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Focusing on Marginalized Communities

Get to Know Five of Our 2021 Social and Behavioral Research Grant Partners

By: Abigail Quinn, BA, Deeva Agravat, MSc, Kate Hopkins, PhD, MPH

The Sabin Vaccine Institute’s Vaccine Acceptance & Demand initiative is proud to provide funding to 10 grant partners awarded through the 2021 Social and Behavioral Research Grants Program. This blog is the second in a series examining the selected research projects based on one of three themes: vaccine equity, marginalized communities and social media/messaging.

In 2020, the World Health Organization (WHO) announced its Immunization Agenda 2030 (IA2030) with the goal of sustaining global progress in immunization, recovering from disruptions caused by the COVID-19 pandemic and improving upon vaccination rates to eliminate vaccine-preventable diseases and related morbidity and mortality. One of IA2030’s strategic priorities is to increase coverage of vaccines amongst zero-dose children and the most disadvantaged populations.

Marginalization is both a process and a condition that excludes either an individual or communities from participation in mainstream social, economic, education and/or cultural life. There is a vast literature base reporting that marginalized groups experience extreme health inequities, having been systemically excluded in policy-making forums, which then lead to gaps in service provision. To achieve IA2030, it is important to understand how receptive vulnerable groups are to implemented strategies supporting immunization acceptance, demand and uptake. Examples of exceptionally marginalized groups are as follows:

Sabin is proud to support the following five 2021 Social and Behavioral Research Grant partners focused on understanding the barriers to vaccine acceptance and uptake amongst a diverse range of marginalized populations ranging in location from Central America to South Asia. Knowledge gained from these projects will have a variety of uses, including informing government health communication campaigns and breaking down systemic grievances.

Meet Our Project Teams Focused on Marginalized Populations

Structural Inequities in COVID-19 Vaccine Access and Uptake Among Transgender and Disability Communities in India: A Qualitative Study through Intersectionality Lens

This project will be led by Dr. Anant Bhan, a researcher in bioethics and policy at SANGATH, and Dr. Sunita Bandewar, director of the Health Ethics and Law Institute. The project intends to explore how COVID-19 vaccine access and uptake is shaped by historic and entrenched structural inequities that affect transgender and disability communities in India. The study will integrate community-based participation through a qualitative study in two communities, acquiring insight from both community members and local vaccination specialists.

The inclusion of the socio-ecological model will further investigate the complexities of local, interpersonal, community and policy-level dynamics influencing this community’s access to vaccine information, vaccine decision-making, experiences with vaccination and post-vaccination and relationships and experience with vaccine providers. Twenty to 30 in-depth interviews will be conducted with community representatives, as well as 10 to 20 key informant interviews from other stakeholders, including health system policy makers and immunization specialists.

“This project builds on the felt need expressed from both the communities on healthcare access and vaccine equity during the pandemic,” shared Dr. Bhan. “This work will help us better understand systemic challenges in access and uptake which could help make vaccination services more equitable.”

COVID-19 Vaccination and People Living with HIV in Thailand: Information Needs, Decision-Making, Vaccine Seeking Patterns, Determinants of Uptake, Challenges and Solutions

Led by Tarandeep Anand, CEO of the Adam’s Love Global Foundation for Men who have Sex with Men (MSM) and Transgender Health (ALGO), and Chattiya Nitpolprasert, social and behavioral researcher and PhD candidate at the Amsterdam University Medical Center, this project will assess decision-making behaviors among people living with HIV, encompass physiosocial aspects of their COVID-19 acceptance and explore solutions to vaccine service access and delivery. Findings from in-depth interviews and focus group discussions among 30 MSM living with HIV, 50 community workers affiliated with HIV care clinics, and healthcare providers at major vaccination centers in red zone provinces will inform a quantitative online questionnaire among 300 to500 MSM living with HIV across Thailand.

“Our study aims to address the unique challenges inherent in COVID-19 vaccine access for populations in the most fragile contexts,” said Nitpolprasert. “Our efforts will result in a better understanding of the enablers and barriers to COVID-19 vaccination, provide critical insight into vaccine needs of Thais living with HIV and help refine and tailor interventions for better health outcomes.”

Building a Pathway for an Informed Vaccination Campaign in Santiago Atitlan & Panajachel, Guatemala

This robust project, led by Dr. Monica Berger, Daniela Da Costa and Daniela Ochaita of the Universidad del Valle de Guatemala, has four objectives and uses a community-centric approach to calculate the prevalence of COVID-19 vaccination hesitancy, identify existing mental models around vaccines and deepen the understanding on shaping beliefs among two indigenous communities in Lake Atitlán.

The team will transfer investigative data collection and analysis skills to local community personnel and conduct a co-created, cross-sectional, face-to-face survey and four focus group discussions of varying population profiles to assess the determinants of vaccine hesitancy amongst a representative sample in both regions. Preliminary data will be presented to both teams of community researchers for validation and feedback during a data analysis workshop to identify key content for vaccine-related messaging and select main media channels for information dissemination. Main findings will be delimited together in the framework of vaccine determinants in a process of collective intelligence and presented to both health and local authorities.

“The pandemic changed our lives. Using research tools, we can support communities to gradually overcome the crisis. Culturally pertinent health interventions, that involved all relevant stakeholder have a greater impact, than top-down interventions,” said Dr. Berger.

Understanding the Social and Behavioral Dimensions of COVID-19 Vaccine Acceptance Among Health Workers in Sierra Leone: Implications for Community Vaccine Uptake

Dr. Zephon Lister, Dr. Susanne B. Montgomery and Dr. Jacinda C. Abdul-Mabakabbir, all professors at Loma Linda University, are leading a project to improve upon the understanding of perceptions and acceptance of the COVID-19 vaccine amongst healthcare workers in Sierra Leone. A concurrent nested mixed-method study will be carried out within the facilities connected to the Christian Health Association of Sierra Leone and with the Waterloo District Health Medical Team, which is coordinating the vaccination efforts within the region. Two cadres of healthcare workers (high-level: doctors, nurses, pharmacists, etc.; and community-level: female community health volunteers) directly or indirectly involved in COVID-19 patient care will be recruited for telephonic interviews and structured questionnaires.

Given Sierra Leone had pockets of communities ravaged by a recent Ebola epidemic, the team hopes to utilize the Trauma Recovery and Empowerment Model in their findings to identify a strategy to support vaccine acceptance amongst these health workers and formulate a provider training curriculum. A second training will be developed to focus on equipping providers with the education and shared decision-making skills needed to interact with patients, community members and family who are potential vaccine recipients.

“The funding opportunity provided through the Sabin Vaccine Institute will support efforts to better understand the social and behavioral dimensions of COVID-19 vaccine acceptance among healthcare workers in Sierra Leone, which is a vital component in increasing vaccine uptake in the general public. Additionally, this project will continue to build and expand on the important work of previous Sabin grant recipients within the Sierra Leone region,” said Dr. Lister.

Assessing Social, Demographic, and Clinical Drivers of COVID-19 Vaccination Behavior in post-Ebola Liberia

This project will be led by Dr. Laura Skrip, associate professor in the School of Public Health, and Dr. Wahdae-Mai Harmon-Gray, director of the Research Lab on Social-Behavioral Risk Factors of Disease, both of the University of Liberia College of Health Sciences (ULCHS). This mixed-methods study will investigate the sociodemographic and health characteristics of individuals who opted for COVID-19 vaccination in Liberia and assess how likely this population is to seek the second dose, as well as explore if personal experiences during the Ebola epidemic impacted their decisions.

Cluster sampling at the county-level, proportional to population size, will be undertaken to recruit adults for a structured telephonic questionnaire. A randomly selected subset of 30 survey participants will be asked whether they are willing to also participate in interviews to provide more detail about what drove their motivation to be vaccinated, what their vaccination experience was like (during and after) and what they would like to see in future campaigns to facilitate higher vaccine acceptance and vaccination coverage. A 14-day rolling incidence of acute respiratory infection (ARI) symptoms from date of vaccination will be calculated to assess whether risk of ARI symptoms changed over time.

“Close collaboration with the Ministry of Health’s Expanded Programme will maximize the policy relevance of project activities and findings as the country works towards achieving higher vaccination coverage. Likewise, through community engagement efforts to enhance awareness about the project, the ULCHS will aim to become an increasingly trusted resource to the public for evidence about COVID-19 vaccination in Liberia,” said Dr. Skrip and Dr. Harmon Gray in a joint-statement.

Authors

Abigail Quinn, BA

Abigail Quinn is currently a third-year undergraduate student at the University of Virginia, where she studies Global Public Health with double minors in French and foreign affairs. She is also a first-year in the Master’s of Public Policy Program at UVA where she focuses on healthcare policy. She is originally from Norwell, Massachusetts. At the University of Virginia, Abigail holds a variety of leadership positions, from working on a student-run research podcast to tutoring fellow students in French. She was recently published in the Virginia Journal of International Affairs with a paper discussing regional disparities in female healthcare access in India. She is always eager to engage further with global health equity and vaccination research.
Abigail Quinn, BA

Deeva Agravat, MSc

Deeva Agravat is the Vaccine Acceptance Associate for the Sabin Vaccine Institute’s Vaccine Acceptance & Demand initiative. Her work focuses on attitudes, behaviors and perceptions impacting vaccine uptake in low- and middle-income countries (LMICs). Her portfolio consists of assisting with programmatic activities, curation of the Vaccine Acceptance Resource Hub and resources for the Insights Dialogue project. She received her MSc in Emerging Economies & International Development from Kings College London. The focus of her dissertation addressed the relevance of intellectual patent laws and multinational pharmaceuticals impacting domestic pharmaceuticals in LIMICs. Her specialization areas include development of healthcare infrastructures, health-related advocacy and the urban/rural divides within the context of South Asia and East Africa.
Deeva Agravat, MSc

Kate Hopkins, PhD, MPH

Dr. Kate Hopkins oversees the research programming across the Vaccine Acceptance & Demand team to implement program activities, expand and manage partnerships, invest in new research projects and continue the growth of Sabin’s thought leadership programming. Prior to joining Sabin, Kate spent 11 years living and working in sub-Saharan Africa conducting infectious disease prevention and psychosocial-behavioral research and health service program implementation in low- and middle-income countries—with particular focus on high-risk and vulnerable populations. Managing multi-country and multidisciplinary teams, her past portfolio of work included supporting clinical research site operations and strengthening capacity for the conduct of HIV and COVID-19 vaccine clinical trials within the HIV Vaccine Trials Network and COVID-19 Prevention Network. Kate supported the implementation of the ENSEMBLE J&J Phase III clinical trial and the subsequent SISONKE J&J COVID-19 vaccination rollout amongst healthcare workers in South Africa. Kate has been a joint-Faculty Researcher for the Faculty of Health Sciences, University of the Witwatersrand in Johannesburg, South Africa, for nine years; and is a virtual course lecturer on Operational Research within a post-graduate diploma program in TB/HIV Management for the University of Cape Town in South Africa. She was awarded funding for her PhD study from the CDC as a PEPFAR-funded activity under its Cooperative Agreement with the South African Medical Research Council, earning her degree from the University of the Witwatersrand School of Public Health. She also holds a Masters in Public Health, with a focus on Global Health, from Boston University School of Public Health.
Kate  Hopkins, PhD, MPH
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