Citizens' Assembly on vaccination confidence

15. August 2021

A UN Democracy Fund (UNDEF) project in North Macedonia used the citizen assembly model to address high rates of vaccine hesitancy and mistrust of government - illustrating the need for such mechanisms when public trust is under strain in emergencies.

It used a random selection of citizens from all age groups and demographics - and an equal mix of those planning and not planning to take the vaccine.  In the Citizens' Assembly, the participants met for 10 full-day online sessions from February to July 2021. They were asked to find common ground for recommendations that would answer the question: What can we do to prevent a resurgence of COVID-19 cases?

Northern Macedonia has been struggling with very high levels of vaccination refusal. While this has complicated the country's response to Corona, it is also an example of the lack of trust in public institutions and their communication.

Citizens drove the agenda

Amid increasing rates of public scepticism about experts, the group were asked to identify experts they needed to hear from to reach a trusted decision, which again reinforced that decisions were not being imposed from above. The approach helped moderate extreme views, by citizens hearing voices of moderation from peers.

The citizens drove the agenda throughout and formulated questions that they needed answered to reach an informed common-ground position. To overcome mistrust of experts, the assembly members identified speakers to attend meetings to address questions directly.

15 concrete recommendations

Experts from the Ministry of Health, the World Health Organization, and senior representatives from reputable medical research institutes answered questions around availability and type of vaccines, the role of the government, and preventive measures.After a total of 40 hours spent together, they found common ground on a range of recommendations, including on politically vexed questions.

The assembly has produced a final report with 15 concrete policy recommendations to be presented to Government officials in public hearings. Recommendations included more fora for citizens to pose their own questions directly to medical professionals. The use of vaccine passports was concluded to be acceptable and fair. Government officials committed to taking the Assembly’s recommendations into account.

An example for the world

In this way, the North Macedonian Citizens’ Assembly on COVID-19 has demonstrated to the world that including everyday citizens in complex public health decisions can lead to sensible and clear recommendations that originate in the agreement of a mix of everyday people, imbuing those decisions with legitimacy and public otherwise hard to find in this space.

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