Vaccine Risk Communication

A routine immunization communication plan should address both short-term crisis situations (for example, when an AEFI occurs) and long-term support that the immunization programme requires. The crisis communication plan needs to be an integral part of an overall communication plan for routine immunization.

11.1 Vaccine Risk Communication
Communication is an important and integral component of any public health programme. News media is also an important part of the ecosystem and not outside of it. Cooperation from the community is crucial to the success of such programmes. The community will actively take part in a public health programme if the benefits of the programme and the need for interventions are properly communicated to the stakeholders. An example of this is the acceptance of the cost and inconvenience of using bed nets even in hot and humid conditions by people in malaria-endemic regions, as they are aware of the risks and consequences of not using bed nets.

Vaccines are given to healthy individuals mostly infants and children to protect them against diseases that may happen in future hence the threshold for acceptance of the risk of any side effects following vaccinations is much lower. The vaccines may be repeated per the dose schedules and mostly are in the form of injections which can be painful as well as carry the risk of adverse effects (actual, perceived or coincidental). With diseases under control due to higher immunization coverage, the acceptance of vaccination by caregivers must come as a natural choice, but it does not happen many a time. The gap can be explained due to ignorance, misinformation and lack of or ineffective communication and advocacy. Effective behaviour change communication is the key to the success of public health campaigns. Communication needs to be undertaken both as a proactive strategy to inform, educate and communicate with various target groups in the community and also as a reactive strategy in case of adverse events following immunization (AEFIs). If people are well informed, it is much easier to handle AEFI situations. Media has to be taken on board as a partner and not be seen as an adversary or only a tool of information dissemination.

Effective communication around vaccine safety, including management of public reactions, requires serious investment of resources and efforts into strategic communication for immunization. Strategic communication is an evidence-based, result-oriented process, undertaken in consultation with the participant group(s).

11.1.1 Media and Public Health
Public health may not necessarily be a priority coverage option for news media in general, but adverse events in public health do often occupy prime space and time in various news like print, electronic, and social media. The social media platforms have changed the way people, in general, consume news and react to it. It is here that people in charge of communication in the public health arena need to understand the importance of the changing contours of this phenomenon and be proactive in their approach.

Before we understand the crisis in the context of immunization and the need for planning for crisis management, it is important to know about the media ecosystem in the country to understand the media bandwidth, its sociology and its role in the dissemination of information and the concomitant impact on influencing public opinion on issues of public interest.

Media in India
India has a mind-boggling media bandwidth, which is unparalleled in the world. The governments, both at the center and states have large public relations/information setups that engage with the news media constantly, for two reasons. One is to reach out to people and various constituencies through mass media on issues of public welfare including public health as it has a large reach and two, for damage control on media reporting which may not always be factual and may result in the spread of misinformation.

Print Media
From a mere 200 publications at the time of independence in 1947, today there are more than
1.46 lakh publications in India, out of which almost 17000 are newspapers, the largest number in any country. As per the RNI (Registrar of Newspapers of India), the total circulation of publications increased from 38,64,82,373 copies per publishing day in 2020-21 to 39,17,12,282 copies per publishing day in 2021-22.

News Channels
There are over a thousand television channels, out of which over 400 are news channels, which broadcasts news 24×7 in various languages including English and Hindi. While the television viewership across India is over 90%, the news channels do not command much viewership (less than two digits). In times of crisis, however, one has seen a huge surge in viewership. For instance, during the COVID-19 pandemic, the viewership overall surged from 7% to 21%.

Online Media
There has been exponential growth in online media in the last few years. Most of the newspapers and news channels can also now be accessed online. There were 833 million Internet users as of July 2022, comprising 59% of the population (Internetworldstats.com). India has the second largest number of internet users in the world after China.

Radio
Radio in India has a reach of almost 99% population. There are many FM radio stations for entertainment, the news however can be broadcast only by the All India Radio in the radio genre. the listenership of radio per se has gone tremendously down with a large surge in the ownership of mobile phones.

News media referred as the ‘Fourth Estate’ in a democracy and has the power to influence public opinion. An average person makes sense of the world around her/him based on media stimuli. News media generally functions on the basic premise that it is the ‘bad news’ that must get precedence over the ‘good news’. The argument often posited by media for this argument is its ‘watchdog’ function, which empowers it to question on behalf of the public those in power, especially on critical issues.

Sociology of News Media
The news media in India is owned and controlled by various interests, corporate, political, and individual among others. Except for the All India Radio (AIR) and Doordarshan News, all the other news channels are in the private sector. The print and online media is entirely in the private sector. Both newspapers and television channels are in most cases owned by large corporates and international funding organizations/ agencies. With the kind of access and impact of news media, it will be easier to understand why media has to be taken seriously and how to manage relations and sensitize it on immunization, both in normal and critical times.

11.2 Regular Routine Immunization Communication
Communication activities for routine immunization during regular days should follow a plan. This plan is usually prepared once a year with an approved budget, implemented throughout the year and revolves around the regular and pre-planned routine immunization activities. This is also the opportunity to prepare communication plans for crisis situations in routine immunization. This is a resource-intensive activity as the state and district have to plan and prepare for all types of potential crisis situations. It requires a good understanding of the crisis situation both at the community /grassroots level, as well as knowledge and skills for interacting with the media to ensure it does not explode at a higher level.

11.2.1 Communication Plan for Routine Immunization
An ideal routine immunization communication plan should cater to the following:
1. Generating community awareness about the importance of immunization, how it proactively protects against diseases; where and when vaccines are administered free of cost and at what ages.
2. Address the barriers to demand generation which includes hesitancy to return for subsequent doses because of the fear or discomfort following vaccinations (vaccine risk communication).
3. Engage with community and media whenever there is a crisis affecting trust in vaccines.

In addition to the awareness generation and information activities, the district communication plan should also address issues of vaccine safety and include a plan for communication during crisis situations such as AEFIs (see Figure 1). It is important that the plan should also include components of identifying hesitant groups or groups showing reluctance to get vaccinated and address their concerns in a systematic and focused manner. Addressing vaccine safety issues and preparing for crisis situations in RI should be done when there is no crisis.

An ideal programme will have a media mix comprising IPC (interpersonal communication) channels for reaching out to communities in an informal setup, mass media (newspapers, TV channels, cinema theatres viewing, social media) and outdoor media including, banners, posters, billboards to serve as a reminder media and advocacy literature for creating an overall communication ecosystem on RI. In short, the choice of media will depend on need and particular challenges, threats and potential impact on vaccine confidence.
Immunization communication plans are developed at district and state levels once a year by the State/District Mass Education and Information Officer / IEC officer or consultant and supported by the DIO. A template for RI communication planning has been shared with all states and districts (Annexure 18). The following are imperative in the making of a communication plan:

Communication Plan Template
1. Situation analysis and a review of current communication plan and strategies
2. Setting of objectives based on evidence-based research on the current methods
3. Defining target audience (primary and secondary)
4. Defining a media mix that would disseminate the programme message in the proposed catchment area (IPC through advocacy and social mobilization, mass media for general awareness, outdoor media as a reminder medium, and social media for creating buzz and reaching out to the young population)
5. Pre-testing of communication messages
6. Campaign seasonality (i.e., when to launch the communication campaign, keeping in view the immunization program, other considerations, social and political).
7. Evaluation and feedback (impact analysis of communication for course correction, future lessons)
8. Budget and division among various media keeping in view reach access and impact

11.2.2 Addressing Vaccine Safety Issues
One of the barriers to demand generation and a major cause of dropouts is the refusal to get children vaccinated due to the discomfort suffered after vaccination. Mild fever, local pain and swelling, irritability, reduced feeding, etc., are expected reactions. These are self-limiting and disappear within two-three days even if no treatment is provided. Syrup paracetamol helps in providing relief along with local cold compresses. However, parents invariably worry about the side effects and may not be willing to get their child vaccinated again. There are other misperceptions based on rumours and myths which often dissuade parents from going in for vaccination, like an unfounded belief that vaccination may cause impotency. This may not be explicitly expressed by parents for fear of offending frontline workers and vaccinators.

11.2.2.1 Interpersonal Communication
Health workers, ASHAs and AWWS are the first point of contact for information on immunization by beneficiaries and caregivers. Interpersonal communication is one of the most effective ways of conveying to beneficiaries that the risk of suffering from minor side effects of vaccines is less than the risk of hospitalization, disability, and death in the case of not vaccinating children against vaccine-preventable diseases. IPC enables front-level workers (FLWs) to share correct information about immunization, respond to queries and questions, clarify myths and misconceptions, and motivate hesitant families to accept immunization services.

Stop the blame game, support health workers
Whenever a serious AEFI occurs, the police department should be urged to protect health worker against public outrage. The FLWs (including vaccinators) have to be protected from violence by the affected community members. A designated senior person needs to assure the aggrieved family expressing concern and empathy, of the action taken by the government to go into the cause of death/serious illness.

The FLWs including vaccinators need to themselves trust and support vaccinations. It is important to consult health workers, ASHAs and AWWs to understand their concerns regarding vaccine safety and to know where they lack knowledge.

11.2.2.2 Capacity Building of FLWs
Use the non-crisis period to empower frontline workers to enable them to share accurate immunization facts, respond to questions, clarify possible doubts, encourage families and communities to adopt healthy behavioural practices, including understanding the importance of immunization, risks faced by unimmunized and partially immunized children and availing timely vaccines. Build their capacity to engage with the community and practice inter-personal communication (IPC) skills by:
◦ Building their technical knowledge on vaccines, risks of common, minor AEFIs and VPDs
◦ Using BRIDGE training (Boosting Routine Immunization Demand Generation) for frontline workers to improve general communication skills, including listening, empathizing, counselling, group communication and negotiation skills as part of interpersonal communication (IPC) skills to improve RI demand generation and expansion.
Essentials of Risk Communication
While communicating with parents/caregivers who are delaying vaccination or are wary of exposing their minor children to risk, and common side effects following vaccinations, keep the following in mind:
1. Listen to what the caregiver is saying.
2. Understand local perceptions of the disease, injections, and the vaccine.
3. Keep key messages in mind. Use the appropriate key message for the particular clarification sought.
4. Make sure to communicate the benefits of vaccination.
5. Avoid technical terms and long words or phrases.
6. Anticipate counterpoints and prepare effective responses.
7. Provide a big picture on the safety of vaccines per say.

11.2.2.3 Engaging with Media
When there is no crisis, it is the best time to build a rapport with media personnel, especially those covering the health or development sector.

 

 

• Create and update a list of reporters with contact numbers and email addresses.
• Understand the requirements of the reporters and regularly provide them with information and news related to the latest health and immunization activities.
• Push for positive news stories related to immunization and other health programmes related to immunization such as child nutrition, maternal health, etc. to create a positive environment about immunization and encourage people to vaccinate their children.
• Create a media corner on the website and post all press releases and other videos regularly. Empirical research suggests that government website becomes a good source of information for media and communities, especially during crisis situations.
• Explain to them how the programme works and give them routine immunization fact sheets related to the district, state and national level. Organise workshops and field visits to session sites and cold chain points and show the mechanisms in place for safe vaccination.
• Monitor the media for reports from time to time.
• Train spokespersons to respond to media queries regarding AEFI, building rapport, ensure evidence-based reportage and a follow-up story on the incident.
• Engaging regional/language media which is trusted by marginalised and minority communities. It is only prudent not to create a communication vacuum as it will be soon filled by misinformation, gossip-mongering.

11.2.2.4 Social Media Messaging
Use social media to spread positive messages regarding vaccines and immunization programme. Each social media platform has its own characteristics and user base. There should be a system for rigorous monitoring, tracking of rumours, myths and identification of rumour-mongers. After tracking, the focal point needs to be informed and updated with immediate alerts through the established chains of communication. Facebook pages, WhatsApp groups and official Twitter accounts of state and district health departments can be used to share positive messages/best practices. It is best if messages and GIFs and videos are created at the state level and shared with districts for dissemination. Each district should identify a focal person to maintain and circulate these messages regularly.

Some of the dos for use of social media, when there is no crisis are as follows:
1. Messages, GIFs, and videos should be carefully crafted and pre-approved before these are shared on social media.
2. Ensure messages contain facts and are not speculative in nature
3. Photographs used depict proper/ideal vaccination practices
4. The language used is simple and non-technical and conveys the message appropriately
5. If personal photographs are being shared, take written permission from the concerned person to post them for social media messages.

Make sure of the following don’ts:
1. Do not use incorrect information or facts which cannot be verified
2. Do not use messages targeting a particular community, class or race
3. Do not use language which is offensive or defamatory
4. Do not name a particular vaccine brand or vaccine manufacturer
5. Do not give names and other personal information to any person in messages without the permission of the person.

11.2.2.7 Engagement with Radio
Radio is the main source of entertainment to the marginalized sections of society. Radio as part of the equity-focused communication strategy, has been used to create awareness and engage audiences in remote parts of the country for routine immunization, Mission Indradhanush and Measles Rubella campaigns. Engaging Radio Jockeys (RJs) has been found to be particularly effective in allaying fears of parents regarding AEFI and vaccination especially during campaigns such as the MR campaigns.

11.2.2.8 Capacity-building of Media Persons
In addition to swiftly and effectively responding to the AEFI queries of media, it is vital to help media persons provide balanced and evidence-based reporting by introducing them to online training courses such as Critical Appraisal Skills (CAS)43. Courses like these impart competencies to critically appraise health and public health-related information and encourages accurate reporting of AEFI cases and responding to media queries. A tool to assess a news report for quality and balanced reporting is available at Annexure 19 (Media Rating Tool developed as part of CAS).

11.2.3 Preparing Communication Plans for Crisis Situations
A crisis in immunization is an emergency situation which is a result of an unexpected series of events that pose a risk to the integrity or reputation of the routine immunization program, immunization services or vaccines. Such situations are usually brought on by negative attention from the media or community members and can include adverse events, legal disputes, accidents, or man-made disasters attributed (rightly or wrongly) to the program and government efforts*. Often, crisis can be avoided through foresight, care, and training. If managed properly, the crisis will strengthen the program and boost public confidence. When a crisis occurs, it is crucial that the government respond quickly and responsibly to minimize harmful fallout.

The best time to prepare for a crisis is when there is no crisis. Developing a crisis communication plan involves a lot of preliminary preparatory steps. Once the crisis communication plan is prepared, it must be shared with all stakeholders. Constant monitoring is important to identify a crisis early and act according to the possible impact on vaccine trust.

11.2.3.1 Developing a Routine Immunization Crisis Communication Plan
A crisis communication plan helps to respond to different types of crises in order to pre-empt a drop in public confidence in vaccination, and also possible disruptions to immunization programs.
43. https://agora.unicef.org/course/info.php?id=22296

The crisis communication plan is prepared and managed by a communication crisis management group led by the DIO and the DMEIO/consultant responsible for developing the district immunization communication. Other officials such as the District Public Relations Officer, members of the district AEFI committee, etc., may be included in this group.

The crisis management team at all such levels will be responsible for:
1. developing a crisis communication plan by listing potential crisis situations, grading them as per possible impact on vaccine trust, defining activities for each impact level, and responsibilities and tools to implement the communication plan.
2. identifying a situation which can trigger a crisis and taking appropriate action as per plan to manage it
3. assess the impact of the activities and review the plan.

11.2.3.2 Key Messages
As discussed earlier, district-specific key messages and supportive messages need to be developed for events triggered by AEFIs. Some examples have been given in section 11.4. The key messages and supporting messages developed in English may be translated into the regional language. It is important to share these with key stakeholders who may be contacted by the public or the media.

11.2.3.3 Monitoring Mechanism
The plan should include details of a monitoring mechanism to alert when a potential crisis occurs. This may be a system for tracking news reports related to vaccines/vaccination programme appearing in newspapers, TV channels and also on social media every day. Any alert needs to be conveyed to the person designated to decide further action as per the crisis communication management plan. This person should, as indicated in the plan, coordinate to implement communication, social mobilization and media relations activities.

At the end of the crisis, review the impact of the activities in the plan. Assess critically the successes and failures to improve the crisis communication plan.

11.3 Crisis Communication Plan44
11.3.1 Contingencies: Plan for the worst-case scenario for each type of crisis and develop a response for it.
11.3.1.1 Types of Crises:
The crisis plan anticipates contingencies and crisis situations and lists activities related to communications to address/mitigate each situation. At the state and national levels, the crisis could be a controversy regarding the introduction of a new vaccine or changes to the immunization programme/vaccination schedule. The crisis can also be a critical public, media or scientific debate on vaccination. There may also be rumours or a misconception regarding vaccines/vaccination programme which has become viral on social media. Usually, the most common crisis a district is likely to face is an adverse event following immunization during routine immunization or an immunization campaign.

11.3.1.2 Prescribing Actions for Each Event Based on Impact Level
Having listed all kinds of possible crisis in the plan, the impact of each crisis/event on vaccine confidence should be assessed and calibrated actions should be listed. Some situations require informing the public early on using appropriate key messages. This may prevent the situation from escalating. Over-communicating about some minor events or events not really related to vaccination can cause unnecessary public concern and needlessly damage public confidence. An example is given below:

11.3.2 First Step Actions
Define communication actions that can be taken within a few hours of the event. Preparations may include developing:
• holding statements and key messages
• list of frequently asked questions with answers and key facts (e.g. on vaccine safety and vaccine-preventable diseases)
• preparing and keeping updated (every month) district AEFI response template (Annexure 20) and district or state RI factsheets
• identifying a primary spokesperson authorised to interact with media and secondary spokespersons (third-party experts who would be effective information sources for the media)
• media contact lists
• list of the key stakeholders you need to keep informed
• list of immediate information channels to all stakeholders (e.g. web, social media, e-mails, press release)
• vaccine reaction background notes.

In addition to the above, it is important to get as many details about the incident and keep updating the details as and when it is received. Once the vaccine details and details of the event are known, find out the expected reaction types using the vaccine reaction background note list.

11.3.2.1 Holding Statements
Prepare statements that can be used for initial media encounters in most types of vaccine crisis. Some examples are as follows:
1. Our deepest sympathy goes to the families of the child/ children. The following actions are being taken as of now: the child has been admitted to hospital, a team has already started investigations, other vaccine recipients are under close observation.
2. We have started the investigation of this unfortunate incident and doing our utmost to know the reasons behind it as soon as possible.

11.3.2.2 Decision-Making and Information Release Authority
Ensure that as soon as the plan is ready, it is approved by the competent authority at the district both for the SOPs, tools and financial aspects. The plan should have clearly defined information approval mechanisms during a crisis (who releases what, when, how) and procedures for information verification and expedited clearance. This is important as it speeds up the process of verification and approval of information regarding the event after collecting and compiling the information for quick release to stakeholders and media if required.

11.3.2.3 Roles and Responsibilities
Define clear roles and responsibilities during a crisis. Include guidance on coordination and collaboration between stakeholders representing different divisions and with specific areas of expertise (e.g., pediatricians, epidemiologists and communicators). Include a designated spokesperson who develops a clear plan on how activities will be coordinated, and who liaises with key internal and external stakeholders.

11.3.2.4 Information Sharing
Define how information will be shared with key stakeholders, media, and the public. Consider different routes to reach different audiences (e.g., face-to-face, announcements, web). Define mechanisms to ensure media inquiries are addressed as appropriate. Consider the media’s needs i.e., deadlines, and ease of obtaining information. Ensure all media outlets have access to updated information and methods to get answers (e.g., post-press conference transcripts online).

11.3.2.5 Monitoring Public Opinion
Include guidance on monitoring public response (e.g., via social media and/or a hotline) to ensure an immediate response if warranted to any development, event or misperception.

11.3.2.6 Contacts
Prepare and continuously update lists with media contact information, including members of crisis response team’s after-hours contact numbers, and other relevant stakeholders.

11.4 Preparing Key Messages
1. Messages should be well-prepared, accurate and empathetic.
2. Key messages should be shared with all stakeholders (including spokespersons) so that everyone sends out the same message!
3. Messages should ideally be tested on the target audience to determine comprehension and potential barriers to recommendations.
4. Use a message map to help prioritize and structure messages and identify gaps in knowledge. Message maps help to:
(a) agree on messages
(b) be precise with complicated topics
(c) be consistent and repeat key messages
(d) manage difficult questions and challenges
(e) be more confident and convincing.

Use the format at Annexure 21 to start defining three key messages and substantiate each key message with three supporting messages. An example of three Key messages and Supporting messages is given below.

Other examples of key messages are as follows:
1. Adverse events following vaccination are very rare.
2. Most adverse events are coincidental and have no relation to the vaccination.
3. The occurrence of adverse events does not mean that vaccines are unsafe.
4. Minor adverse events such as fever, pain and swelling are common and expected and will disappear within two-three days.
5. If a child becomes severely sick following vaccination, the ASHA/AWW/ANM should be informed for advice and the child should be taken to the nearest hospital for treatment.

Once these key messages and supporting messages are created, these can be shared with medical officers, block extension educators, other health functionaries and also professional associations, to use it to advocate with “custodians” (keepers of good and positive relationships with the community) who are in regular touch with the community to make rigorous efforts in encouraging vaccinations, to prevent the community from losing confidence in vaccinations and reduce occasional negative public opinion related to immunization.

These messages can be used for advocacy with other local community leaders and panchayat functionaries, religious leaders and key influencers, workshops, mothers’ meetings, community meetings, etc.; used while interacting with the media; considered while developing information material for mid-media activities – posters, banners, hoardings, leaflets, wall paintings, miking, etc.; and also for preparing messages, posts and tweets for social media (design local and context-specific messages, GIFs, video bytes, etc.

It takes a lot of effort, patience, and resources to maintain the trust and goodwill of the community and media in the vaccination programme must be sustained. If the community and the media have trust in the health department to be a source of factual and credible information during the ‘good’ times, they will be more receptive to information and explanations during ‘crises’.

11.5 Communication Activities During a Crisis
11.5.1 Interpersonal Communication
An immediate response in case of a crisis is to engage with the affected families/community and establish a rapport with them as early as possible. A health worker or medical officer with good communication skills should be nominated as a focal person to empathize with the care-givers and the community. Local influencers and leaders should be identified, and support sought from them to reach out to the affected family/families. Timely dissemination of a consistent set of easy-to-understand key messages to concerned families and communities will help to ease their anxiety. The district should immediately ensure proper medical treatment is arranged for those requiring hospitalization. Arrangements should be made for transportation and referral to hospitals and free treatment.

11.5.2 Engaging the Media During a Crisis
Follow the AEFI media management protocol when the media takes interest in an AEFI. The AEFI response protocol is a set of actions which are recommended to be implemented in a timebound manner to keep the media informed of the AEFI, gives facts regarding the case, the response of the health department, status of the affected person and what steps are being taken to prevent the recurrence of the event. The objective is to reach out and respond appropriately to the media, killing speculations or at least make sure that the scientific and program point of view is conveyed, creating confidence in the program.

The protocol also creates a ‘standard procedure for communicators’ to make the process faster. It lists SOPs or activities required to resolve the AEFI crisis and enables the government spokespersons. Other tools that can be used are the ‘AEFI response templates’, state RI factsheets and ready reckoners to help them with ‘uniform messaging’ while communicating with the media. It also sets up a ‘timeframe for response’ that will ensure that the media gets access to correct information in time, mitigating the crisis. The protocol also lists the role of partners and how best they can help while keeping the messages uniform.

All state immunization spokespersons are to be notified immediately about any media report and query from all administrative levels using the latest means of communication e.g., by email or phone. A summary of the SOPs is given below:

There are different ways of reaching out to the media to help communicate with the public. A few of them are listed below:
• Press Statement
• Press Release
• Press Conference
• Press Interview
• Clip of the spokesperson uploaded on the website

11.5.3 Social Media and Crisis Communication
When there is a crisis situation, it is always better not to give out information regarding the specific event in the social media. It is very likely that any information shared in one WhatsApp group can be easily forwarded to other groups unknowingly by any member of the group.

If information is received on Twitter or Facebook regarding an adverse event, convey that the information has been noted and conveyed to the concerned person for further action which includes providing medical help and investigation of the case to know the cause and preventive actions, if any. Do not engage with anyone posting negative posts/comments about vaccine safety on social media as it gives traction and contributes to making the message viral.
Continue to send out positive messages about vaccine safety. Special positive messages contextualizing the event can be created, carefully vetted before approval and dissemination.

11.5.4 Managing an Adverse Event Crisis
If effective communication is exercised at all levels, it can avert the possibility of a crisis. If at all a crisis occurs, it can be managed by following the steps given below in table 11.5. Remember that some of these activities need to be done beforehand in anticipation of a crisis.

Summary
• Crisis communication related to adverse events following immunization should be part of regular routine immunization communication plans.
• Frontline workers and medical officers in PHCs should be trained on inter-personal communication skills as this is the most effective medium to communicate during crisis.
• Engaging with print and TV media should be a continuous and a part of the planned activity.
• Social media messaging has its own rules. It is important to have a person familiar with social media to handle it.
• Other available communication media may be explored as per the purpose of engagement, the key messages to be communicated, the target audience and reach of the media.
• Developing Key messages and Supporting messages is an important activity for regular and crisis communication.
• Developing crisis communication plans is a group activity involving all stakeholders with tailor made responses actions for specific situations and based on the level of impact on trust on vaccines and the programme.
• A media response protocol should be in place for responding to media during crisis. All respondents and stakeholders should have a copy of the plan and should know their exact roles and responsibilities.
• The crisis communication plan should be developed proactively when there is no crisis.