Raising Confidence in COVID-19 Vaccines in a Tajikistan District
Trusted community leaders ease concerns of a hesitant populace
Having witnessed firsthand the devastating effects of COVID-19, Dr. Ghafur Nazarov, a frontline health worker and director of the vaccination center in Tajikistan’s Dusti district, was dismayed when COVID-19 vaccinations plummeted last summer. Misinformation, and a lack of evidence-based information to counter it, was eroding the community’s confidence in the vaccine.
The problem was not limited to the Dusti district, which lies in Tajikistan’s Khatlon region. Despite widely available vaccine services across the country and health worker advocacy for the shots, vaccine hesitancy has prevented a large percentage of the population from getting fully vaccinated. As recently as January 2023, just 56 percent of Tajikistan residents had received at least one dose of the COVID-19 vaccine.
A case study of three districts in the Khatlon region by USAID’s Local Health System Sustainability Project (LHSS) found that while residents were motivated by a fear of COVID-19 disease to participate during the first round of vaccination, doubts about the vaccine’s safety and efficacy kept many people from seeking additional doses in later rounds.
But the study also pointed to potential solutions for countering vaccine hesitancy. It found that people regarded health care workers as the most trusted source of information on health issues and vaccination. At the same time, it found that certain other influential community leaders, including religious leaders, were uninformed about the safety and efficacy of the vaccine. There was also evidence that when a district had a vaccination awareness-raising campaign that emphasized community engagement through health care workers, residents were more likely to get vaccinated.
After attending an LHSS-supported training workshop on the COVID-19 vaccine and ways to encourage uptake, Dr. Nazarov was convinced that the kind of intense community engagement that had worked elsewhere could make a difference in Dusti district. In July 2022, he had an opportunity to try out the approach as a participant in the Ministry of Health’s “Protect Yourself from COVID-19” contest.
The one-month contest, held in 15 districts and cities of the Khatlon region, challenged district directors and health care workers to use community outreach tactics to improve public confidence in the vaccine and increase vaccination in target populations. Over 1,000 health care workers from rural health centers and medical clinics participated.
“The contest encouraged us to work harder and dedicate ourselves to save the lives of our people.” — Dr. Nazarov
Dr. Nazarov threw himself into the competition, mobilizing a small army of trusted community leaders — including clinical health workers, healthy lifestyle coaches, teachers, and religious leaders — to help carry out the campaign. At in-person sessions, he gave them accurate information about the vaccine and asked them to share the information throughout their communities.
Health care workers spoke with people at community education sessions, household visits, and office visits with patients. Teachers talked with schoolchildren about vaccines in general and COVID-19 specifically, and how vaccines are saving lives around the world. Religious leaders who had themselves been skeptical about COVID-19 vaccination began promoting it in Friday prayer services. Vaccination rates began rising across the district.
In peer-to-peer learning sessions with other district directors, Dr. Nazarov shared his comprehensive community engagement approach and specific practices that were working, such as tailoring messaging to different audiences.
By the end of the contest, Dusti district, with a population of around 120,000, had logged the highest number of vaccinations and Dr. Nazarov was named one of three winners. Cumulative COVID-19 vaccinations in the district climbed from 6,803 in August to 14,103 in September.
“The contest provided an opportunity to remind health care workers about the importance and value of their work for the communities. It encouraged us to work harder and dedicate ourselves to saving the lives of our people.” said Dr. Nazarov.
“Everyone in our community has to get vaccinated. This is the vital part, coming together as a community to defeat COVID-19 and coming back to normal life without fear.”
