An adverse vaccine safety event and the related crisis communication preparedness and response can have important consequences for the perceived safety of vaccines, including an adverse effect on vaccine confidence. Examples of such events include information about a serious AEFI, the release of new findings or other data related to vaccine safety, a report in the media, a local rumour about vaccine safety or a change in the vaccination programme, such as recall of a vaccine or introduction of a new vaccine. Situations in which vaccine fears have reduced coverage and information on how programmes recovered from such experiences and how they could have acted to mitigate the negative consequences provide valuable lessons. Such “stories” can be considered central to cognition and communication.

The subgroup on vaccine safety communication was asked to examine several cases in which communication at several levels might have fuelled or mitigated a crisis in confidence. The communication responses in 7 countries in different regions were assessed to better understand what went wrong and what went right. To identify patterns and lessons learnt from the various situations, a WHO supporting document²⁴ was used as a framework. Thus, the cases were assessed for: coordination and engagement, understanding the problem, informing the public and continued monitoring of public opinion.

In all the cases reviewed, crisis appeared to have been averted or fuelled according to whether the actions were taken. Consistent themes suggested that the set of actions result in effective communications in all countries and in diverse contexts. The insufficient action taken in some cases is of concern, as it negatively affected programmes. A crisis communications plan and personnel with the knowledge and expertise to execute it may help avert a crisis. The personnel may include a person or a group in charge of coordinating or leading the communications plan. The plan should also be aligned with a routine communications strategy that includes an “inner circle” of key personnel who are involved in all communications. Communities were identified as important stakeholders. Continuous monitoring of public opinion can guide adjustments to communications strategies to ensure that they are responsive to local needs and perspectives and contribute to maintaining and restoring vaccine confidence. A document synthesizing the case studies and key messages was made available to the Committee for review, which expressed interest in extending the repository of case studies on vaccine safety communications.

Examples of successful approaches, best practices and interventions were inclusion of a communications subgroup in the AEFI review committee and prompt management of a major crisis fuelled by misinformation during an HPV vaccination session in a school and a polio vaccination campaign in a hard-to-reach community, with stakeholders including schoolteachers and religious leaders. A systems approach to error management rather than treating it as an individual failure was recommended. Protection of health workers was emphasized as well as training in disclosure of errors. The importance of transparency in highly sensitive, politicized situations was stressed. The case studies were considered to lack detail on community feedback and concerns. The Committee invited the subgroup to include the level of preparedness in each case study. It emphasized that investment is needed to assist countries in enhancing their safety communication. Reference was made to the important contribution to safety communications of the new manual on “immunization stress-related responses” (ISRR).²⁵ A series of measures to prevent and mitigate the negative impact of ISRR are proposed for programme managers and health professionals.

The subgroup was advised to continue monitoring cases as they arise, to focus its work on misinformation and “fake news” and to propose proactive communication and listening strategies. The next steps will include a work plan on communications for vaccine safety crisis management and a framework for evaluating the enhanced communications section of Blueprint 2.0. For this purpose, indicators of vaccine safety communication will have to be defined and aligned with the indicators of vaccine pharmacovigilance regulatory communications. Cumulative case studies and facilitated access to a repository of data will provide the best evidence on vaccine safety science. GACVS highlighted the need to respond to programmatic needs continuously, although work on vaccine safety communications remains distinct from communication on vaccine demand and promotion.

²⁴Four immediate steps when responding to an event that may erode trust. Copenhagen: WHO Regional Office for Europe; 2017 (http://www.euro.who.int/__data/assets/pdf_file/0018/333135/VSS-4-steps-trust.PDF?ua=1, accessed December 2019).

²⁵Immunization stress-related responses. Geneva: World Health Organization; 2019 (https://www.who.int/vaccine_safety/committee/topics/global_AEFI_monitoring/ISRR_Dec_2018/en/, accessed January 2020).

Full report of GACVS meeting of 4-5 December 2019, published in the WHO Weekly Epidemiological Record on 24 January 2020