Does it matter who addresses whom in vaccination promotion campaign?

Abstract Background A vaccine promotion campaign is primarily grounded on the selected message features, namely, a carefully chosen information source. People holding diverse views towards vaccination could experience the same information source differently, and it is the comprehension of these diversities that is important to tailor effective interventions. The aim of this study was to determine differences in perceived source credibility between the vaccinated and unvaccinated. Methods Overall 172 adults aged 18 and older from Western Balkans both vaccinated and unvaccinated, voluntarily after obtaining informed consent, were randomly assigned to one of four message interventions. The messages were developed combining two prototypical COVID-19 vaccine decision narratives (determined vs. hesitant) with two communication sources (physician vs. lay peer), resulting in four conditions: determined physician, hesitant physician, determined peer, hesitant peer. After the message exposure, participants evaluated three components of source credibility - expertise, trustworthiness and, goodwill. Two-way ANOVA was applied. Results Compared to the vaccinated, the unvaccinated judged the source as less trustworthy (p < 0.01), regardless of the message they have been exposed to. Although not statistically significant (p = 0.064), the unvaccinated evaluated all sources with the exception of hesitant physician as having a lower level of good intentions. Vaccinated perceived the determined physician as a source with most expertise, while unvaccinated attributed highest expertise to the hesitant physician (without significant difference (p = 0.719)). Conclusions The unvaccinated are generally less likely to experience the information sources as goodwill and trustworthy. In order to perceive the source as more competent the focus should be on the objective characteristics of the communicator, as well as on the congruency in attitudes between the communicator and the audience.

Vaccine hesitancy is a relatively new concept, developed by WHO's Strategic Advisory Group of Experts (SAGE) on Immunization in 2014 as a response to the growing awareness of the decline in global confidence in vaccination. Vaccine hesitancy is a context-specific behavioural phenomenon whose occurrence ranges between full acceptance and complete refusal of vaccines. Several studies have explored factors that influence people's decision to get vaccinated and in 2018 WHO and UNICEF conducted a joint study to explore the reasons for vaccine hesitancy. The study aimed to determine the reported rate of vaccine hesitancy across the globe and the reasons for hesitancy. In most studies three top reasons were identified. 1) vaccine safety concerns, 2) lack of knowledge and awareness of vaccine importance, and 3) religion, culture, gender and socio-economic issues regarding vaccines. Other factors contributing are negative perception of vaccine efficacy, safety, convenience, and price. Some of the consistent sociodemographic groups that were identified to be associated with increased hesitancy included: women, younger participants, and people who were less educated, had lower income, had no insurance, lived in a rural area, and self-identified as a racial/ ethnic minority. Vaccine hesitancy is associated with the global crisis of trust in science and institutions, namely lack of political trust, which can be defined as public judgment that the system and its representatives are responsive and reliable. Furthermore, distrust in one institution is related to distrust in other, indicating the unidimensional phenomenon. This kind of distrust is exemplified by the appearance of infodemic -an overabundance of information. In addition, support for conspiracy theories related to COVID-19 which correlates with the scepticism towards vaccination has significantly higher rates among Balkans' populations.

Background:
The vaccine hesitancy is a matter of global concern with inadequate global uptake postponing the moment of reaching herd immunity and bringing the COVID-19 pandemics under control. Countries in the Western Balkans struggle with vaccine hesitancy, trying to bring vaccine acceptance and ways to improve it into the focus.

Methods:
A cross-sectional study on vaccine hesitancy was conducted from July to September 2021 and included adult population from Albania, Bosnia and Herzegovina, North Macedonia, Montenegro and Serbia (1605 individuals). Convenience sampling was applied using anonymized online questionnaire (shared through social media) measuring, among others, trust in societal factors, social responsibility and, the credibility of information sources about COVID-19 vaccines.

Results:
The highest degree of trust in societal factors was found in North Macedonia (M = 3.65, SD = 1.06), followed by Montenegro (M = 3.50, SD = 1.19) and Serbia (M = 3.24, SD = 1.26). In Albania 44.7% respondents believed in reluctance of pharmaceutical companies to publish detailed research reports on the risks of adverse reactions to COVID-19 vaccines. The view that the health authorities when they encourage vaccination do so with the best intentions supported 66,3% respondents in North Macedonia and 49% in Albania and Serbia. The highest level of social responsibility (M = 4.12, SD = 1.09) was revealed in North Macedonia. Primary care physicians, health professionals in media, webpages of public health institutions, and scientific literature are the most trusted sources of information about COVID-19 in all countries.

Conclusions:
The study demonstrated moderate trust in societal factors and moderately high level of social responsibility in all countries. The health professionals enjoy the greatest trust, which implies that medical doctors, especially physicians in primary health care should have a pivotal role in promoting vaccination and educating the general public in the Western Balkans.

Background:
A vaccine promotion campaign is primarily grounded on the selected message features, namely, a carefully chosen information source. People holding diverse views towards vaccination could experience the same information source differently, and it is the comprehension of these diversities that is important to tailor effective interventions. The aim of this study was to determine differences in perceived source credibility between the vaccinated and unvaccinated.

Methods:
Overall 172 adults aged 18 and older from Western Balkans both vaccinated and unvaccinated, voluntarily after obtaining informed consent, were randomly assigned to one of four message interventions. The messages were developed combining two prototypical COVID-19 vaccine decision narratives (determined vs. hesitant) with two communication sources (physician vs. lay peer), resulting in four conditions: determined physician, hesitant physician, determined peer, hesitant peer. After the message exposure, participants evaluated three components of source credibility -expertise, trustworthiness and, goodwill. Two-way ANOVA was applied.

Results:
Compared to the vaccinated, the unvaccinated judged the source as less trustworthy (p < 0.01), regardless of the message they have been exposed to. Although not statistically significant (p = 0.064), the unvaccinated evaluated all sources with the exception of hesitant physician as having a lower level of good intentions. Vaccinated perceived the determined physician as a source with most expertise, while unvaccinated attributed highest expertise to the hesitant physician (without significant difference (p = 0.719)).

Conclusions:
The unvaccinated are generally less likely to experience the information sources as goodwill and trustworthy. In order to perceive the source as more competent the focus should be on the objective characteristics of the communicator, as well as on the congruency in attitudes between the communicator and the audience.

Background:
The COVID-19 pandemic placed a call for action worldwide. Based on scientific investigation, governments need to assess strategic priorities. Health system capacity constraints and failures in response to the pandemic have social, medical, productivity, and economic implications. It compounds health equity issues and confronts with excess mortality, higher chronic disease prevalence, and risk factors. Despite initial progress in vaccination against COVID-19 and attempts to speed up vaccination, the Western Balkan lags behind. Infodemic and low trust in institutions are among the main factors associated with low success and adverse effects on other vaccination programs. This presentation aims to shed light on the importance of health literacy in resilient communities supported by inclusive governance.

Methods:
A narrative review based on literature on inclusive governance, health literacy, and resilient communities during COVID-19 and other emergencies. Primary sources are databases, scientific articles, Health System Response Monitor, and observations by ECDC and OECD.

Results:
Results show that characteristics of resilient communities in possessing knowledge and ability to assess risk, manage an emergency, monitor change, and address threats stand out. Many studies highlight the interconnectedness of community members with the wider external environment and their participation in decision-making to improve health services. Examples include interventions for developing future vaccination programs in program planning, conducting sound evaluations, transferring results to those who need to know, and receiving feedback. The key to this success is enhancing digital and health literacy. Conclusions: COVID-19 requires cross-sectional strategies to reinforce collaborative gains and build resilient communities, ready to apply population strategies for prevention. Inclusive governance and a bottom-up approach will be essential to optimize the response to future challenges. 11.N. Workshop: School-based sexual health education: from evidence to implementation and evaluation Sexual and reproductive health (SRH) is a key dimension of health and well-being of individuals. Sexuality Education (SE) is one of the most important means of promoting sexual wellbeing of youth and a key component of HIV and sexually transmitted infections (STIs) prevention. International treaties and global health organisations explicitly urge governments to take the necessary measures to ensure the provision of SE, that should: be age-appropriate, start as soon as possible, promote mature decision-making, be directed towards improving gender inequalities and engage young people in all phases of activities. It is widely recognised that school plays a central role in learning about health and health promotion skills, including sexuality and sexual health. Although school-based SE (SBSE) alone may not be enough to ensure the rights of young people to SRH and prevent STIs, school programs are a very costeffective way to contribute to these goals. Moreover, 15th European Public Health Conference 2022