BACKGROUND:
In West Africa, vaccine hesitancy continues to undermine immunization efforts, fueled by misinformation and eroding community trust. Traditional health communication often fails to capture real-time sentiments or equip frontline workers to respond empathetically. This study evaluated the impact of a hybrid model combining digital rumor surveillance, community engagement, and motivational interviewing (MI) on vaccine confidence and uptake.

METHODS:
A stepped-wedge cluster trial (2024–2025) was conducted across 24 districts in Cameroon and Burkina Faso. The intervention integrated (1) digital rumor tracking via WhatsApp, SMS, and community radio; (2) microgrants for local champions facilitating public dialogues; and (3) MI training for health workers. Data were collected from 3,600 caregiver–child dyads pre- and post-intervention. Primary outcomes were caregiver vaccine confidence and verified full immunization coverage. Mixed-effects regression models adjusted for confounders.

RESULTS:
Vaccine confidence improved from 3.1/5 to 4.2/5 (+1.1, 95% CI 0.95–1.25; p<0.001), and full immunization coverage rose from 58.0% to 77.0% (+19.0 pp; p<0.001). Districts with high champion engagement and active rumor reporting achieved the strongest gains. Health worker MI competency increased by 28% (p<0.001). The cost-effectiveness ratio was US.40 per additional fully vaccinated child.

CONCLUSIONS:
A digital–community hybrid model offers a scalable, low-cost strategy to strengthen vaccine confidence and routine immunization uptake in resource-limited settings. Integrating rumor monitoring and motivational interviewing into national programs could accelerate progress toward universal immunization and pandemic preparedness.