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Skip to 0 minutes and 12 seconds HEIDI LARSON: So the kinds of issues that might face a new Ebola vaccine, when we would hopefully get one, are general concerns about, as I said, a new vaccine, something they’re unfamiliar with. Is it safe enough? Will it work? And then there are the issues about trust in the provider. We’ve had some I think– one of the best parallels is with polio. Here’s a vaccine that was tested, proven, high efficacy for years, decades now, and we still have major issues. Some of the same headlines in the newspaper about people’s distrust of the vaccine, and the lengths they go to avoid it, are very similar to some of the headlines we’ve seen recently about fears about Ebola.

Skip to 1 minute and 3 seconds Not just Ebola itself, but the response, the distrust of the providers who are trying to administer– whether it’s a vaccine or a control effort. Especially if it’s not people from the local village. The importance of familiar, trusted providers whether it’s health providers or people, caregivers, or in the case of Ebola people coming to quarantine, help with burials. In the trust research, two key things determine what people’s decision to trust someone. One is trust in the ability of the person or the provider, and the other is the trust in their motive. Is the person’s motive in my interest, or is it going to get them extra money from their supervisor for having done one more vaccine?

Skip to 1 minute and 58 seconds What is their motive in terms of our population? Why are these people so interested in coming to us? And in the case of Ebola and the situation in West Africa, the general immunisation rates have dropped, plummeted. The anxieties about vaccines in general in an environment where there are great fears about Ebola and its transmission, transferred to other types of vaccines. The other issue with vaccine delivery that we’ve learned with polio is the importance of not making assumptions. There’s a general tendency sometimes to think that if people don’t want a vaccine they don’t have enough information. The typical public health response is, I’ll give them more information on benefit and risk, give them more reasons why.

Skip to 2 minutes and 50 seconds And sometimes it’s nothing to do with the information– there’s something else about the delivery that they’re uncomfortable with, they’re distrusting. We had a situation in Uttar Pradash in India several years ago where people were saying they don’t want it because of where– they’ve heard rumours, or they’ve heard things. And actually, when we sat down with groups of some of the women, the real issue was they did not want their child vaccinated by a man. And they didn’t want their child vaccinated by a man coming from outside their village, never mind all the way from Delhi, far away and these are even locals, not international staff coming in.

Skip to 3 minutes and 31 seconds And once that was changed, once women started administering the vaccines, the rates went up. And the anxieties of what they referred to as rumours were just something that they were saying because other people were saying, but that wasn’t their real issue. So it’s really important to understand why because it may not be on the face of things what it seems. Having said that, the other lesson we learned from that is the importance of recognising that every local situation is different. The importance of understanding, not just the cultural dynamics, but the political ones are really important. Because you may be making a gesture that you think it’s very culturally sensitive, but it makes someone a political target.

Skip to 4 minutes and 15 seconds Well, I think in West Africa it’s the same issue. Some of– getting the right trusted leaders. Understand– getting the community– and not all formal community leaders are the trusted ones. So it’s really important to understand from the local community who are the people that are trusted. That may not be formal leaders but informal leaders, trusted whether it’s religious or the local school teacher or someone from the health centre. Who do people trust? Who do they turn to in normal times, nevermind times of emergencies that could be helpful.

Skip to 4 minutes and 55 seconds And we’ve seen in some settings it’s really people coming from outside– of which there are many in the current response– that are really important to make sure that the already heightened anxieties are not aggravated but eased.

Vaccines and population responses

A vaccine having been proven effective in trials does not guarantee that it will be accepted by the community. In this video, Dr Heidi Larson draws on experience of responses to vaccines for other diseases to discuss the issues that policymakers, vaccine implementers and the scientific community must consider before introducing a future Ebola vaccine into the affected communities.

Fears in a community are likely to be fuelled by rumours and misinformation, and are often exacerbated in crisis situations. It is therefore essential that concerns are addressed in a timely, culturally and politically appropriate manner. An important first step is to identify and engage with trusted community leaders, who may be different from the official ones. It is also essential to select suitable health care workers to deliver the vaccine so that they are accepted by the community and are able to guarantee their own personal safety. It is therefore not enough to have an effective vaccine: only once the community accepts the vaccine can an intervention be successful.

For more information on trust and the acceptability of vaccines, please view the related links in the ‘SEE ALSO’ section at the bottom of the step.

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This video is from the free online course:

Ebola in Context: Understanding Transmission, Response and Control

London School of Hygiene & Tropical Medicine