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COVID-19 Vaccine Hesitancy in Belize: How to Overcome it?    

December 12, 2022 por Giuliana Daga - Florencia Lopez Boo - Lajos Kossuth - Cynthia Boruchowicz - Diego Rios Zertuche - Emma Margarita Iriarte - Ana Mylena Aguilar Rivera - Natalia Largaespada Leave a Comment


Increasing COVID-19 vaccine take-up is key to protecting people from death and disability. Research increasingly shows that COVID-19 not only increases the risk of premature death but also can have long-lasting consequences resulting in chronic conditions and incapacitating illnesses –also known as long COVID. However, despite the benefits of vaccines, governments are still struggling to vaccinate large proportions of their population. According to PAHO, 10 out of the 13 countries in the Americas that have not reached WHO’s 2021 goal of 40% vaccination coverage by February 2022 were in the Caribbean, and even fewer countries have achieved WHO’s 2022 goal of vaccinating 70% of the population by mid-2022. Although limited vaccine supply was the main reason for low vaccination rates at the beginning of the pandemic, this is no longer the case in most LAC countries during 2022.

Belize is one of the countries facing these challenges. The country has made significant progress, reaching 50% of the population fully vaccinated by December 2021. However, despite enough supply to cover 100% of the population, the vaccination rate started slowing significantly since generating concerns (Our World Data). The Belizean government has been doing formidable work to increase the impact of their vaccination campaigns. Still, after more than two years of the pandemic, challenges remain to ensure all people get vaccinated, especially those at risk.

The Belizean Ministry of Health and Wellness (MOHW) partnered with the IDB and other organizations to understand the reasons behind vaccine uptake and hesitancy and measure the effectiveness of different interventions to address them.

What are the views of unvaccinated persons about the COVID-19 vaccine?

According to a nationally representative household survey conducted by the Salud Mesoamerica Initiative (SMI) in September-October 2021, the perceptions of easy access to vaccines, higher vaccine safety, and increased protection were among the main reasons explaining people getting vaccinated. Among the unvaccinated (20.7% of the sample), 65.4% showed some degree of hesitancy, and intentions to get a vaccine increased if they perceived it would protect their health, it would help them resume social activities, or follow government mandates. On the contrary, fear of side effects, lack of trust, and a perception of not needing a vaccine are among the reasons for not getting vaccinated. These findings are similar to those found in other studies in Caribbean countries.

Figure 1: Vaccination intentions and views among unvaccinated people

Source: SMI/ IDB survey data from September-October 2021

Can a positive message increase interest in COVID-19 vaccines?

In Belize, an IDB social protection and health behavioral economics team worked closely with the Ministry of Health and Wellness (MOHW) and a digital marketing firm (IdeaLab Studios Digital Marketing, financed by the IDB) to design and launch behaviorally informed Facebook campaigns. The campaigns were sequentially displayed to the entire population of Belizean Facebook users and informed by previous research, aimed to encourage vaccination take-up by highlighting its safety (“It’s Safe” campaign), effectiveness (“It’s effective”), probability of side effects (“When vaccinated…”), self-protection (“Are you protected?”), and children’s eligibility (“Children”).

Within one of the campaigns, we experimentally tested the effects of different messages on online engagement. Using data for around 260,000 Facebook users (about 65% of the population who were eligible at the time of the study) and making use of the Facebook AB Testing tool, three different messages were randomized among Facebook users in Belize by district: “When vaccinated… (i) only 3 out of 100 reported discomforts“; (ii) “ … few people have discomfort“; and (iii) the majority didn’t have discomfort.” All the messages included the sentence: “Click here (link) to find your nearest vaccination site” at the end, giving them access to a website containing scientific information related to the vaccine’s effectiveness and instructions to get their appointments. We track the number of “clicks” on the ad as a proxy for interest in getting information about COVID-19 vaccines.

We find that the “Majority” sub-campaign (compared to the “3 out of 100” message, which was the base category) was more effective at raising people’s interest, implying that a positive message (communicating no discomfort) seems to work better than a negative one (communicating discomfort).

Figure 1: Facebook AB Testing tool

Source: Idealab
Source: Idealab

What else has been done?

Protecting people against the COVID-19 virus has been a priority for the Belizean government. In addition to the digital campaign, the government has been sending vaccination teams to remote villages, hospitals, schools, and elderly centers, and increased their presence on local TV shows and radio advertising specific vaccination sites and events. The government also created a website including scientific information related to the vaccine effectiveness and the mortality and hospitalizations rate of the vaccinated compared to the unvaccinated by age group.

However, a lack of evidence on which communication strategies work and pandemic fatigue could challenge this work. In this study, we contribute to the discussion and hope it could serve as preliminary evidence for public health officials to consider if they wish to tackle vaccine hesitancy.

Download this publication to find out more about combating COVID-19 vaccine hesitansy

Filed Under: Health services Tagged With: behavioral-economics, covid-19, covid-19 vaccine, health, IDB, Inter-American Development Bank, vaccine, vaccine hesitancy

Giuliana Daga

Giuliana Daga works as a consultant specializing in impact evaluation and economic analysis of social and health policies. She previously worked in the Social Protection and Health Division of the Inter-American Development Bank (IDB), where she focused on projects related to early childhood development, behavioral economics, and poverty reduction. She has collaborated on research and impact evaluations on human capital at the University of California, Berkeley, the IRC, and Georgetown University. She has also worked as a professor at the Torcuato Di Tella University and as a consultant for the World Bank and the government of Argentina. Giuliana holds a bachelor's degree in Political Science and a master's degree in Applied Economics from Torcuato Di Tella University, as well as a master's degree in International Development Policy from Georgetown University. She is currently pursuing a PhD at the University of Oxford, where she specializes in health economics and financing for the resilience of health systems.

Florencia Lopez Boo

Florencia Lopez Boo is a Director, Global TIES; Economics and Applied Psychology at NYU. Prior to joining NYU, she was a Lead Economist at the Social Protection and Health Unit of the Inter-American Development Bank (IDB), where she led the Early Childhood Development (ECD) agenda, the IDB ECD Innovation Fund, the knowledge agenda of her unit, and an initiative on behavioral economics and social policies. She was a professor at the University of Louvain and worked at the World Bank and UNIDO. She has a PhD in Economics from Oxford University (Clarendon-Oxford University Press award). She is also a Young Lives Research Associate at the University of Oxford and the Institute for Labor Studies (IZA) in Bonn. Twitter: @florlopezboo

Lajos Kossuth

Lajos Kossuth is currently a Post-Doctoral Researcher at CEMFI, in Madrid, Spain, where he is part of a team advising the Spanish Ministry of Social Inclusion on the execution of several RCT programs. Additionally, he has over six years of experience in the analysis, design, implementation and evaluation of public policy in the public and private sectors of Peru. Lajos holds a PhD in Behavioral Sciences from Warwick Business School, the University of Warwick, a Master of Science in Development Studies from the London School of Economics and Political Science, and a Licenciatura in Economics from Universidad del Pacífico.

Cynthia Boruchowicz

Cynthia Boruchowicz es candidata a doctorado en la Escuela de Políticas Públicas de la Universidad de Maryland y fue la consultora 2020 en Economía del Comportamiento en la División de Protección Social y Salud del Banco Interamericano de Desarrollo. Previamente ocupó cargos tanto en el Departamento de Investigación como en la Vicepresidencia del Sector Privado. Tiene una Maestria en Políticas Públicas de la Universidad de Chicago, Harris School of Public Policy y es Licenciada en Economía de la Universidad del CEMA (Argentina)

Diego Rios Zertuche

Diego Rios Zertuche is a Senior Monitoring and evaluation officer for the Salud Mesoamerica Initiative and the Regional Malaria Elimination Initiative at the Inter-American Development Bank. As part of this role, Diego oversees large-scale performance measurements for the result-based financing model of each initiative. He is interested in improving metrics to measure healthcare quality, and in the use of data for managerial decision-making and quality improvement. His latest publication focuses on measuring healthcare quality to support malaria surveillance. Diego has over 10 years of experience supporting program design and development and quality improvement projects in governmental and non-governmental organizations across the United States, Latin American, and India. He is originally from Mexico City.

Emma Margarita Iriarte

Emma Margarita Iriarte is a health specialist and Division Chief a.i. of the Health, Nutrition and Population Division at the Inter-American Development Bank. She also serves as the Executive Secretary of the Salud Mesoamerica Initiative and the Regional Malaria Elimination Initiative.

Ana Mylena Aguilar Rivera

Ana Mylena Aguilar se desempeña como especialista senior en salud y protección social. Es Doctora en Salud Global y Demografía por la Universidad de Harvard, Maestra en Economía Aplicada por la Universitat Pompeu i Fabra, y economista por el CIDE. Trabaja en la oficina de México, Belice, y ahora en República Dominicana coordinando la cartera del Banco en áreas críticas como respuesta COVID, fortalecimiento de sistemas de salud, primera infancia, y sistema de cuidados entre otros. Anteriormente se desempeñó como economista senior en salud en el Banco Mundial para la región de Europa del Este, Asia Central, y África del Este, y como Economista de Salud para la Organización Mundial de la Salud (OMS) en Ginebra, Suiza. Sus publicaciones abordan temas de financiamiento de los sistemas de salud, fecundidad y educación, envejecimiento, primera infancia, entre otros. Es ilustradora en ciernes, viajadora, y orgullosa dueña de Chiki y Momo.

Natalia Largaespada

Dr. Natalia Largaespada is a Medical Doctor and Specialist in Sexual and Reproductive Health, currently serving as the Technical Advisor of the Maternal and Child Health Unit in the Ministry of Health in Belize. She is a member of the Caribbean technical working group on the elimination of mother to child transmission of HIV and syphilis, and the focal point for the Salud Mesoamerica Initiative Project in Belize, which seeks to reduce health equity gaps faced by those living in extreme poverty.

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Latin American and Caribbean countries face multiple challenges to provide quality healthcare for their citizens. In this blog, IDB Specialists and international experts discuss current health issues and hope to build a dynamic dialogue through your comments.

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