Duaa Alammari1,2, Hanan Al-Kadri1,2,3, Mansour Al-Qurashi2,4,5, Majid Alshamrani2,6,7, Fayssal Farahat1,2,8, Aiman Altamimi9, Anmar Najjar4
1College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (Correspondence: D. Alammari:
Abstract
Background: COVID-19 vaccine acceptance and uptake are major public health challenges in Saudi Arabia.
Aims: To vaccinate all affiliates of King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS) within a limited time period using evidence-based strategies to address COVID-19 vaccine hesitancy.
Methods: A survey was distributed electronically to develop an evidence-informed vaccination plan to address hesitancy factors. Initial survey results from March 2021 showed that only 60% of affiliates had taken at least 1 COVID-19 vaccine dose. KSAU-HS designed a 6-month vaccination campaign to raise awareness and increase compliance. Barriers and hesitancy to vaccination were managed through mass media, social media, and reminders to achieve high vaccination rates by overcoming fear and misconceptions.
Results: The evidence-based planning resulted in a significantly high vaccination rate, with 99.7% of affiliates vaccinated by October 2021; one of the highest vaccination rates among public universities in Saudi Arabia.
Conclusion: The implementation of evidence-based campaigns through social media can help address prevailing public health concerns, as well as COVID-19.
Keywords: vaccination, COVID-19, public education, evidence-based, evidence-informed policy-making
Citation: Alammari D; Al-Kadri H; Al-Qurashi M; Alshamrani M; Farahat F; Altamimi A; et al. Lessons learned from an academic institution for improving COVID-19 vaccine uptake in Saudi Arabia. East Mediterr Health J. 2023;29(5):xxx-xxx https://doi.org/10.26719/emhj.23.034
Received: 18/07/22; accepted: 08/12/22
Copyright: © Authors; licensee World Health Organization. EMHJ is an open access journal. All papers published in EMHJ are available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).
Introduction
COVID-19 has had a profound impact on public health locally and globally. A report by the Saudi Ministry of Health on 9 February 2021 showed that there were 362 368 cases of COVID-19 and 6415 deaths in the country (1) (Figure 1).
King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS) is a governmental university that was founded on 6 March 2005 (2). In early 2020, KSAU-HS had 14 922 affiliates: 777 faculty members, 2979 administrative staff, and 11 166 students (2). Shortly after the first case of COVID-19 was diagnosed in Saudi Arabia, academic institutions were urged to take precautions to contain the spread of the disease. KSAU-HS reported 121 cases in April 2021, but no deaths were recorded at that time.
Vaccination during a pandemic is among the most effective strategies for containment of the situation (3, 4). Therefore, the Saudi Government and Ministry of Health developed a risk management plan to mitigate the impact of COVID-19 and reduce the rate of infection. Widespread vaccination was one of the recommended strategies, especially in high-risk facilities like universities. In mid-December 2020, Pfizer-BioNtech was the first vaccine against COVID-19 approved in Saudi Arabia, with 500 000 doses delivered (5). However, COVID-19 vaccine hesitancy contributed significantly to the slow vaccination coverage throughout Saudi Arabia.
KSAU-HS is under the umbrella of the Ministry of National Guard Health Affairs, which had extensive experience with infection control and prevention following the MERS-CoV outbreak at the facility in 2015. At that time, emergency preparedness and infection prevention practices were revised to contain the spread of the disease. As a result, plans for future crisis management were developed and made available at the facility to deal with similar situations (6). During the MERS-CoV outbreak, management was aided by involving all staff in sharing experiences and relevant knowledge, developing trust and teamwork, and promoting collective leadership. Recommendations were also made to improve crisis management strategies, coordinate media management, and take a proactive stance in advising and supporting staff (6).
In light of the precedent set by Ministry of National Guard Health Affairs, the KSAU-HS COVID-19 Crises Management Committee was formed in February 2020 with the goal of implementing health protection and disease prevention programmes and policies across all 3 campuses. The KSAU-HS COVID-19 Infection Prevention and Control Advisory Subcommittee was also formed. Shortly after that, all Saudi universities were instructed to establish committees to combat the spread of COVID-19. Vaccination planning was delegated to the Infection Prevention and Control Advisory Subcommittee, which met with stakeholders to discuss plan formulation and implementation. The preliminary vaccination plans included the establishment of vaccination centres on campuses to facilitate vaccination among university affiliates. The Subcommittee sought to collect accurate data on vaccination history and hesitancy among affiliates to propose an evidence-based vaccination plan that met the needs of the university and the urgency of the pandemic. To this end, the Subcommittee used evidence-based strategies to address vaccine hesitancy.
The aim was to vaccinate all KSAU-HS affiliates within a limited time period using evidence-based strategies to address COVID-19 vaccine hesitancy. All affiliates were required to be vaccinated with 2 doses by 1 August 2021, otherwise they would not be allowed on university premises as per the government regulations.
Methods
KSAU-HS developed a comprehensive plan to improve COVID-19 vaccine uptake that consisted of 3 phases: (1) situational analysis (baseline assessment); (2) stakeholders’ engagement (streamlining current and accurate data); and (3) community engagement through social and traditional media (awareness programme).
Phase 1: situational analysis (baseline assessment)
On 17 March 2021, the COVID-19 Infection Prevention and Control Advisory Subcommittee needed accurate data to inform future decisions. The first step was to create a standard form and distribute it to colleges and deanships to collect data about vaccination rates among affiliates, with weekly follow-up. The second step included working with the Saudi Ministry of Education to update vaccination data based on national sources (such as Tawaklna). Throughout the process, college deans and directors were actively involved and provided timely reports to the Subcommittee at KSAU-HS. As a result of baseline and situational assessment, current and accurate vaccination rates were available at KSAU-HS. This phase helped decision-makers understand the situation to support the development of plans, policies, and strategies for vaccination management.
Phase 2: stakeholders’ engagement (streamlining current and accurate data)
After the initial phase of data collection, the COVID-19 Infection Prevention and Control Advisory Subcommittee planned to gather more information about vaccine uptake rates and reasons for hesitancy, and an in-house survey was developed. On 23 March 2021, the first survey was distributed between March and May 2021 via email through the University Message Center with a link to the web survey. The survey included demographic information, vaccination data, and reasons for vaccine hesitancy. A total of 7167 (48%) participants completed the survey. Results were reported periodically to relevant decision-makers and COVID-19 committees. A live dashboard was created to provide timely updates to senior leadership (Figure 2). The dashboard displayed various data in graphs, including the reasons given by KSAU-HS affiliates for not vaccinating, such as safety concerns, appointment availability, efficacy, past COVID-19 infection, preference for a particular vaccine that was not available, and pregnancy or breastfeeding (Figure 2 and Table 1). The survey results were used to develop an evidence-based vaccination plan to achieve the target vaccination rates.
Drawing on the university’s past experience with the MERS-CoV outbreak, it was critical to reach out to different stakeholders, such as affiliates and management, to increase their involvement in the decision-making process and successfully control the spread of COVID-19 at the institution. This strategy yielded positive results in the past and fostered shared leadership and accountability (6).
Phase 3: community engagement through social and traditional media (awareness programme)
The COVID-19 Infection Prevention and Control Advisory Subcommittee developed a COVID-19 vaccination awareness programme utilizing the results of the survey, which used social media as one of the main distribution channels. The Saudi population is one of the largest Internet users globally, with nearly 96% of people using the Internet and 80% using social media in 2021 (7). A review of scientific evidence suggested the positive impact of using social media to raise awareness and change health behaviour by disseminating brief messages to the target population (3, 4). Social media is also a fast and efficient way to communicate with the general public and health professionals to implement infection prevention strategies and community engagement, especially during outbreaks (3, 4). Therefore, the Internet and social media were used extensively in the awareness programme (intervention) implemented by KSAU-HS (Tables 1 and 2).
Intervention
The COVID-19 committees launched a COVID-19 vaccine hesitancy and awareness programme aimed at highlighting the importance of vaccination to prevent and control the COVID-19 pandemic. The plan was to accomplish this goal by increasing vaccination rates and addressing reasons for vaccine hesitancy. The programme was developed in collaboration with the Department of University Relations and Media Affairs at KSAU-HS and relied on multiple sources, including survey results and national (Ministry of Health) and global (World Health Organization; WHO) data. The survey results were used to identify the target audiences and create targeted messages that addressed reasons for vaccine hesitancy (Table 1). It was critical to address vaccine-specific issues, risks, and benefits, and to highlight issues related to newly approved vaccines, and the establishment of active and accessible vaccination centres on university campuses, as these were among the reasons for vaccine hesitancy. The programme was launched on 6 June 2021. The content of the programme was designed to encourage individuals and social groups (university affiliate groups) through contextual influence. This was accomplished by disseminating key facts and sharing affiliates’ personal experiences. The Department of University Relations and Media Affairs was responsible for disseminating regular awareness messages and social media posts. This also included university-owned communication channels, such as social media, SMS, and Message Center. Initiatives also included educational media, announcements, workshops, seminars, and consultations. A list of the interventions is outlined in Table 2.
Results
Uptake of the first dose of COVID-19 vaccine increased significantly from 63% to 87% between May and July 2021 (Figure 3). The progress made by KSAU-HS was achieved prior to the COVID-19 vaccination mandate, which took effect on 1 August 2021. The mandatory national vaccination was a Saudi Government decision, and universities were instructed to adhere to the deadlines set by the Ministry of Education and Ministry of Health. Following the mandate, vaccination rates for the first and second doses increased to 99.7% and 99.3%, respectively in October (Figure 3). By the end of October 2021, KSAU-HS had the highest rate of COVID-19 vaccination among the 27 public universities in Saudi Arabia.
Key Challenges for implementing the vaccine uptake programme
The presence of outdated or miscommunication of data regarding university affiliates presented a challenge to collecting accurate data and determining situational analysis. A designated team had to manually filter and update the data to eliminate discrepancies.
Vaccine availability was limited between June and August 2021 because of high demand locally and globally, which restricted adherence to vaccination requirements and guidelines.
Survey distribution via email did not produce a high response rate when used as a stand-alone data collection method.
Conclusion
Evidence-based strategies can yield the desired results within a short period of time, especially for time-sensitive issues. Fear and uncertainty hampered COVID-19 vaccine acceptance among health science affiliates as well as the general public. Social media is a powerful tool for reaching a large audience in a timely and cost-effective manner, particularly in critical situations like pandemics. It also contributes to public awareness and encourages acceptance of new regulations and policies. One key factor to note is that the commitment of the Saudi Government to increasing the uptake of COVID-19 vaccine nationwide may have also contributed to the overall increase in vaccine coverage at KSAU-HS.
References
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Acknowledgements
We would like to acknowledge the contribution of Dr. Arash Rashidian, Director of Science, Information and Dissemination at WHO Regional Office for the Eastern Mediterranean (EMRO); Dr. Mehrnaz Kheirandish, Regional Advisor for Evidence and Data to Policy at EMRO; and Ms. Sumithra Krishnamurthy Reddiar, Technical Officer, Evidence and Data to Policy at EMRO for their technical advice and support through all stages of the development of the case study. We thank Ms. Hala Hamada, Programme Assistant, Evidence and Data to Policy at EMRO for administrative support. We acknowledge the Division of Science, Information and Dissemination/Evidence and Data to Policy Unit at EMRO for funding development of the case study.
Conflict of interest: We certify that: (1) we have no affiliations with or involvement in any organization or entity with any financial gains or interest, or nonfinancial interests in the subject matter or materials discussed in the case study; (2) the case study was developed in coordination and collaboration with staff from WHO, who were involved in the response to COVID-19; (3) given the involvement in the COVID-19 response, the principle of objectivity has led the development of the case study; and (4) the development of the case study did not involve financial or professional benefit and served to share our experiences.
