Addressing stigma in hard-to-reach communities in Colombia

Introduction

The Colombian League Against Cancer ( la Liga Colombiana contra el cancer – hereafter, the League) has been working in the in hard-to-reach communities, such as the Department of Arauca, to reshape the perception of the vaccine after misinformation spread causing significant vaccine hesitancy in the population. The organisation has created tailored approaches for educating the public and employs different methods for demand generation adapted to the communities. 

Background

In 2012, the HPV vaccine immunisation programme in schools was introduced, achieving coverage rates of up to 80% by June 2014. However, misinformation and rumours spread quickly about side effects of the vaccine in a small Colombian town and combined with the anti-vaccine movement, public trust was eroded, causing a sharp decline in coverage rates. To get back on track, in 2018, the League initiated a project in collaboration with the Ministry of Health of Colombia, local authorities, the American Cancer Society, and Johns Hopkins University to restore confidence in the HPV vaccine. The project focused on Arauca, one of the departments with the highest cervical cancer mortality rates (11.4 per 100,000) and the lowest HPV vaccination rates (4.7% in 2017). The Arauca department is also affected by the highest levels of political instability and violence in Colombia, worsening the impact in terms of inequities on local communities.

Actions

The League's role was to rebuild community trust by engaging in awareness campaigns and interpersonal conversations with parents, adolescents, educators, communicators, and other local stakeholders. Based on a study on knowledge, attitudes and practices,  conducted to better understand the roots of the misinformation and stigma, the League designed a tailored communication strategy and reframed communication materials about the safety and medical benefits of the vaccine tailored to the perceptions and needs of these specific communities. The League itself was also responsible for vaccinating girls in schools in this department, with vaccines funded and procured by the government. In order to boost demand for the vaccine, a ‘vaccine meter’ was established in different cities within the region to encourage vaccination by creating healthy competition. A similar approach was later implemented in other regions, offering rewards to cities with higher vaccination rates. 

Results

After initiating the programme, the vaccination rates in the area have been significantly and positively impacted. With this specific focus on schools, through targeted strategies for educating, addressing fears, and building trust among girls and their parents, vaccination rates increased from 4.5% in 2017 to nearly 84% in less than two years. The coverage rate continues to be maintained today.

Conclusion

The League realised that the success in Arauca was based on personalised and community-level efforts this specific context and population. Indeed, contextual factors are key in designing community mobilisation programmes. In different settings, in Bogotá for example, due to the high density of the population, the League opted to send personalised text messages to mothers, fathers, and girls, informing them about vaccines with support from their doctors. In order to shift public perspectives and restore the vaccination rate, they also found value in conveying the message that vaccination was a commitment shared by everyone, especially by medical professionals, and not a political matter.