94% of girls in Uzbekistan aged 12–14 are now covered with a first dose of human papillomavirus (HPV) vaccine, according to the country’s Ministry of Health. The HPV vaccine was first introduced into the national immunization plan in 2019, with the help of WHO and UNICEF, in order to protect girls in the country against developing cervical cancer.
With the help of WHO and UNICEF, the country developed a communication plan, which was one of the keys to the successful vaccine rollout. Formative research was carried out in advance, but it was through ongoing monitoring of the local situation that problems were spotted and measures were taken to keep the rollout on track.
“The National Immunization Programme (NIP) was able to conduct ongoing monitoring of vaccine uptake to immediately identify where there was a critical problem and then use all avenues to address it,” says Sahil Warsi, a Consultant with Vaccine-preventable Diseases and Immunization (VPI) at WHO/Europe, who provided support to national counterparts to develop and implement the communication plan.
When numbers started dropping in one school in the capital, Tashkent, a parent-teacher meeting was organized under the NIP. Health care workers were invited to address questions relating to misinformation circulating about the vaccine on social media. These interventions were possible due to monitoring, good planning, and having a crisis communication plan.
Face-to-face meetings with parents were very effective, according to the WHO Uzbekistan team. Every concern that parents had was answered by experts with data, examples, and studies. After hearing this information, parents wanted not only their own child to be vaccinated but as many children as possible.
Communicating in a crisis
Instances such as this draw attention to the need for communication planning, and especially crisis communication. At the time of the HPV rollout in Uzbekistan, internet coverage was limited to urban areas, but social media still had an impact. “The response to the social media event was a learning experience,” Sahil explains. “The key is having health care workers and influential people ready and equipped with the correct information to respond when misinformation spreads, and them knowing how and where to signpost it.”
WHO provided support in organizing training sessions for television, radio, and print journalists before the start of the vaccine rollout. The aim of the training was to provide media channels with all the relevant information journalists needed on the HPV vaccine, and to supply them with a list of people they could interview and from whom they could gather more information.
However, while research has found that it is important to equip a country’s media and to respond to events on social media, global research also shows that, in the end, people tend to say ‘I don’t trust the media, I trust my doctor’. Therefore, the focus should be on engaging and informing those figures of authority who people trust and turn to for reliable information. In Uzbekistan, these included ministers, heads of municipalities, health care workers, teachers and religious leaders.
Educating key target groups
Bringing all the stakeholders together to speak with one voice was one of the key factors for the success of the HPV vaccine programme in Uzbekistan. Teachers were targeted for training as they are well-respected members of the community, with about half a million teachers providing education to more than 6 million students, 50% of whom are girls. One teacher in Tashkent noted “we write quizzes and talk with students about vaccination. We also try to explain to parents in a straightforward way that vaccination is meant to save their child from catching a disease, to prevent it.”
This is one of the key positive messages promoted during the HPV vaccination campaign in Uzbekistan, where the focus of messaging was not on sexual and reproductive health, but on promoting healthy lives and protecting the possibility of future motherhood for girls. Efforts were undertaken to educate parents and grandparents and to address any concerns they had around vaccine safety, in order to encourage widespread HPV vaccine uptake.
Uzbekistan is collaborating with WHO to introduce HPV screening at the national level alongside HPV vaccination. As one of the partner countries of the WHO global call for action to eliminate cervical cancer, the country hopes to become a regional benchmark for accelerating the elimination of cervical cancer by implementing essential components of the regional roadmap.