The national COVID-19 vaccination strategy in North Macedonia aims at achieving 70% uptake for 2 doses of vaccine by 30 June 2022. However, only 46.5 % of the population have received 2 doses of vaccines and 8.4% have received a third dose.
Results from 2 recent behavioural insights studies conducted by the WHO Country Office, North Macedonia, highlight a low interest in COVID-19 vaccination among unvaccinated citizens. Using data collected in February–March 2022, the studies assessed risk perceptions, behaviours, trust and knowledge related to the COVID-19 pandemic among the general public and health care workers in the country.
“Behavioural and cultural insights are profoundly changing the way we work with public health issues, such as antimicrobial consumption, vaccine acceptance, mental health, and health literacy,” noted Dr Anne Johansen, WHO Special Representative and Head of Office at the event ‘Latest behavioural insights studies on COVID-19 in North Macedonia: What do they tell us?’ organized on 12 April 2022 in Skopje. “These studies are not only conducted to create suitable messaging, but also to monitor knowledge, practices and beliefs related to what we know so far about the virus, in order to create acceptable interventions.”
Population insights guide response
The event gathered representatives from the United Nations family, health professionals and members of academia and the non-governmental sector to discuss the results from the studies and their implications for future policies related to the COVID-19 response.
“Population insights become increasingly important to inform response measures,” said Dr Bekim Sali, Minister of Health. “The results from the studies will be valuable evidence to guide further communication and messaging, decreasing people’s resistance to public health initiatives, especially related to COVID-19 vaccination.”
The results from the studies reveal that, in general, the decision to get vaccinated against COVID-19 was mostly affected by the possibility of serious side effects, whether the vaccine had been in use for a long time, and the producer of the vaccine. Regular access to consistent information and up-to-date evidence on these issues could motivate health care workers to be vaccinated and help them address patients’ concerns regarding vaccination.
Building trust in communication
The data shows that around two-thirds of the respondents find it is easy to understand information on what to do if they think they have COVID-19 and understand and follow recommendations about COVID-19 vaccination. However, with the epidemiological situation in the country stabilizing, 7 out of 10 citizens never or rarely seek information about COVID-19.
The most trusted sources of information are the health care workers, followed by the Ministry of Health and the Institute of Public Health. The majority of respondents (52%) do not find it easy to judge whether the information about COVID-19 in the media is reliable.
“We need to be open and transparent if we are to build more trust in communicating with the public in different segments of the COVID-19 pandemic response”, said Thanas Goga, Risk Communication and Community Engagement Technical Officer at the WHO Health Emergencies (WHE) Balkan Hub. “We need a tailored approach and targeted communication. We need to speak to different community groups, through different community structures, for different targets in a different language, and probably using different communication channels, in order to reach them and make information more accessible to them, with community engagement being the missing link.”
Next steps to turn results into action
Gaining a better understanding of the public and health care workers’ perceptions about the COVID-19 pandemic and vaccination is an important part of WHO’s work to support national efforts in ensuring successful uptake of COVID-19 vaccination. Evidence-based messaging can lead to positive social and behaviour change, community engagement, shielding of high-risk populations, and a decrease in people’s resistance to public health initiatives.
“Behavioural factors, including social and cultural aspects, account for an overwhelming 60% of the determinants of health, compared to medical care, which accounts for just 11%,” added Dr Johansen. “This is why the ‘United Action for Better Health’ European Programme of Work (2020–2025), adopted by all WHO European Region Member States, identifies behavioural and cultural insights as a flagship priority. WHO will further engage and support forthcoming activities to transform the findings into productive actions for the benefit of the population in the country.
The findings from these studies, undertaken with financial support from USAID North Macedonia, will be taken forward by the health authorities to define immediate policy and communication actions.