Understanding the Behavioural and Social Drivers of Vaccination

As measles increases in incidence in many countries, there is now an intense focus on addressing low vaccination uptake. Yet most countries do not systematically measure the drivers of vaccination. This prevents them from understanding the causes of low coverage and prioritising interventions.

The answers we get are often as good as the questions we ask. If we only ask about certain drivers of vaccination, we will never know all the possible influencers. For example, let’s imagine country A assumes that its biggest problem with vaccination uptake is a lack of confidence. They decide to survey parents to ask them how they feel about the safety of vaccines, their effectiveness, and benefits. They find that 12% have many concerns about vaccine safety. However, the survey has only looked at the ways people think and feel about vaccination, and not all possible reasons for not vaccinating. In country B however, a survey asks parents about the full range of possible barriers to vaccination – not just how people think and feel but the practical issues too, among other factors. They find the largest problem is difficulties with accessing convenient and welcoming health services. This finding is enriched by in-depth qualitative work with caregivers and health workers.

Comprehensively understanding the reasons that parents do and do not get their children vaccinated is so vital to selecting the right interventions. Hence, the World Health Organization convened a working group to develop a set of ways to measure the drivers of vaccination uptake in November 2018. Named “Behavioural and Social Drivers of Vaccination” (BeSD) this is a workstream under the larger multi-partner Demand Hub and in consultation with UNICEF, the US Centers for Disease Control (CDC), Gavi, the Vaccine Alliance, and the Bill and Melinda Gates Foundation.

As chair of this working group, I am delighted to be leading an effort that combines the expertise of world-leading researchers in vaccination uptake, program experts, and agency partners. My colleague Dr  Kerrie Wiley, also a social scientist at the University of Sydney who specialises in vaccination, is also a member. At WHO headquarters, Lisa Menning is leading the secretariat work.

BeSD’s objective is to develop tools and guidance to enable immunisation programmes and partners to measure and address local reasons for under-vaccination, and to track consistent and comparable data over time at a national and global level. The tools will include quantitative survey questions for caregivers of children and qualitative interview guides for caregivers and healthcare workers. There will also be a related user guide. These tools will support high-quality data collection, analysis and application of findings to immunisation programmes. They will also be developed with a long-term view conversant with coming generational changes in decision influences. The development work will take another year and include further end-user informant interviews and extensive field testing in a range of countries using cognitive interviews and some validation tests.

It is hoped that this standardised set of tools will enable consistent measurement of the drivers of vaccination over time and between countries. This will help track trends in vaccination confidence, intentions and the practical issues that also affect vaccine uptake. It will be a vital tool for countries to better understand the issues surrounding vaccination and target appropriate interventions if needed to improve country and thereby, enable vaccines to continue to achieve their success in disease control.




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