Outcomes of a social media campaign to promote COVID-19 vaccination in Nigeria

Cost-effectiveness of a behavioral insights-informed digital campaign to increase HPV vaccination in Bangladesh

Digital platforms like social media are increasingly used to promote vaccine uptake in low- and middle-income countries (LMICs), yet limited evidence exists on their economic value. This study estimates the cost-effectiveness of a behavioral insights-informed social media campaign designed to increase HPV vaccine uptake among adolescent girls ages 9-14 in Bangladesh. A static cost-effectiveness analysis was conducted from the health system perspective. Inputs included campaign delivery costs, vaccine procurement and distribution, and treatment costs averted through cervical cancer prevention. Disability-adjusted life years (DALYs) averted per vaccinated girl were modeled using global burden-of-disease parameters. Effectiveness estimates were drawn from a quasi-experimental evaluation of the campaign, which reported a 9.5 percentage-point increase in vaccine uptake in one study arm and a 5.3 percentage-point increase in another, relative to a control group. These findings were preceded by a posttest study in Dhaka Division, which showed a strong association between campaign exposure and vaccination behavior. The incremental cost per vaccinated girl was $6.02, and the cost per DALY averted - i.e. the Incremental Cost-Effectiveness Ratio (ICER) - was $39.57. This falls well below established cost-effectiveness thresholds, including 40% of GDP per capita, commonly applied in LMICs. The findings suggest that digital campaigns guided by behavioral insights can represent a highly cost-effective approach to addressing persistent immunization coverage gaps. These results support the integration of such strategies into national immunization programs, particularly in contexts where traditional outreach methods may face financial constraints.

Effects of a multimedia campaign to increase human papillomavirus vaccine acceptance in Dhaka, Bangladesh

Increasing the uptake of Human Papillomavirus (HPV) vaccine among adolescent girls is a high priority for the government of Bangladesh. This study examines correlates of HPV vaccine adoption in Dhaka Division, the largest division in Bangladesh. The 18-day vaccination campaign was accompanied by multimedia messages. We use the Fogg Behavior Model (FBM) as the theoretical framework for our analysis. Using a survey instrument based on the FBM, we analyze cross-sectional data collected from 611 caregivers of girls aged 9-17 in Dhaka. Survey data was collected in November and December 2023. Caregivers were recruited via Facebook and Instagram ads and interviewed through the Facebook Messenger App. About one-third of caregivers reported that their child had been vaccinated. We conducted bivariate and multivariate analyses to assess the relationships between the caregivers' motivation, ability, exposure to the campaign and their child's vaccination status. Adjusted odds ratios from logistic regression analyses, suggest that caregivers' motivation, ability, and exposure to the multimedia campaign contributed to vaccine uptake. Caregivers' motivation to get their child vaccinated was high (74%) but their ability was low (20%). Exposure to campaign messages had a dose-response relationship with vaccine adoption. However, 48% of caregivers remained unexposed to the multimedia campaign. We discuss challenges that the government's HPV vaccination program is likely to face and identify program-related research questions that are important to answer for the success of future vaccination efforts.

Design and Baseline Evaluation of Social Media Vaping Prevention Trial: Randomized Controlled Trial Study

BACKGROUND

Electronic cigarette (e-cigarette) use is a major public health problem and young adults aged 18-24 years are at high risk. Furthermore, oral nicotine products (ONPs) are growing in popularity in this population. Poly-use is widespread. New methodologies for rigorous online studies using social media have been conducted and shown to reduce nicotine use.

OBJECTIVE

We report on the design and baseline evaluation of a large-scale social media-based randomized controlled trial to evaluate the effects of antivaping social media on young adult vaping and determinants of use.

METHODS

Using the Virtual Lab social media platform, participants were recruited using an artificial intelligence chatbot and social media advertising, completed a baseline survey, and were randomized to 1 of 4 study arms. The design was to achieve specific numbers of impressions per arm over 3 survey time points. We recruited 8437 participants, stratified by vaper (n=5026) and nonvaper (n=3321) status. Questionnaire data were collected using the Qualtrics survey platform. Future analyses will examine the effects of social media content on vaping at the endline. Our data analysis describes the 2 cohort samples, examines balance across the 4 study arms on baseline variables in each of the cohorts, and evaluates the internal consistency of several multi-indicator measures of psychosocial constructs.

RESULTS

Among vapers, almost three-fourths were current vapers, >40% were current smokers (using in the past 30 days), and >48% were current poly-users (using e-cigarettes and ≥1 other tobacco products). Substantial numbers of current vapers also currently use some other product, including cigars (n=1520, 30.2%), hookah (n=794, 15.8%), smokeless devices (n=462, 9.2%), and ONPs (n=578, 11.5%). The average age of participants was 21.2 (SD 2) years. Just less than 45% of participants were non-Hispanic White (n=3728, 44.7%), just less than 47% (n=3913, 46.9%) of the sample was male, more than 44% (n=3704, 44.4%) reported completing high school, and 79.3% reported meeting basic needs or better. There were no significant differences between arms and strata by any of these demographics. We calculated scale scores for depression and covariates related to nicotine use and found high alphas. Finally, participants who reported having seen antitobacco brand advertising were more likely to have higher levels of these variables and scales than participants who reported not having seen the advertisements. These results will be examined in future studies.

CONCLUSIONS

Social media can be used as a platform at scale for longitudinal randomized controlled trials over extended periods, which extends previous research on short-term trials. Interventions delivered by social media can be used with large samples to evaluate social media health behavior change interventions. Future studies based on this research will evaluate the intervention and dose-response effects of social media exposure on vaping behavior and determinants.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04867668; https://clinicaltrials.gov/study/NCT04867668.

Modelling the mitigation of anti-vaccine opinion propagation to suppress epidemic spread: A computational approach

Information regarding vaccines from sources such as health services, media, and social networks can significantly shape vaccination decisions. In particular, the dissemination of negative information can contribute to vaccine hesitancy, thereby exacerbating infectious disease outbreaks. This study investigates strategies to mitigate anti-vaccine social contagion through effective counter-campaigns that disseminate positive vaccine information and encourage vaccine uptake, aiming to reduce the size of epidemics. In a coupled agent-based model that consists of opinion and disease diffusion processes, we explore and compare different heuristics to design positive campaigns based on the network structure and local presence of negative vaccine attitudes. We examine two campaigning regimes: a static regime with a fixed set of targets, and a dynamic regime in which targets can be updated over time. We demonstrate that strategic targeting and engagement with the dynamics of anti-vaccine influence diffusion in the network can effectively mitigate the spread of anti-vaccine sentiment, thereby reducing the epidemic size. However, the effectiveness of the campaigns differs across different targeting strategies and is impacted by a range of factors. We find that the primary advantage of static campaigns lies in their capacity to act as an obstacle, preventing the clustering of emerging anti-vaccine communities, thereby resulting in smaller and unconnected anti-vaccine groups. On the other hand, dynamic campaigns reach a broader segment of the population and adapt to the evolution of anti-vaccine diffusion, not only protecting susceptible agents from negative influence but also fostering positive propagation within negative regions.

Social media use and vaccination among Democrats and Republicans: Informational and normative influences

Our objective was to determine whether social media influences vaccination through informational and normative influences among Democrats and Republicans. We use a probability-based longitudinal study of Americans (N = 1768) collected between December 2022 and September 2023 to examine the prospective associations between social media use and vaccination as well as informational and normative influence as mediating processes. Greater social media use correlates with more frequent vaccination (cross-lagged coefficients: COVID-19 = 0.113, p < 0.001; influenza = 0.123, p < 0.001). The underlying processes, however, vary between Democrats and Republicans. Democrats who use social media more are more likely to vaccinate because they encounter information about new pathogens. In contrast, Republicans who use social media more are more likely to vaccinate because they think that people who are important to them receive the recommended vaccines. Our findings underscore the potential for social media campaigns to promote vaccination, among both Democrats and Republicans by paying attention to the specific processes in each audience.

Randomised experimental evaluation of a social media campaign to promote COVID-19 vaccination in Nigeria

Background

The coronavirus disease 2019 (COVID-19) pandemic has challenged public health and behaviour change programmes, and has led to the development of innovative interventions and research. In low -and middle-income countries (LMICs) such as Nigeria, new strategies to promote vaccination, increase pro-vaccination social norms, and reduce vaccine hesitancy have been deployed through social media campaigns and evaluated using digital media platforms.

Methods

We conducted two randomised experimental evaluations of social media content designed to promote COVID-19 vaccination and to complement research on a nationwide vaccination promotion campaign in Nigeria run in 2022. We conducted two studies in March and August 2022 among Nigerians drawn from 31 states that had not been targeted in the aforementioned nationwide campaign. We randomised the participants to either receive the pro-vaccination social media campaign or not and collected data at pre- and post-test time points to evaluate psychosocial predictors of vaccination and vaccination outcomes following the Theory of Change based on Diffusion of Innovations; the Social Norms Theory, and the Motivation, Opportunity, Ability (MOA) framework. Data were collected through a novel intervention delivery and data collection platform through social media.

Results

We found that pro-vaccination social norms and vaccination rates increased, while vaccine hesitancy decreased among participants randomised to the social media intervention study arm.

Conclusions

Social media campaigns are a promising approach to increasing vaccination at scale in LMICs, while social norms are an important factor in promoting vaccination, which is consistent with the Social Norms Theory. This study demonstrates the capability and potential of new social media-based data collection techniques. We describe implications for future vaccination campaigns and identify future research priorities in this area.

Registration

Pan African Clinical Trial Registry: PACTR202310811597445.