Communication Strategies to Combat COVID-19 Vaccines Hesitancy

COVID-19 infectious disease resulted in a pandemic that has threatened millions of people in the world. It is caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), and it has created a global health crisis. Hence, the present study aimed at assessing communication strategies used by Ethiopian Public Health Institute and Ministry of Health to address COVID-19 vaccine hesitancy, make analysis of vaccination messages, and hybrid media messages to label best practices of communication techniques to address vaccine hesitancy. To attain this objective, a qualitative research method was employed to analyze messages that were disseminated with the Original Research Article Yemer et al.; JPRI, 33(40B): 72-85, 2021; Article no.JPRI.71593 73 hybrid national and regional media and social media platforms. MOH and EPHI disseminated messages; ministers, prominent people, opinion leaders and activists’ speeches used as subjects of the study. COVID-19 vaccination messages were selected through purposive sampling method. The contents of messages regarding health communication were analyzed. The finding showed that building COVID-19 vaccine acceptance through effective communication is important to stop the spread of the virus. The participatory and presumptive style communications are the possible method to promote COVID-19 vaccination before it reaches on refusal stage. Moreover, the results revealed that communication strategies contributed to vaccine advocacy and vaccination campaign to improve vaccine acceptance. MOH and EPHI used the hybrid media to mold the unscientific information and the misinformation of the vaccine. In sum, using effective communication strategies is very important to create awareness about COVID-19 vaccines, and avoid vaccine hesitation to strength the public vaccines acceptability.


INTRODUCTION
The blowout of COVID-19 infectious disease resulted in a pandemic that has threatened millions of lives. It is caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) [1]. The virus didn't have a vaccine for a year to cure, but to protect the spread of COVID-19, different mechanisms were taken: frequent hand washing with soap, using alcohol-based hand sanitizer, stay at home, avoidance of hand shaking/public gathering, and using face mask [2].
Scientists and health institutions were trying tirelessly to find the vaccine, and the first mass vaccination program started in early December 2020. 175.3 million vaccine doses have been administered in three platforms in Feb 2021 [3]. The vaccine was distributed all over the world by COVAX, and administered by the health organizations despite the doubts and limitations. Headache, muscle ache, feeling tired, fever and tenderness, swelling and/or redness at the injection site were the common side effects [4]. AstraZeneca brought a blood clot in Ghana [5], Netherland, France, Germany [6], so 18 suspended to use the vaccine [7].
Due to this, people in Ethiopia felt hesitancy on the cure of the vaccine. However, in Ethiopia there are 269, 782 total COVID-19 cases (34, 054 active cases, 231, 635 recovered and 4, 093 deaths) that were recorded on May, 2021 [8]. MOH and EPHI tried to disseminate information presentation mechanisms via hybrid media and declared a state of emergency [9] besides giving the vaccine. Ethiopian Public Health Institute (EPHI) prepared a national risk communication team and engagement plan to develop and identify the packages of key messages and shared with rapid response teams based on the polls result of the public even if it was not sufficient. 8335 hotline was being used by the institute to revive and respond to public calls and to monitor rumors and misinformation [10].
Ethiopia had received the first 2.184 million doses of AstraZeneca COVID-19 vaccine via the COVAX facility on Mar 7, 2021 [11,12], and MOH launched COVID-19 vaccine introduction ceremonies in high level national events at Eka Kotebe COVID-19 Hospital on March 13, 2021 [13]. At the ceremonies, different state ministers, Dr. Boureima Hama Sambo, the representative of the WHO in Ethiopia, prominent people, religious leaders, opinion leaders, UN, CDC, NGOs representatives, health workers and media experts were attended. The ceremony was going at the same time in different regional cities (FBC March 13, 2021 reportage).
Nevertheless, different media and opinion leaders expressed their hesitation concerning the vaccine. Diverse opinions and myths of COVID-19 are spreading and getting acceptability easily. Due to this, people were reluctant and maleficent towards vaccination, and they had low vaccine acceptability rate in Nigeria [14]. Even if the vaccine is testified and licensed by WHO to cure COVID-19, people have hesitancy about the medicine on vaccination services [15]. The people have different understandings about the vaccine. The accuracy level of the medicine and the side effects lead people to hesitate. However, vaccination is one of the world's most important medical interventions to save people against acute and chronic infections and their consequences in a year [16,17].
The concept of vaccine hesitancy has been considered by WHO as one of the top ten treats to global health [18]. Unquestioning acceptors, cautious acceptors, hesitant group, late or selective vaccinator and refuser have been identified by researchers concerning vaccines [19]. Different studies verified the COVID-19 vaccine hesitancy [20,21]. Long life of WHO experts established the vaccine confidence project and the vaccine advisory committee to create awareness, potential strategies and to strengthen vaccines acceptance hesitancy [22].
The social media platforms affected the mainstream media messages which were disseminated at the national level. COVID-19 vaccination did not have any complementary policy because it was a pandemic, and the vaccine was not accessible in a short period of time for the Ethiopian population. The Federal Government of Ethiopia planned to give a vaccine for 20% of the population at the end of 2021 (Fana Broadcasting Corporate March 15, 2021 Reportage). Nonetheless, the people politicized and gave low attention to the vaccine to compare with the current ethno-centered conflicts and war going in the state, and the negative attitude towards health institutions. The study which was conducted in Addis Ababa revealed that people were unwilling to take the vaccine due to the fear of the side effects; they developed negative attitudes towards the vaccine, and they saw it as biological weapons [23].
As a consequence, effective communication is necessary for the implementation of the vaccine policy. It can be delivered credible information to the people to build trust and avoid vaccine hesitancy. MOH and EPHI involve defining the organization 's  overall  strategy  for  communication,  analyzing  the  relevant  constituencies and delivering messages appropriately [24]. Based on these scenarios, the study was conducted to assess communication strategies used by MOH and EPHI. More specifically, the study tried to (1) identify vaccine hesitancy, (2) evaluate delivered messages, and (3) assess the best practices of communication techniques to address COVID-19 vaccine hesitancy.

METHODS
For the effectiveness of this study, a qualitative method was used to analyze messages disseminated with the hybrid national and regional media, and social media platforms in the time frame of March 13, 2021, to April 26, 2021. MOH and EPHI disseminated messages, ministers, prominent people, delegators, and opinion leaders' speeches were the subjects of the study. The messages were selected using the purposive sampling technique; they were mainly prepared in Amharic language and transcribed into English language. The messages contents were analyzed concerning health communication to address COVID-19 vaccination information to the concerned body for vaccination campaign and advocacy and decrease the vaccine hesitancy.

RESULTS AND DISCUSSION
Most of the COVID-19 vaccines have great acceptability in many countries [25]; yet people will have hesitancy on the vaccines, for they are new. Vaccination hesitancy is complex and context-specified, varying across time, place, and vaccines [26]. Different countries have doubts about the vaccines, especially on AstraZeneca. Due to this, more than 18 countries suspended the vaccine [7]. They asked questions on perfection, especially the side effects. Thus, hesitators, cautious acceptors, hesitant groups, and late or selective vaccinators were created. To avoid this hesitancy, participatory and presumptive style of communication is essential.

COVID-19 Vaccines Precariousness Information
Vaccination is the primary presentation of disease and one of the most cost-effective public health measures available [27]. Currently, different countries give COVID-19 vaccines; however, the pandemic of misinformation about the vaccine is the major challenge. Health institutions, health experts, activists, and opinion leaders expressed their opinions in relation to the vaccines, and different countries suspended to giving the vaccination [7]. Ethiopia has given the AstraZeneca vaccine to higher officials and health workers in the first round. Nevertheless, different regional and national mainstream media and social media expressed the side-effects of the vaccine. The people had fear of the side effects and the accuracy of the vaccine. They also thought that the vaccine as biological weapon [23]. Due to this, people worried in order to take the vaccination.
As stated in Table 1, all media platforms gave coverage for COVID 19 vaccination program and made an analysis on the side effects of the vaccines. Private radio stations and social media platforms raised the questions of vaccine accuracy, and they discussed the low qualities of AstraZeneca vaccine. In addition, radio, newspaper, and social media talked about the issues of safety testing.  75 the vaccine. The people had fear of the side effects and the accuracy of the vaccine. They t the vaccine as biological ]. Due to this, people worried in order 1, all media platforms gave coverage for COVID 19 vaccination program and made an analysis on the side effects of the te radio stations and social media platforms raised the questions of vaccine accuracy, and they discussed the low qualities of AstraZeneca vaccine. In addition, radio, newspaper, and social media talked about the news March 14, 2021: "Ethiopia launches COVID Vaccination in Addis Ababa" As stated above, the health experts didn't accept the vaccine to take with the priority of the government schedule. The Ministry made the vaccination campaign that higher officials, prominent people and health workers involved in the ceremony. However, after the vaccination, a number of COVID 19 cases and deaths were recorded, and it has become augmented.
Most of the people shared that the virus has quickly infected many people after the vaccine started in Ethiopia (Table 2). Besides, the Amhara ethnic has complained on the director of WHO, Dr. Tewodros Adhanom. WHO director was involved in a health conspiracy on our people especially in related to contraceptives; we still don't believe, like and take the vaccine" ( Table 2). People see the vaccine as 666 route [23], and they believe the vaccine makes them barren ( As stated above, the health experts didn't accept the vaccine to take with the priority of the government schedule. The Ministry made the vaccination campaign that higher officials, prominent people and health workers involved in the ceremony. However, after the vaccination, a number of COVID 19 cases and deaths were recorded, and it has become augmented. Most of the people shared that the virus has er the vaccine 2). Besides, the Amhara ethnic has complained on the director of WHO, Dr. Tewodros Adhanom. WHO director was involved in a health conspiracy on our people especially in related to contraceptives; we ieve, like and take the vaccine" 2). People see the vaccine as 666 route ], and they believe the vaccine makes them

Social media
Since the Corona vaccine arrived in Ethiopia, the virus has quickly infected Corona Vaccination is a Conspiracy to Dr. Tewodros Adhanom, a World Health Organization official, is known to have been accused by the Amharas. During his time in the Ethiopian Ministry of Health, the doctor conspired against the Amhara tribe. … So let's believe the vaccine came from the World Health Organization.
Though the pandemic spreading rate reached 30% at the state level, people showed reluctance on the prevention mechanism and vaccination. The anti-scientific arguments and emotive language led people to develop high hesitancy about the vaccination [28]. The Ethiopian government has to boost public trust and enthusiasm.
"The vaccines were developed in different countries and companies by different societies. As a developing country, we receive the vaccine from the donors, and we can buy the cheap one" (Solomon Ayele) As stated above, the quality or accuracy of the vaccine twisted hesitancy. Producers of the vaccines, the scientists' outputs, the economic inequalities and the donor intentions were the major sources of the hesitancy. Due to this, they saw the vaccine as one major attacking mechanism to the blacks. Although it is a pandemic, people did not give much attention to the virus.

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Though the pandemic spreading rate reached 30% at the state level, people showed reluctance on the prevention mechanism and vaccination. scientific arguments and emotive language led people to develop high hesitancy ]. The Ethiopian government has to boost public trust and "The vaccines were developed in different countries and companies by different societies. As a developing country, we receive the vaccine from the donors, and we can buy the cheap one".
As stated above, the quality or accuracy of the vaccine twisted hesitancy. Producers of the vaccines, the scientists' outputs, the economic inequalities and the donor intentions were the major sources of the hesitancy. Due to this, they saw the vaccine as one major attacking mechanism to the blacks. Although it is a pandemic, people did not give much attention to "We are in developing nations, the medicine donated by different countries and donators have limitations. Our health system and service are low, and it lacks the quality to check the side effect of the vaccine." (Mahilet Taye) There was a trend that donor organizations and states donated low quality materials. Ethiopian health infrastructure is also low, so there i mechanism to know the side effects of the vaccines.
As stated in the background of this study, the Ethiopian government tried to address the vaccine for 20% of the population at the end of 2021 (FBC March 23 reportage). Except for the shortage of COVID-19 vaccines, EPHI had good experiences concerning the vaccination programs that were given in the state MOH structure, communication strategy and the health workers had a good opportunity to give the COVID-19 vaccine to the public; however, the public perception and awareness have to be shaped before it reaches the refusal stage.

News cutting in native language
English Version More than a dozen European countries stopping giving AstraZeneca, which causes blood clots. It causes other problems with hormone! Who has given a guarantee to continue to give the vaccine?
The World Health Organization (WHO) has stated that AstraZeneca does not cause blood clots. Few of the more than 17 million people who have been vaccinated with AstraZeneca are said to have coronary heart disease. Studies of side effects have shown that people who are vaccinated are more likely to have side effects. … the side effects are less common among older people than younger people.
… Therefore, as long as there is no scientific evidence that AstraZeneca vaccine will cause blood clots, Ethiopia will continue to provide the vaccine to its citizens, he said. There was a trend that donor organizations and states donated low quality materials. Ethiopian health infrastructure is also low, so there is no mechanism to know the side effects of the As stated in the background of this study, the Ethiopian government tried to address the vaccine for 20% of the population at the end of 2021 (FBC March 23 reportage). Except for the 19 vaccines, EPHI had good experiences concerning the vaccination programs that were given in the state [29]. The MOH structure, communication strategy and the health workers had a good opportunity to give 19 vaccine to the public; however, the public perception and awareness have to be shaped before it reaches the refusal stage.

Main stream media and activists vaccine hesitancy messages
More than a dozen European countries stopping giving AstraZeneca, which causes blood clots. It causes other problems with Who has given a guarantee to The World Health Organization (WHO) has AstraZeneca does not cause blood clots. Few of the more than 17 million people who have been vaccinated with AstraZeneca are said to have coronary Studies of side effects have shown that people who are vaccinated are more likely to have side effects. … the side effects are less common among older people than … Therefore, as long as there is no scientific evidence that AstraZeneca vaccine will cause blood clots, Ethiopia will continue to provide the vaccine to its "More than a dozen advanced European countries stop vaccinating AstraZeneca because of anemia and other hormonal problems. We continue to give the vaccine, why?" Bedanie) (Table 3).
She is an artist, activist and opinion leader who has 203, 000 followers at the end of May 2021. She expressed her hesitancy and asked a question. Who has given a guarantee to take the vaccination? Most of her followers express their different doubts in the comments, and they had similar perceptions towards the vaccination.
"The side effects are less common among older people than younger people." Bisrat Radio ( 3).
Bisrat radio also reported that the vaccine had side effects and more young people affected by the vaccine effect. The net generation is so sensitive and energetic to accept or reject issues in support of net messages. (Table 3). "The side effects are less common among older people than younger people." Bisrat Radio (Table Bisrat radio also reported that the vaccine had side effects and more young people were affected by the vaccine effect. The netgeneration is so sensitive and energetic to accept or reject issues in support of net

"'Ethiopia continued vaccinating AstraZeneca which eighteen countries stop vaccination' Ato Wasu Mohammed
He is a journalist and activist and he has 72, 543 friends and followers. In this reportage, there was no reason why they continued giving the vaccine, and there was no reason why other countries stopped giving the vaccine.
"The vaccine has a side effect, but it is not serious. It also affected young people." Ethiopian Press Agency (Table 3).
The Ethiopian Press Agency testified about the side effects of the vaccines, but it didn't verify to what extent it has affected people.
However, WHO and MOH gave a guarantee for the severe side effects of the vaccines. The overflow of unscientific information misled people to vaccine hesitancy. Public Health Institute has its own role for adequate communication towards the vaccine. The health experts addressed the scientific information to the public.
"If there is a serious health problem with the vaccine, the company that made the drug is responsible for it" (Vatican News, Table   "Ethiopia has signed an international agreement to provide compensation to those affected by the severe side effects of the vaccine" (Bisrat Radio, Table 4).

News cutting in native language English Version
The WHO has stated that AstraZeneca does not cause coagulation. Few of the more than 17 million people who have been vaccinated with AstraZeneca are said to have coronary heart disease.
Ethiopia has signed an international agreement to compensate the vict vaccine causes serious side effects.
In some parts of the world, AstraZeneca has been shown to cause coronary heart disease in some parts of the world.
He pointed out that there is a serious health problem caused by the vaccine and that the company that produced the drug is taking responsibility. All the national and regional media were cooperative to disseminate information to the public, but the message framing did not consider the communities characteristics. However, the misinformation and the WHO uncertainty on the vaccine led people to hesitate to take the  All the national and regional media were cooperative to disseminate information to the public, but the message framing did not consider the communities characteristics. However, the misinformation and the WHO uncertainty on the ccine led people to hesitate to take the vaccine. Presenting clear and accurate information concerning health literacy of the community is important to avoid people's doubts [31]. MOH and EPHI tried to address the information based on the online survey as in Fig. 1.

Fig. 1. MOH and EPHI online COVID 19 Survey to address need based information
Depending on the survey they tried to address in SMS messages (

COVID 19 misinformation, real information and WHO uncertainty
Real information WHO uncertainty More than a dozen advanced European countries have stopped to give AstraZeneca, which causes anemia and other hormonal problems! If there is a serious health problem caused by the vaccine, the company that produced the drug is taking responsibility. The WHO has stated that AstraZeneca does not cause coagulation. Of the more than 17 million people who have been vaccinated against AstraZeneca, less than 40 are said to have developed anemia.
Ethiopia has signed an international agreement to provide compensation to those affected by the severe side effects of the vaccine. … Side effects are less common among older people than young people.
Of the more than 17 million people who have been vaccinated against AstraZeneca, less than 40 are said to have developed anemia. ]. The messages c language and disseminated for the mass without considering the characteristics of people. In addition, the ethods were similar and

COVID 19 misinformation, real information and WHO uncertainty WHO uncertainty
If there is a serious health problem caused by the vaccine, the company that produced the drug is taking Ethiopia has signed an tional agreement to provide compensation to those affected by the severe side effects of the vaccine.
Of the more than 17 million people who have been vaccinated against AstraZeneca, less than 40 are said to have developed

Building Vaccine Acceptance Through Opinion Leaders
The vaccination communication has a goal to inform message content, format, mode of

SMS messages in native language English Version
The increase in the number of patients with CVD 19 has been exacerbated by respiratory failure and death.
Get a new training about COVID-19 and have your certificate.
Participating in various gatherings increases the chances of being caught in CV 19. Protect yourself from the virus.
Make sure you keep a record of the phone number and address you will be using when you make COVID If you suddenly have trouble smelling or feeling tired; isolate yourself and test COVID 19. Physicians must decide whether to stay home for follow It is recommended that COVID 19 patients over the age of 60 be monitored at a specialized treatment center.
Patients with comorbidities are recommended to be monitored at a specialized treatment center.
Protect yourself from COVID 19 by reducing social gatherings such as weddings and mourning.
Protect yourself from COVID 19 as it is killing many of our people today.
Be careful not to overdo it, as you may be caught by COVID 19 during any of your activities.

Building Vaccine Acceptance
The on from the official's limitations and the counterpart of the vaccination messages were the challenges. Communication is the strategy to address COVID acceptability effectively [33]. The messages should be prepared with plain language by considering the public needs.
Ethiopians had underappreciating the risk of COVID 19, and they had misconceptions about the effectiveness of the vaccines. The people didn't trust information sources and the government's health policy. Due to this, the MOH tried to use religious leaders to avoid the hesitancy of the people. messages were the challenges. Communication is the strategy to address COVID- 19 vaccine ]. The messages should be prepared with plain language by Ethiopians had underappreciating the risk of COVID 19, and they had misconceptions about the effectiveness of the vaccines. The people didn't trust information sources and the government's health policy. Due to this, the MOH o use religious leaders to avoid the

Ethiopian Public Health Institute Message Delivery Extent, Structure, Content And Medium
Health messages are persuasive that are designed to change the behavior of patients. They require knowledge to understand the attitudes, perceptions and motivations of the receivers of messages [34]. MOH and EPHI prepared COVID-19 recantations, vaccination messages and delivere them to the audience in different ways.

Amhara Media Corporation
Patriarchs call on stakeholders to do their part to make the Coronavirus vaccine a success.
Religious leaders have urged the public to step up their efforts to prevent the spread of cholera virus.
Religious leaders also called on the public to take precautionary measures to curb the spread of Coronavirus. They called on stakeholders to do their part to ensure the success of the current Coronavirus.  As shown above (Table 6), the messages were delivered 3-7 days. They had 45.5 % of presentations contents to take preven measures, 27.3% health experts' advice, the reset messages focused on examination, examination data recorded, training and zero percent vaccination contents. The messages recipients were Ethiopians who can read the Amharic language. The messages didn't provide

English version Ethiopian Broadcasting Corporation
The most vulnerable sections of the society were asked to get rid of the stereotypes and get vaccinated against COVID 19.
The Addis Ababa Health Bureau has asked the most vulnerable groups in the community to get vaccinated against the disease by dispelling misconceptions about the vaccine. According to a workshop organized by the bureau, the vaccine, which is currently being given to people over the age of 65 and over the age of 55, is not being used properly due to social stigma. Speaking at the workshop, Addis Ababa Health Bureau Head, Dr. Yohannes Chala, said there is a lack of awareness on how to get the vaccine due to various misconceptions in the society. So far, 72,000 citizens have been vaccinated in Addis Ababa.

The workshop to create awareness about COVID 19 vaccines
6), the messages were 7 days. They had 45.5 % of presentations contents to take preventable measures, 27.3% health experts' advice, the reset messages focused on examination, raining and zeropercent vaccination contents. The messages recipients were Ethiopians who can read the Amharic language. The messages didn't provide accurate vaccine information, increase vaccine confidence and acceptance though WHO recommended that vaccine messages should include assurance of vaccine safety and efficacy.
Clear and effective language helps to address the vaccine information and significant to the people [31,32]. The language that is used by medical experts and doctors has to reflect the ; Article no. JPRI.71593 us is increasing day by day.

Ethiopian Broadcasting Corporation
The most vulnerable sections of the society of the stereotypes and get vaccinated against COVID 19.
The Addis Ababa Health Bureau has asked the most vulnerable groups in the community to get vaccinated against the disease by dispelling misconceptions about the vaccine.
ized by the bureau, the vaccine, which is currently being given to people over the age of 65 and over the age of 55, is not being used properly due Clear and effective language helps to address the vaccine information and significant to the ]. The language that is used by medical experts and doctors has to reflect the cultures, norms, traditions and values of society. Most delivered messages hadn't had this structure. The messages prepared by EPHI should keep the structure of the message and enrich it with contents and address the appropriate media. Media is a more immediate short-term weapon to pursued people's attitudes [35]. Creating awareness about the benefits of immunization, correcting false beliefs, rumors and providing accurate and scientific-based vaccination information is significant to avoid people's hesitation.
Providing scientific and timely information about vaccination and emphasis on the facts over the misinformation are the basics to avoid vaccine hesitancy [31]. Create media relations and advocate the vaccine benefits with trust media channels are also the other mechanisms.
In Ethiopia, the media coverage and accessibility is poor. The number of health literacy is low. The health infrastructure is poor. In this extent, using the hybrid media is crucial to address the COVID-19 vaccine information. Most people do not have a web-2 communication sites; then, the messages have been prepared in different media formats and languages to prevent the antivaccination misinformation. Before the misinformation changes into viral and selfpropagative, the EPHI should make the provaccine advocates to combat the misinformation.

Possible Communication Strategies for COVID-19 Vaccination Campaign
The vaccination campaign has to run to create good awareness and vaccine acceptability to the audience besides giving the vaccine. , and what they say as they do something (90%). Moreover, the medium of the messages need high attention. The messages need to be simple and reflective. The messages should not be a slogan or call action. They have to use different expressions and contents depending on the nature of the audience. Evaluate the messages with different intervals because they will bring different impacts on the audiences.
In addition, using simple and natural narratives are important. Compelling different participants' stories and making good narratives on how it affects people's lives help to transform society into good practices. The media cares about the messenger because the medium is the message. Use prominent, opinion leaders; it will help to carry the messages. The narratives have to develop with a human interest angle and seek third-party verification.

Use Hybrid Media for Participatory Communication to Raise Awareness about COVID-19 Vaccines
Increasing the confidence of people who are taking the vaccine is the first duty of the vaccine providers. For any communication with the vaccine hesitant is discussion of science which addresses their specific questions or concerns [37]. COVID-19 pandemic needs a structured response, and MOH and EPHI tried to address the prevention mechanism, which adopts with WHO informs of community awareness creation and capacity development. Different scientists prepare information toolkits that talk about COVID-19 and address with national and regional active media. As the health institutions, MOH and EPHI should build good media relationships with national and regional media beyond the prominent social media activities. The networks help them to address the proper message to the target audience. The organizational public relations and communication experts can easily follow up the day-to-day activities of the media and make regular information briefings. The communication experts of MOH and EPHI prepare a conducive environment for the journalists to report the efforts of the institutions in offering background, current information and anticipation. It enables the EPHI to take the proactive communication with the hesitators.
Furthermore, responding to criticism is important to counter attack the misinformation. Setting the record straight, transparency, accountability, clarification and prevention are the possible mechanisms to responding the misinformation about the vaccine. Depending on the health specialists and doctors, scientific outputs share responsible and credible information to the public. Create transparency and honesty between the health institutions and the public is the output of open-door policy.

CONCLUSION
COVID 19 is becoming vaccine-preventable diseases (VPD); however, different people, media and health experts expressed their hesitancy. In contrast, communication strategies contributed to vaccine advocacy and vaccination campaign to improve vaccine acceptance. It is very important to create awareness about COVID 19 vaccines, and avoid vaccine hesitation to strength the public vaccines acceptability before it reaches on vaccine refusals. This is because vaccine hesitancy is believed to be responsible for decreasing vaccine coverage and increased the risk of VPD outbreak and pandemic. In this regard, hybrid media has the power to mold the opinion of the public and the unscientific arguments and precariousness information. MOH and EPHI prepared different communication strategies to address misinformation; however, uncertainty of the vaccine was also the obstacle to convince the people. Thus, building the vaccine acceptability through presumptive style communication is significant.