Pan American Health Organization · 1st edition, 2021
A practical framework for health authorities in the Americas to develop risk communication and community engagement strategies for COVID-19 vaccination programmes.
- Issuer
- Pan American Health Organization
- Edition
- 1st edition, 2021
- Audience
- Ministries/secretariats of health, public health authorities, communication teams managing COVID-19 vaccination in the Americas
- Evidence
- Expert consensus and established risk communication principles
- Reviewed
- 19 Oct 2026 · GMJ
What this guideline says
GMJ summary
This PAHO guide provides a systematic framework for developing risk communication and community engagement (RCCE) strategies for COVID-19 vaccination. It addresses the unique communication challenges posed by phased vaccine rollout, public concerns about vaccine safety and efficacy, managing expectations with limited initial supply, and countering misinformation in the context of an ‘infodemic’.
The guide outlines eight core strategy components: defining objectives (reducing perceived risks, managing uncertainty, increasing vaccine acceptance); establishing official spokespeople and training them; identifying strategic partners across media, civil society and community leaders; mapping latent threats through territorial analysis; defining target audiences with tailored approaches; preparing evidence-based messages; selecting appropriate communication channels; and implementing social listening to adapt messaging based on public concerns.
The document emphasizes proactive rather than reactive communication, two-way dialogue with communities, territorial deployment of communication teams to hard-to-reach areas, continuous monitoring of information flows (telephone hotlines, social media, coverage data), and adaptive management as the vaccination programme evolves through different phases and as new evidence emerges about vaccines and virus variants.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Identify and train 2–3 official spokespeople with credibility, knowledge and empathy to deliver standardized messages and avoid public contradictions
- Define target audiences beyond the general public: priority groups (health workers, elderly, those with comorbidities), non-priority groups requiring explanation of phasing, hard-to-reach populations (isolated communities, immigrants, rural populations)
- Prepare 2–3 key messages maximum per communication event; the public does not retain extensive information and central messages become diluted with excess content
- Establish daily monitoring of information through telephone hotline reports, social media metrics, vaccination coverage data, and media monitoring to identify rumours, misinformation and information gaps requiring response
- Form territorial deployment teams for complex areas to conduct educational activities, respond to doubts, disseminate locally relevant information, and engage communities in the vaccination process
- Map latent threats from highest to lowest vaccine acceptance by geography, identify anti-vaccine groups and their arguments, and prepare evidence-based responses proactively rather than reactively
- Engage strategic partners (media professionals, public figures, social leaders, religious leaders, scientific societies, international organizations) to amplify messages and access hard-to-reach audiences
- Use social listening (focus groups, surveys, social media monitoring) to understand attitudes, behaviours and perceptions, then adapt messages and communication approaches based on findings
Six potential communication scenarios requiring strategy adaptation
Table extracted from the guideline
| Scenario | Key communication challenges |
|---|---|
| Vaccine introduction and partial distribution | Demand from non-priority groups during initial phases; logistics and distribution transparency |
| Administration of several vaccines | Safety, quality, efficacy, schedule and target population differences for each vaccine |
| Priority groups | Selection criteria justification; adherence targets for first and second doses; reasons for vaccine hesitancy; AEFI monitoring and education; reinforcement of protective measures post-vaccination; importance of complete vaccination schedule; equitable distribution and potential delays |
| Non-priority groups | Explanation of exclusion criteria and waiting times; prioritization of protective measures; potential citizen mobilization due to perceived discrimination; potential judicialization |
| Delays in universal access | Purchasing and distribution timelines; international agreements (COVAX, PAHO Revolving Fund); vaccine donations; political and social reactions; global production capacity; bilateral purchases |
| Increased demand for vaccine | Demand from initially non-priority groups; production capacity; country purchasing power; capacity to access more vaccines; strategic partnerships |
Source: Pan American Health Organization, Guide for the preparation of a risk communication strategy for COVID-19 vaccines. Reproduced in summary form.
From the guideline
Verbatim
“Risk communication is considered a linchpin for confronting emergencies that impact public health and is one of the components that the International Health Regulations (IHR) require of World Health Organization (WHO) Member States.”
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 communication during Georgia's hepatitis C elimination programme and UHC implementation, I recognize the critical importance of this systematic approach to vaccine risk communication. The guide's emphasis on territorial deployment resonates strongly with our experience—Georgia's mountainous geography and dispersed rural populations require locally trusted messengers, not just central ministry spokespeople. The framework for identifying and countering misinformation proactively is particularly valuable given the Russian-language disinformation that has affected vaccine confidence in Georgia and across the South Caucasus. For Georgian implementers, I would stress the section on community engagement and partnering with religious leaders, given the Georgian Orthodox Church's significant influence on public health behaviours. The main implementation challenge will be maintaining the recommended daily monitoring of telephone hotlines and social media while health communication teams are already stretched thin managing routine immunization messaging and responding to other public health priorities with limited dedicated communication staff.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 19 Oct 2026
Applicability
Georgia and the South Caucasus
Georgia has demonstrated strong vaccine introduction capacity (rotavirus vaccine in 2013, routine immunization programme achieving >90% coverage for most antigens) and experience with risk communication during the COVID-19 pandemic. This framework is directly applicable to Georgia’s ongoing COVID-19 vaccination programme and future vaccine introductions. The emphasis on territorial deployment is particularly relevant for reaching rural populations in mountainous regions of Georgia and addressing vaccine hesitancy in specific communities. Georgian health authorities should adapt the community engagement strategies to account for the country’s linguistic diversity (Georgian, Armenian, Azerbaijani-speaking populations), orthodox Christian religious context where clergy can be strategic partners, and experience with misinformation campaigns. The guide’s focus on monitoring social media and telephone hotlines aligns with Georgia’s existing digital health infrastructure. For the wider South Caucasus region, the framework’s guidance on managing multiple vaccines with different efficacy profiles and addressing cross-border information flows (particularly Russian-language misinformation) would require specific adaptation.
Questions this guideline answers
Quick answers
How many key messages should spokespeople communicate at one time?
Limit to 2–3 key messages per communication event. The public does not retain large amounts of information and central messages become diluted when too much is communicated. Be proactive rather than reactive, and avoid speaking more than necessary.
Which audiences should risk communication prioritize?
Target messages to audiences willing to be vaccinated who need information, and focus on convincing the undecided. Avoid expending energy on those who will not change their minds. Do not minimize audience concerns—every question is useful for clarifying concepts that may not have been completely clear.
How should authorities respond to anti-vaccine groups?
Identify who they are, where they are located, how much support they have, and what they say. Analyze their discourse and prepare evidence-based responses proactively. Avoid fruitless public debates. Respond indirectly with data, validated information and evidence to dispel public doubts rather than engaging in direct confrontation.
What information monitoring should be implemented during vaccination campaigns?
Daily reports from telephone hotlines on main queries; vaccination coverage monitoring by group; daily or weekly social media metrics on main topics; observation of what is happening in other countries; and monitoring of anti-vaccine declarations to determine whether indirect evidence-based responses are needed.
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Quality & accreditation
- ASF PHC — Standard 4 — Acute & Same-Day Care · Primary Health Clinic
- ASF PHC — Standard 7 — Governance & Staffing · Primary Health Clinic
- ASF Hospital — Standard 5 — Safety & Emergency Preparedness
- ASF Hospital — Standard 11 — Critical Care
- ASF Medical Transport — Standard 6 — Emergency Response During Transport
Other guidelines on this topic
- Guidelines for Prophylaxis and Management of Patients with Mild and Moderate COVID-19 in Latin America and the Caribbean
- Crisis Communication related to vaccine safety: Technical guidance
- 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
- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Edition
- 1st edition, 2021
- Status
- Current
- Published
- 2021-01-01
- Languages
- English, Spanish, Portuguese
- Scope
- Risk communication and community engagement strategy development for COVID-19 vaccination programmes
- Audience
- Ministries/secretariats of health, public health authorities, communication teams managing COVID-19 vaccination in the Americas
- Licence
- CC BY-NC-SA 3.0 IGO
- Evidence
- Expert consensus and established risk communication principles
- Record history
- Created 19 Oct 2026 · updated 19 Oct 2026 · next check Apr 2027
Pan American Health Organization. Guide for the preparation of a risk communication strategy for COVID-19 vaccines: A resource for the countries of the Americas. Washington, D.C.: PAHO; 2021. (PAHO/IMS/FPL/COVID-19/21-0009).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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