{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T14:25:00Z","timestamp":1782483900688,"version":"3.54.5"},"reference-count":50,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2024,4,10]],"date-time":"2024-04-10T00:00:00Z","timestamp":1712707200000},"content-version":"unspecified","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2024,3,31]]},"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:p>In a health emergency, governments rely on public trust in their policy, and anticipate its compliance to protect health and save lives. Vaccine hesitancy compromises this process when an emergency involves infections. The prevailing discourse on vaccine hesitancy often describes it as a static phenomenon, ignoring its expanse and complexity, and neglecting the exploration of tools to address it. This article diverges from the conventional perspective by explaining the case of Pakistan and its communication strategy for the COVID-19 vaccine. Decades of polio vaccine hesitancy, rooted in the country\u2019s fight against terrorism, constitute its history. On the other hand, the first-ever launch of typhoid conjugate vaccine involving 35\u2009million kids during 2019\u20132021 was a success. Against this backdrop, the country considered vaccine hesitancy as a dynamic phenomenon, interwoven with the social ecology and the responsiveness of the healthcare system. Its communication strategy facilitated those willing to receive the vaccine, while being responsive to the information needs of those still in the decision-making process. In the face of both hesitancy and a scarcity of vaccine doses, the country successfully inoculated nearly 70% (160 million) of its population in just over 1 year. People\u2019s perceptions about the COVID-19 vaccine also improved over time. This achievement offers valuable insights and tools for policymakers and strategists focused on the demand side of vaccine programmes. The lessons can significantly contribute to the global discourse on improving vaccine confidence and bolstering global health security.<\/jats:p>","DOI":"10.1136\/bmjgh-2024-015200","type":"journal-article","created":{"date-parts":[[2024,4,10]],"date-time":"2024-04-10T13:20:11Z","timestamp":1712755211000},"page":"e015200","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Building confidence in the COVID-19 vaccine in a polio-endemic country: strategic communication lessons from Pakistan"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4656-9879","authenticated-orcid":false,"given":"Zaeem Ul","family":"Haq","sequence":"first","affiliation":[{"name":"GAVI the Vaccine Alliance, Islamabad, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9147-5911","authenticated-orcid":false,"given":"Soofia","family":"Yunus","sequence":"additional","affiliation":[{"name":"World Bank, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6486-0452","authenticated-orcid":false,"given":"Naveed","family":"Jafri","sequence":"additional","affiliation":[{"name":"Expanded Programme on Immunisation, Pakistan Ministry of National Health Services Regulations and Coordination, Islamabad, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,4,10]]},"reference":[{"key":"2025073015272726000_9.4.e015200.1","doi-asserted-by":"crossref","DOI":"10.1016\/j.jpubeco.2020.104316","article-title":"Trust and compliance to public health policies in times of COVID-19","volume":"192","author":"Bargain","year":"2020","journal-title":"J Public Econ"},{"key":"2025073015272726000_9.4.e015200.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2015.04.036"},{"key":"2025073015272726000_9.4.e015200.3","unstructured":"World Health Organization . 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