Summary

Girl Effect in India and Gavi, the Vaccine Alliance, ran a first-of-its-kind Facebook ad campaign to help improve perceptions of childhood vaccination among young women likely to be mothers in India’s Hindi belt, with the particular aim of reaching those that were vaccine hesitant in some way.

Girl Effect used Facebook insights available in the public domain, and research gathered by young women in Jaipur and Alwar (Rajasthan, India), to create ad content that resonated with the target audience. Over 3 months, Girl Effect reported that the campaign reached 7.1 million young women in their 20s. A focused impact measurement survey was run for a month of the campaign, which showed that the campaign led to a 3.8 percentage point increase in perceptions that vaccines protect children from life-threatening diseases. Among people surveyed, more than 84% of people who saw the ads believed that missing a vaccine dose will make a difference in a child's ability to fight life-threatening diseases.

Approach

In 2019, vaccine hesitancy was named as one of the top ten threats to global health and lack of confidence in vaccines continues to threaten childhood vaccination programs in India. To help address this problem, Girl Effect - a non-profit that uses media to help millions of girls in Africa and Asia make choices that change their lives - partnered with Gavi, the Vaccine Alliance, to design and launch an ad campaign in India to explore how to increase favorable attitudes towards vaccines.

The goal was to reach young women aged 19-25 in urban areas in India’s Hindi Belt with ads to increase favorable attitudes towards vaccines, address motivational barriers contributing to vaccine hesitancy, and create a playbook for future vaccine-related campaigns using social media platforms. Two audience cohorts were used within the Hindi belt. The first encompassed the full Hindi belt, known as the ‘wide audience’ and the second was a subset of government-identified underimmunized geographic areas in the Hindi belt referred to by the team as the ‘hotspot audience’.

The campaign design was informed by findings from Girl Effect’s mobile research tool, Technology Enabled Girl Ambassadors (TEGA) and insights from public conversations on Facebook. Through TEGA girl researchers collected real-time insights into the lives of their peers focusing on vaccines. Combined, this research helped identify three likely challenges to address -

Campaign Design

With the research findings in mind, Girl Effect designed a social-media campaign called Point Toh Hai” (“You’ve Got a Point”) that included characters and storylines that reflect girls’ everyday choices as young mothers. Girl Effect’s content showed them how to overcome barriers to getting their child vaccinated and make choices for their child's health, acknowledged vaccine concerns and encouraged young women to ignore hearsay and rely on information from health experts.

The campaign centred on the story of a young mother named Meenal who wants to make the right health decisions for her young daughter but faces resistance from her mother-in-law who views vaccines as unnecessary. A series of videos and static posts about Meenal’s story delivered entertaining and educational vaccine content that mimicked real-life, fast-paced conversations. Two of the top performing pieces of content were a rap battle between Meenal and her mother-in-law and a fictional WhatsApp conversation between Meenal and her girlfriends about vaccines.

Impact

The campaign, which ran in August-November 2020, reached 7.1 million young women in their 20s over three months. Girl Effect used Facebook to survey its target audience and inform real-time changes in order to better identify, reach and engage young women throughout the campaign. For example, Girl Effect found that posts written in Devanagari script rather than Hinglish performed better and adjusted their strategy accordingly.

To measure its impact towards the goal of increasing favorable attitudes towards vaccines, Girl Effect surveyed people over one month of the campaign, in October-November, 2020. During that one month period, ads reached over 3.5 million young women and led to 43 million impressions, meaning that each woman was targeted with 12 ads on average. The estimated promotional cost towards the goal of improving confidence in vaccines during the month was in the range of USD 0.39 - 0.60 per person.

Survey results also showed that more than 84% of people who saw the ads believed that missing a vaccine dose will make a difference in a child's ability to fight life-threatening diseases. There was a 3.8 percentage point increase in reported perceptions that vaccines protect children from life-threatening diseases during that month. Women that saw the ads in areas with the lowest vaccination coverage (the ‘hotspots’) showed a 4.2 percentage point increase in perceptions that doctors and ASHAs (community health workers) have the most accurate information about vaccination.

The results were not without surprises, however. Among the young women surveyed, 40% said that if their friends were hesitant about vaccines, they would not insist on immunization, highlighting an opportunity to improve vaccine confidence further in this population.

Learnings

One of the greatest challenges with this campaign was directing the Facebook ads to the correct audience of young, likely vaccine hesitant mothers. Girl Effect tested and refined their approach three times to increase their chances of reaching people likely to be young mothers based on factors like the content they watch and keywords they use in public posts.

To identify an audience most likely to have low vaccine confidence, Girl Effect relied on learnings from a study they partnered on with the Centre of RISC at the University of Chicago. The study indicated that with online audiences, age and education status were possible predictors of low vaccine confidence. Girl Effect used age, educational status and geographic location for targeting more narrowly for likely vaccine hesitance. Publicly available data from the Indian government was used to target geographic areas known to have low vaccination coverage.

Girl Effect will use the experience of designing and evaluating the “Point Toh Hai” campaign to inform its strategy to encourage vaccine confidence for routine immunisation in 2021.

*Case study results will vary, as they depend on a variety of factors. These results may not be achieved by all.