Using Advocacy to Increase Investment in Enteric Vaccine Development

Enterotoxigenic Escherichia coli (ETEC) and Shigella are among the leading bacterial causes of moderate-to-severe diarrhoea among children under 5 years of age. Yet, catalysing and sustaining momentum for long-term research investments can be a challenge. The workshop "Using advocacy to increase investment in enteric vaccine development" provided a forum at the July 2018 Vaccines Against Shigella and ETEC (VASE) Conference to build the capacity of scientists to communicate about their own research and advocate for additional attention and funding for enteric disease and vaccines research. Workshop presenters shared best practices and examples of advocacy, communications, and messaging tactics that have been used during early stages of vaccine development research for other pathogens. The presentations were followed by an interactive, hands-on training for real-life communication opportunities for scientists, including a review of media interview best practices. This article provides an overview of the discussions.

The first two presenters (this paper's authors) shared their experience with PATH's Defeat Diarrheal Disease (DefeatDD) Initiative:

• Hope Randall focused on the importance of knowing one's audience, their motivations, and their influencers when engaging in global health advocacy and communication. Though any presentation should be evidence-based, she stressed, deeper reader engagement with the data and can take many forms, including compelling anecdotes, memorable angles, personal asides, or framings of a topic within broader trends and themes. For example, recent research has shown that messages about children reaching their full potential resonate best with global health donors. This finding can inform the framing of messages and data around the burden of ETEC and Shigella diarrhoea, which have a lower mortality but a significant underlying burden of morbidity. Randall also explained that the DefeatDD Initiative has found that presenting a problem (e.g., the global burden of diarrhoea) without a feasible solution can engender feelings of helplessness instead of constructive engagement.
• Because diarrhoea gets less attention than other global health issues, Laura Edison Kallen stressed the need for many voices and methods to raise awareness and urgency for solutions. Kallen emphasised that there can be significant overlap between presenting data and advocating; that is to say, when evidence is presented in an engaging, relevant, and memorable way, it helps the message stick and consequently raises awareness of the issue among that audience. In this way, scientists may already be more engaged in advocacy than they realise. Outlets for advocacy Kallen discussed included social media, traditional media, blogs and other non-traditional media, institutional and academic networks, in-person advocacy events, and scientific meetings and conferences. Kallen encouraged scientists who may not feel comfortable using social media themselves to connect with their institutional social media managers when they have results or messages to share. Even if a particular study seems too technical for a lay audience, Kallen urged participants to work with their institutional communications departments, as well as those of interested partners, to see if there could be a "hook" for a media story or press release. Finally, Kallen presented best practices for how to disseminate evidence to key audiences. These included:
  1. connecting first with institutional media and communications departments to learn about their media contacts, opportunities, and processes;
  2. reading and following relevant news, blogs, and social media channels to understand their coverage, angles, and areas of influence;
  3. being clear, concise, and accurate about research;
  4. stressing findings that are most surprising and/or unique; and
  5. leveraging partners, connections, and networks for advocacy opportunities.

The final two presenters shared case studies of advocacy tactics they have used in the past to increase investment or interest in vaccine research in low-income country settings:

• Dr. Rubhana Raqib from the International Center for Diarrheal Disease Research, Bangladesh (icddr,b) explained how, by engaging in communications and advocacy activities to raise awareness of the burden of cholera and polio and the success of their vaccine trials, scientists at icddr,b were able to accelerate the introduction of these vaccines in Bangladesh. Tactics included disseminating research via media in several languages, producing multimedia content, tagging research collaborators on digital media when disseminating results, and sharing information directly with policymakers. Raqib characterised icddr,b's partnership and collaboration with the government as an asset. She also shared a video that icddr,b developed with DefeatDD in 2017 to raise awareness about their work in ETEC and Shigella vaccine development.
• Dr. Roma Chilengi from the Centre for Infectious Disease Research, Zambia (CIDRZ) shared his experiences advocating for rotavirus vaccine development and introduction in Zambia, emphasising the importance of advocating "from wherever you are" and the idea that scientists are a key part of that collective responsibility. Scientists like Chilengi became involved by speaking directly to decision-makers, raising awareness of the burden of rotavirus and the availability and potential impact of rotavirus vaccines, working to update and improve Zambia's existing health and cold chain system, and networking with the global community to gain more information and resources. Chilengi urged scientists to become involved in local, small-scale studies whenever possible, because local data are a powerful advocacy tool when talking to local decision-makers. In response, while some participants expressed the need for further routine diagnostics and surveillance of ETEC and Shigella disease in order to measure the potential effect of an intervention like a vaccine, others expressed that the issue lies in a lack of communication and dissemination of the data that already exist.

"All participants in the workshop agreed that the enteric vaccine field needs to do a better job of sharing results externally - not just to other scientists but also to policymakers, donors, the media, and the advocacy community. While a variety of diverse tactics can help disseminate messaging to appropriate audiences, scientists should consider how to craft messaging that is evidence-based as well as resonant, memorable, and impactful. As presenters emphasized, if those working on enteric vaccines do not talk about the importance of these investments, no one else will."