Behavior integration for a sustainable COVID-19 vaccination in Serbia, North Macedonia, and Moldova

ISSUE/PROBLEM: In Serbia, North Macedonia, and Moldova, USAID's MOMENTUM Routine Immunization Transformation and Equity project is using a behavioral integration approach to increase COVID-19 vaccine uptake in priority populations. This approach is aimed at changing provider and community behaviors to embrace COVID-19 vaccination as part of a healthy lifestyle. This approach may be applicable and replicable in countries around the world. DESCRIPTION: In an effort to implement a sustainable model for COVID-19 integration into the primary healthcare system, the project applied a behavioural integration approach to understand barriers and motivators to COVID-19 vaccination. In all three countries, we collected qualitative data through interviews with public health decision-makers, immunization health professionals, and other key partners, and focus group discussions with members of the priority populations. RESULTS: The project created profiles for each priority behaviour, detailing barriers and motivators to adopt it, and supporting people and their actions. We conducted participatory workshops with relevant immunization stakeholders that validated and prioritized key behaviors, and conceptualized integrating COVID-19 vaccination into a healthy lifestyles’ framework. We identified effective messages to promote vaccine uptake, and a course curriculum focused on healthy lifestyles, life-course immunization, and person-centred care. LESSONS: Behavioural insights and the behavioural integration approach helped identify and prioritize critical COVID-related behaviours to increase vaccine uptake amongst key priority populations. For the first time in the region, we proposed the integration of COVID-19 vaccination into a primary healthcare platform, focused on healthy lifestyles and life course immunization, as well as person-centered care, which aligned well with both governments’ and populations’ priorities. KEY MESSAGES: • Behavioral insights and behavioral integration helped identify priority populations and behaviors, and better align the respective priorities of populations and governments for COVID-19 vaccination. • Participatory workshops with relevant stakeholders, together with evidence from qualitative and quantitative research, allowed us to design and adapt public health interventions.