Using Adaptive Learning to Improve COVID-19 Vaccine Interventions in Eastern Europe

The COVID-19 pandemic put immense pressure on Moldova, North Macedonia, and Serbia’s healthcare systems. Despite vaccine rollouts, coverage remained low due to misinformation, lack of health worker training, and ineffective communication. Pregnant women and people with chronic disease 45 years and older (priority populations) were particularly hesitant to get vaccinated, and their health providers inconsistently recommended the vaccine. To address these challenges, MOMENTUM Routine Immunization Transformation and Equity (the project) used a behavioral integration approach to design, implement, and monitor activities promoting two key behaviors: 1) Priority populations get the full course of COVID-19 vaccine and, 2) providers recommend the COVID-19 vaccine to priority populations. The project used collective engagement (CE) participatory workshops and continuing medical education (CME) training to promote these behaviors. Given the difficulties engaging vaccine-hesitant populations, the project integrated adaptive learning approaches such as after-action reviews, monthly pause-and-reflect meetings, and quarterly learning exchanges to create rapid feedback cycles. These approaches helped make key adaptations in program strategies. Some adaptations included the creation of a frequently asked questions document for CME trainers, and an updated curriculum in Moldova to include information on influenza and measles vaccinations. In Serbia, the project gave CE workshop participants take-home gifts to remind them about the importance of getting the COVID-19 vaccine and implemented pilot workshops in homes with family members. Adaptations appeared to have increased participant satisfaction and enhanced the two desired behaviors. Additionally, the project demonstrated that adaptive learning can be effectively integrated into program cycles to support continuous improvement.