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Leveraging Social Networks to Immunize Every Last Child Allison B. Goldberg



Department of Sociomedical Sciences , Mailman School of Public Health, Columbia University , New York , New York , USA Published online: 03 Dec 2013.

To cite this article: Allison B. Goldberg (2013) Leveraging Social Networks to Immunize Every Last Child, Journal of Health Communication: International Perspectives, 18:12, 1399-1401, DOI: 10.1080/10810730.2013.858003 To link to this article:

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Journal of Health Communication, 18:1399–1401, 2013 Copyright © Taylor & Francis Group, LLC ISSN: 1081-0730 print/1087-0415 online DOI: 10.1080/10810730.2013.858003

Guest Editorial Leveraging Social Networks to Immunize Every Last Child

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ALLISON B. GOLDBERG Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA The introduction of vaccines to prevent many childhood illnesses has proven to be one of the greatest public health achievements of the 20th century. Universal immunization has led to the global eradication of smallpox and has almost completely eliminated other infectious diseases, such as polio. Global routine vaccination coverage1 has increased from 75% in 1990 to 83% today, largely as a result of international commitments to reduce childhood illness and death by two thirds worldwide (World Health Organization [WHO] & United Nations Children’s Fund [UNICEF], 2013). Despite this remarkable progress, the remaining gaps in routine vaccination coverage leave 22 million children worldwide unvaccinated and thus susceptible to preventable causes of morbidity and mortality each year (WHO & UNICEF, 2013). Seventeen percent of all children who die before the age of 5 (8.8 million) lose their lives to a disease—such as measles, pneumococcal diseases, or tetanus—that could have been prevented by an existing vaccine (WHO & UNICEF, 2013). According to the WHO, in order to fill the remaining gaps in routine vaccination coverage and meet the global target of 90% coverage by 2020, it is critical that “individuals and communities understand and demand immunizations to be both their right and responsibility” (WHO, 2012, p. 38). Social networks are an underutilized and potentially powerful tool that can be used to increase immunization rates. The Global Vaccine Action Plan 2011–2020 recognizes that social networks can help individuals and communities understand and demand immunizations by allaying fears, increasing awareness, and building trust in vaccines (WHO, 2012). Simply providing information about immunizations or the dangers of vaccinations may no longer be sufficient to compel mothers and families to immunize their children. Instead, what is needed is the dissemination of vital information by individuals with social influence, since these individuals have the natural ability to connect population members to each other and to influence social norms regarding immunization. 1 Global routine vaccination coverage is calculated as the percentage of children globally who received the third dose of the diphtheria–tetanus–pertussis (DTP3) vaccine by the age of 12 months (WHO & UNICEF, 2013). Address correspondence to Allison B. Goldberg, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA. E-mail: [email protected]


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Guest Editorial

The relationships and interactions that occur within social networks are of paramount importance to health because they not only transmit knowledge about illnesses and diseases, but also signal what is perceived to be socially acceptable and “normal” behavior. For example, personal beliefs about immunization (e.g., most people believe that it is beneficial to immunize children) and information about people’s immunization practices (e.g., most people are immunizing their children) (Cialdini & Goldstein, 2004) circulate within social networks. Whether or not these factors subsequently influence other people’s immunization behaviors is a function of learned knowledge about the costs and benefits of using immunizations, social pressure to conform to behavioral norms regarding immunizations (Montgomery & Casterline, 1996), and the relative speed at which individuals within a network adopt this health service (Rogers, 2003). Even with awareness that health decisions are largely influenced by these factors, immunization campaigns often assume that individuals are mainly influenced by information about the costs and benefits of immunization (e.g., by vaccinating my child, I am also protecting my community). While some people may indeed respond most actively to information about the individual and public benefits of immunization, campaigns that draw exclusively on this moral suasion may not reach people who respond more to social pressure exerted by people within their network (e.g., knowledge that a majority of their peers are using immunizations). The impact of immunization campaigns can thus be maximized by incorporating both types of messages into their design. Successfully devising these messages will, however, require information about how social influence is exerted within a community and who the primary influencers are. For example, studies have shown that peers and family members are key influencers in health decision-making (Smith & Christakis, 2008). In some settings, it is husbands, senior females (e.g., senior wives), and specific types of leaders (e.g., religious leaders) that may have an especially pronounced influence on immunization behaviors (Goldberg, 2013). Generating individual and community understanding and demand for immunizations will require expanding the focus of immunization campaigns to include social networks. A coordinated immunization campaign—that integrates the more traditional sources of influence, such as mass media and the formal health system, with that of social influence—could be used to reinforce connections and support between women and families who already immunize their children and other women who have the potential to do the same (Partnership for Reviving Routine Immunisation in Northern Nigeria, Maternal Newborn and Child Health Initiative [PRRINNMNCH], 2013). This approach would help to accelerate progress in reaching the global target of 90% routine vaccination coverage by 2020. Indeed, our ability to meet this target may depend on such an innovation.

References Cialdini, R., & Goldstein, N. (2004). Social influence: Compliance and conformity. Annual Review of Psychology, 55, 591–621. Goldberg, A. (2013). Norms within networks: Opinion leader and peer network influences on mothers/caregivers’ childhood immunization decisions in rural northern Nigeria. (Unpublished doctoral dissertation). Columbia University, New York, NY. Montgomery, M. R., & Casterline, J. B. (1996). Social influence, social learning and new models of rertility. Population and Development Review, 22, 151–175.

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Partnership for Reviving Routine Immunisation in Northern Nigeria, Maternal Newborn and Child Health Initiative (PRRINN-MNCH). (2012). Young women’s support groups in northern Nigeria. Initiative supported by the UK Department for International Development (DFID) and the State Department of the Norwegian Government. Retrieved from http:// Final07March12.pdf Rogers, E. M. (2003). Diffusion of innovations, 5th ed. New York, NY: Free Press. Smith, K. P., & Christakis, N. A. (2008). Social networks and health. Annual Review of Sociology, 34, 405–429. World Health Organization (WHO). (2012). Global vaccine action plan 2011–2020. Geneva, Switzerland: Author. Retrieved from action_plan/GVAP_doc_2011_2020/en/ World Health Organization (WHO) & United Nations Children’s Fund (UNICEF). (2013, July). Global immunization data. Geneva, Switzerland, and New York, NY: Authors. Retrieved from

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