Title: Anthropological exploration of facilitators and barriers to vaccine deployment and administration during disease outbreaks
Funder: Department of Health and Social Care

Abstract: Recent outbreaks have made clear that inadequate consideration of social, cultural, political, and religious factors in humanitarian responses has consequences for the effectiveness and community acceptability of response activities. A growing number of studies have focused on the historical, social, cultural and political determinants of vaccine acceptance, and have highlighted the specificities of these dynamics during emergencies. Whilst these theories are useful to help understand potential issues for vaccine deployment and administration during an outbreak, there are gaps in the evidence, particularly relating to acquiring evidence in real-time. Given the wider range of disease and contexts, there is a need to understand different of perspectives about vaccines and outbreaks, including the political and economic factors that determine whether vaccines can be deployed effectively in an emergency situation, health system perspectives, which are closely tied to cultural, policy, and historical developments in how provision is organised as well as local systems of to identify community perceptions surrounding vaccine use. Finally, given that many diseases are zoonotic, understandings of community experiences of vaccination in both human and animal health are needed. This study sets out to address these gaps through qualitative, comparative research across four different countries to explore the facilitators and barriers to vaccine deployment during outbreaks. Rather than focusing on one disease/vaccine or one context, this study will explore an &ldquo;ecosystem&rdquo; of vaccine deployment drawing on different perspectives in low-income contexts and for the poorest in middle-income contexts. Using a multiple-case study approach and a mix of qualitative and ethnographic methods including key stakeholder interviews, document analysis and participant observation, the project will ensure insights into the complex web of factors that determine countries ability to deploy vaccines during an outbreak. Each case study aims to shed light on different factors that determine preparedness for emergency vaccine deployment. The first case study will focus on Sierra Leone and will explore the political and economic factors that shape the feasibility of deploying vaccines in an emergency scenario drawing on lessons learned from Ebola. The second case study will investigate healthcare systems responses to vaccine controversies using past public vaccine controversies in India as a basis for enquiry. The third case study will look at the construction of local knowledge around vaccines through an exploration of the use of human and veterinary pharmaceuticals in rural Uganda. The final case study will study the impact of the Zika outbreak on public trust and vaccine hesitancy in Brazil, in order to assess how an outbreak context shapes vaccine confidence. A final potential case study will be provided through collaboration with the Public Health Rapid Support Team, who, if deployed during the time of the project, will investigate vaccine confidence and hesitancy in the realistic scenario of an ongoing epidemic. Outputs will include academic papers for each case study and an overarching paper drawing lessons learned together and well as toolkits for use in emergencies. Advisory groups will be involved in the case study design and dissemination.

Lay abstract: This proposed research aims to explore what actions can be taken to optimise vaccine acceptance during a disease outbreak. Whilst some countries already face logistical challenges to vaccine deployment and administration, these system weaknesses are exacerbated during times of disease outbreaks. In addition to access challenges, some populations have underlying distrust in national and international bodies that provide vaccines, which also can amplify in times of emergencies, as seen in the recent Ebola and Zika outbreaks. Rumours and misinformation are also commonly spread in times of outbreaks, especially when the diseases are unfamiliar, or there is an absence of information available. This research will synthesise existing data and collect new data on stakeholder and community views on the deployment and administration of vaccines during an outbreak. To ensure a broader understanding across a range of contexts and diseases, the research will explore public, political, economic, and health system perceptions and dynamics in four contexts&mdash; including both low and middle income settings. In the event of an outbreak, a readily deployable team, the UK Public Health Rapid Support Team, will utilise rapid approaches developed from these case studies to explore community and stakeholder perspectives. The research will be disseminated widely and will involve communities in each country in the design, implementation and dissemination of the research.

Research activity codes: 3.4 VACCINES
Health categories: INFECTION