Pan American Health Organization · 1st edition, 2021
Guidance for national immunization programmes on preparing, implementing and evaluating crisis communication plans to maintain public trust in vaccines
- Issuer
- Pan American Health Organization
- Edition
- 1st edition, 2021
- Audience
- National immunization programme managers, national regulatory authorities, ministries of health, regional immunization bodies
- Evidence
- Expert consensus based on WHO Regional Office for Europe vaccine safety communication evidence and PAHO field experience
- Reviewed
- 19 Oct 2026 · GMJ
What this guideline says
GMJ summary
This technical guidance document helps health authorities develop communication plans to manage crises related to vaccine and vaccination safety. It complements the ESAVI surveillance system by providing structured approaches to maintain or rebuild public trust when adverse events, programme changes, or negative media coverage threaten confidence in immunization programmes.
The guidance organizes crisis communication into three phases: Preparation (understanding evidence, working with key actors, establishing coordination mechanisms, monitoring perceptions), Implementation (coordinating response groups, creating strategies, sharing information, monitoring public opinion), and Evaluation (assessing effectiveness, sharing lessons learned, revising plans). It emphasizes bidirectional communication, transparency, empathy, and addressing the gap between expert evidence and public risk perception shaped by emotions and cognitive biases.
Events are classified by impact level (low/medium/high) and type (ESAVI, programme changes, negative publications). High-impact events require immediate response with prepared spokespeople, aligned key messages across all actors, and adapted communication channels. The framework stresses that crises are opportunities to strengthen systems, that trust depends more on how concerns are handled than on evidence alone, and that resilient, well-informed populations are the best defence against vaccine hesitancy.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Classify all vaccine safety events by type (ESAVI, programme changes, negative publications) and impact level (low/medium/high) to determine appropriate response intensity
- For high-impact events, activate the response coordination mechanism within the first hours and communicate immediately, even when uncertainty exists
- Prepare three core key messages with three supporting messages each (3×3 message map structure) during preparation phase, adapted to specific crises during implementation
- Monitor public opinion through multiple channels: press summaries, social media surveillance, direct health worker reports, and public inquiry lines
- Build trust through six COTICE principles: Competence, Objectivity, Transparency, Inclusivity, Consistency, and Empathy in all communications
- Close the risk perception gap between experts (who use evidence) and public (who use emotions and heuristics) through adapted, empathetic messaging that acknowledges concerns
- Establish a vaccine safety communication working group during preparation phase with defined roles, trained spokespeople, and pre-drafted message maps
- Evaluate communication response using six indicator types: access, feasibility, credibility/trust, relevance, temporality, and comprehension across all target audiences
Classification to evaluate the potential impact of an event
Table extracted from the guideline
| Impact Level | ESAVI | Programme Changes | Negative Publications/Debates |
|---|---|---|---|
| Low-impact | Event is not serious; or serious but not relevant in context; receives no media/public attention | One vaccine replaced with small formulation changes; receives no media/public attention | Receives little/no attention; unlikely public impact; message does not trigger emotions; low credibility story |
| Medium-impact | Event is serious and relevant; does not receive media attention yet but can be anticipated; dynamic situation | Any schedule modification (replacement, target group changes) with little/no public attention, but foreseeable later interest; vaccine replacements usually medium impact | Story receives some public attention; triggers some concerns/fears; is plausible |
| High-impact | Significant media attention and intense public reactions; serious; cause unknown; dramatic/difficult to forget; occurs during programme change; several ESAVI or serious reactions | Negative media coverage; significant public concern with reasons not understood; cultural sensitivities trigger negative response; change related to vaccine safety; new incorporation/withdrawal/suspension/campaigns tend to be high impact | Story receives significant public attention and triggers fears; source has large audience and strong credibility/influence; investigation receives significant public attention; related to sensitive groups (pregnant women/children); published during programme changes |
Source: Pan American Health Organization, Crisis Communication related to vaccine safety: Technical guidance. Reproduced in summary form.
From the guideline
Verbatim
“All good responses to a crisis begin with good preparation.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As someone who has worked with WHO on health system strengthening in Georgia, I recognise that our national immunization programme's recent successes—introduction of rotavirus vaccine in 2013, high routine coverage—make us vulnerable to complacency about crisis preparedness. The guidance's emphasis on the risk perception gap is critical: Georgian parents increasingly access anti-vaccine content through Russian-language social media, and our traditional respect for medical authority is eroding among younger urban populations. The recommendation I would stress to colleagues is to establish the vaccine safety communication working group now, during calm, with trained spokespeople and pre-drafted message maps, because our small country means an ESAVI in Batumi will be national news within hours. The realistic caveat is that Georgian media often prioritise dramatic narratives over evidence, and our public health communication capacity is limited—we would need technical assistance to implement the full social media monitoring and rapid response system this guidance envisions, but even partial implementation of the three-phase framework would substantially improve our current ad-hoc approach to vaccine safety communication.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 19 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus, this guidance is directly relevant to national immunization programmes that have introduced new vaccines (rotavirus, HPV) and face increasing social media-driven vaccine hesitancy. Georgian health authorities would need to adapt the framework to local media landscapes dominated by regional television and Facebook, establish coordination between the National Center for Disease Control, Ministry of Health communications units, and the regulatory agency. The emphasis on addressing emotional and cultural determinants of risk perception is particularly important in contexts where traditional community leaders and social media influencers may have greater credibility than official spokespeople, and where historical mistrust of institutions can amplify minor adverse events into crises.
Questions this guideline answers
Quick answers
When does a vaccine safety event become a crisis requiring immediate response?
A high-impact event requires immediate response when it receives significant media attention and intense public reactions, is serious with unknown cause, is dramatic or affects vulnerable groups (children, pregnant women), or occurs during programme changes. Medium-impact events require intensified preparation but not yet public communication. Low-impact events continue routine communication only.
How should we communicate when we don't yet know the cause of an ESAVI?
Communicate immediately what is known, acknowledge what is unknown, explain transparently what is being done to investigate, when more information will be available, and where the public can get updates. Honesty about uncertainty builds more trust than silence or speculation. State that preliminary data show no causal relationship if that is accurate, while investigation continues.
What is the 3×3 message map structure and how do we use it?
Prepare three key messages, each supported by three specific supporting messages with data/evidence. This structure (maximum nine points) is memorable under pressure, ensures consistency across spokespeople, and allows bridging from any question back to core messages. Example: Key message 'Measles is dangerous' supported by '1 in 500 US children with measles dies,' 'complications include pneumonia, encephalitis, blindness,' and 'almost 150,000 died globally in 2013.'
Who should be the spokesperson during a vaccine safety crisis?
Ideally the highest-level national health authority or delegated senior official, trained ahead of time. A single coordinated spokesperson prevents contradictory messages that erode trust. For specific crises, supplement with credible technical experts (e.g., paediatricians for child deaths, obstetricians for pregnancy events). Identify and prepare backup spokespeople during the preparation phase, and consider involving trusted community leaders if official credibility is compromised.
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- Considerations on Thrombotic Events Following Administration of the Oxford-AstraZeneca COVID-19 Vaccine in Europe
- Developing national meningitis plans: an operational manual
- A Guide for Evidence-Informed Decision-Making, Including in Health Emergencies
- Regional Framework for the Monitoring and Re-Verification of Measles, Rubella and Congenital Rubella Syndrome Elimination in the Americas
- Influenza and Other Respiratory Viruses: Surveillance in the Americas 2021
- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Edition
- 1st edition, 2021
- Status
- Current
- Published
- 2021-01-01
- Languages
- Spanish
- Scope
- Crisis communication strategies for events that may erode trust in vaccines, vaccination, and immunization programmes
- Audience
- National immunization programme managers, national regulatory authorities, ministries of health, regional immunization bodies
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 978-92-75-12312-6 (PDF)
- Evidence
- Expert consensus based on WHO Regional Office for Europe vaccine safety communication evidence and PAHO field experience
- Record history
- Created 19 Oct 2026 · updated 19 Oct 2026 · next check Apr 2027
Pan American Health Organization. Crisis communication related to vaccine safety: technical guidance. Washington, D.C.: PAHO; 2021. (ISBN: 978-92-75-12312-6).GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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