The Little Jab Book: A Playbook for COVID-19 Vaccination in Papua New Guinea

"Understanding the underlying belief systems and norms are essential to design effective strategies that drive up vaccination rates."

COVID-19 vaccination uptake rates have been low in Papua New Guinea (PNG). Inspired by the Little Jab book series, this playbook seeks to uncover the underlying reasons for vaccine hesitancy among adults in PNG and to identify localised solutions to increase uptake of the COVID-19 vaccine. While improving the supply of vaccines is vital to increased uptake, the 12 evidence-based behavioural interventions outlined in this playbook focus on improving demand for vaccination, improving the process for following through on intentions, and building confidence in vaccines, their safety, and their efficacy.

The playbook development began with desk and on-site research on the COVID-19 situation in PNG, active vaccine uptake initiatives, and existing research on the barriers to and enablers of vaccination uptake. Eleven local researchers were trained in conducting in-depth interviews, which they conducted in nine provinces in PNG with 22 women and 27 men. Next, the Busara Center for Behavioral Economics and Save the

Children facilitated two co-design and prioritisation workshops with seven project staff. The initial brainstorming phase generated 95 ideas, which were revised and condensed into 15 complete design concepts. The playbook, featuring 12 of those concepts, was reviewed by key local stakeholders, whose feedback was incorporated in the final version

The playbook first examines the 5 key behavioural barriers to full vaccination in PNG, including: (i) belief in traditional rememdies and lack of urgency; (ii) fear of side effects and low trust in the vaccine; (iii) confusion, misinformation & lack of accurate information; (iv) lack of social proof (explicit and implicit social norms); and (v) limited endorsement of vaccination by religious leaders.

Next, the playbook introduces 5 personas, who are representations of common barriers and scenarios discovered in the qualitative research. Each description provides examples of the experiences people have faced and outlines their level of hesitancy and how they view the vaccines. They include: (i) Adaptive Operators: do not think the vaccine is necessary; (ii) Skeptical Sustainers: have strong fear and low trust in the vaccine; (iii) Careful Planners: are confused about the vaccine; (iv) Community Followers: weigh others' opinions; and (v) Faithful Upholders: are against the vaccine due to religious beliefs.

Finally, the playbook discusses possible solutions for the identified barriers, indicates for which personas they might be most effective and which behavioural science concepts they use, and offers contexualisation tips. In brief, the solutions include:

1. Make religious beliefs part of the vaccine drive.
2. Integrate COVID-19 vaccines into the routine public health system, and promote it with existing public health events.
3. Link COVID-19 vaccines with other routine vaccines.
4. Reframe the risks of COVID-19 vaccines.
5. Increase understanding of COVID-19 vaccines through talk shows.
6. Gather testimonies to build a positive narrative around getting vaccinated.
7. Normalise getting the COVID-19 vaccine.
8. Counter vaccine rumours and misinformation by activating "rumour warriors".
9. Shift and message the social norm of promoting COVID-19 vaccines.
10. Make the information easily accessible and salient in public.
11. Prepare healthcare workers for Q&A at awareness activities.
12. Reframe the relation between COVID-19 vaccines and traditional remedies.

The publishers hope this playbook can inspire smaller, local initiatives by community leaders. To that end: "The implementation and use of this playbook should be tailored to the local context. For all interventions in this book, consider how they might work in your province, what might need to be changed to make them more contextually appropriate, and how they might be perceived by the community." Worksheets and implementation tips that conclude the playbook are designed to support this contexutalisation.