Understanding the Behavioural and Social Drivers of Vaccination

As measles incidence rises 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 prioritise interventions accordingly. The answers we get are often as good as the questions we ask. A comprehensive set of questions that attempts to address all possible barriers to vaccination of children will help to identify those most pressing in a particular setting. For example, a country may assume that its biggest problem with vaccination uptake is parental hesitancy about getting their child vaccinated due to safety concerns. A systematic measurement of the reasons in a representative sample of parents may find, however, that difficulties with accessing convenient and welcoming health services are the largest barrier.

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.

The group is chaired by MBI member, Professor Julie Leask, a behavioural scientist based in the Sydney Nursing School who leads a program of research examining the ways people think, feel and act on vaccination. Dr Kerrie Wiley from the School of Public Health is also a member of the working group. Kerrie’s work focuses on understanding why parents reject vaccination.

BeSD’s objective is to develop tools and guidance to enable immunization 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.

It is hoped that this standardised set of tools will enable consistent measurement over time. 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.