Listening, co-creating and connecting

Kathmandu, Nepal: As Nepal prepared to introduce the human papillomavirus (HPV) vaccine nationwide, for UNICEF this was a chance to test how a layered, human-centred approach—rooted in listening, co-creation and connection—could help overcome the social and cultural barriers that often stand in the way of new vaccines. The aim was not only to build awareness, but also to foster trust in a vaccine that had never before been offered at such scale in the country.

Implemented in phases leading up to the roll out of the vaccines in February 2025, Nepal’s Social and Behaviour Change (SBC) efforts were rooted in the SBC+ model—combining social listening, perception studies, and co-creation workshops to identify and address barriers before, during, and after the campaign. The result: preliminary nationwide coverage reached an impressive 90 per cent by mid-February.

Much of the groundwork began well before vaccines were rolled out. With support from Kathmandu University and UNICEF, researchers conducted a perception study and organized workshops with adolescents, parents, and teachers to understand their concerns. These revealed more than just a knowledge gap—there were widespread misconceptions about infertility, menstruation, and vaccine safety, many of which had been fuelled by online rumours that gained traction during and after the COVID-19 pandemic. Social and cultural norms further discouraged vaccination, particularly when male health workers were involved. For some girls, long lines, lack of privacy, and poor facilities made the experience even harder.

To design effective responses, the campaign combined online and offline listening efforts. From October 2024 to March 2025, social listening tools tracked more than 2,000 mentions and over 2 million online discussions related to HPV. These insights helped shape counter-messaging that addressed recurring myths—such as links between the vaccine and infertility or foreign research—and offered clear, factual information about cervical cancer, which kills more than 40 women per 100,000 annually in Nepal.

At the community level, listening efforts picked up on additional hesitancies. Parents questioned eligibility and worried about side effects. Girls feared the vaccine would restrict menstruation or serve as a covert form of birth control. These concerns were not dismissed—they were acknowledged and addressed through targeted, local communication. Infographics, radio spots, school orientations, and public Q&A sessions helped provide clarity. Community members, including teachers, religious leaders, and youth volunteers, played a key role in building trust face-to-face.

At vaccination sites, counselling services allowed for immediate responses to concerns raised by parents and adolescents. Peer educators and child club members were trained to encourage uptake among their classmates, while on-site coaching helped health workers strengthen their interpersonal communication skills and make the experience more comfortable for girls receiving the vaccine.

Local governments were active partners throughout. Their support helped mobilize demand at the community level and ensured that messages reached families directly. With flexibility built into planning, campaigns adapted to local calendars—avoiding conflict with school exams, festivals, or weddings—and ensured better turnout and participation.

The lessons from this experience remain clear: when communities are heard, involved, and respected, they respond. And when health systems are willing to adapt—not just at the clinic, but at every stage of planning and communication—barriers start to break down.

Nepal’s experience shows how strategic communication and community engagement can shift perceptions, rebuild trust, and turn hesitancy into action.