine confidence.
|
|
Engineering
|
|
| Access and availability [216] |
Improving access to vaccination, including rural areas, is crucial to future success. This will involve multiple groups delivering the vaccines, including community pharmacists, as well as the use of mobile vaccination clinics [217]. Improving storage facilities for vaccines especially in rural areas, which includes upgrading the available cold chains and the installation and maintenance of solar systems that support cold chains and water supplies. Such activities would help with readily available vaccines during pandemics and minimise the burden on government planning and financing.
|
|
Economics
|
|
| Patient Incentives |
Consider offering incentives to the public to enhance vaccination rates. Alongside this, reduce any travelling time to obtain vaccines by ensuring the availability of vaccination sites locally, which can include mobile clinics [217,218].
|
| Local production |
Increasing knowledge transfer to enhance the local production of vaccines to help address concerns with possible shortages and to reduce costs and misinformation with current and future pandemics, building on current initiatives [219,220,221,222]. However, there needs to be a market for locally produced vaccines; otherwise, plants may close [223]. In the meantime, African governments should continue with global groups such as the World Bank and GAVI to help secure adequate local supplies of vaccines.
|
| Financial support |
Financial support to enable demand creation strategies, social mobilisation, and comprehesive communication strategies incorporating motivational messaging, including pertinent social medial platforms, given their increasing influence [120,224].
|
|
Enforcement
|
|
| Compulsory vaccination [225,226] |
Compulsory vaccination programmes were instigated in some countries for key workers, such as those dealing with the elderly, and in at least four countries worldwide for all citizens (Federated States of Micronesia, Indonesia, Tajikistan, and Turkmenistan). However, before instigating compulsory vaccination, there are key legal, ethical, and other issues that need to be considered, including necessity and proportionality, as well as public trust in the effectiveness and safety of the vaccine.
|
| Health system |
|
