Increasing vaccination demand and uptake

Increasing and maintaining vaccination uptake is vital for vaccines to achieve their success. Addressing low vaccination requires an adequate understanding of the determinants of the problem, tailored evidence-based strategies to improve uptake, and monitoring and evaluation to determine the impact and sustainability of the interventions.

1. Understanding the drivers of immunization uptake

A range of factors influence whether a person is vaccinated or not. The framework of behavioural and social drivers (BeSD) of vaccine uptake (see below chart) illustrates the four domains that can be measured to understand reasons for under-vaccination. The BeSD framework includes influences that are measurable, potentially changeable, and specific to vaccination.

To support the systematic assessment of these drivers of vaccination, WHO established the Measuring Behavioural and Social Drivers of Vaccination global working group in October 2018, in collaboration with core partners, to oversee development of field-tested and validated tools and guidance.  

BeSD tools include surveys and in-depth interview guides for both childhood and COVID-19 vaccinations, and guidance is available to support the gathering and use of data. Countries are recommended to systematically collect and analyse data on behavioural and social drivers of vaccine uptake. These data may be routinely used to guide programme planning, implementation and evaluation.

Behavioural and social drivers of vaccine uptake: tools and practical guidance

Understanding the behavioural and social drivers of vaccine uptake. WHO position paper – May 2022

The WHO behavioural and social drivers of vaccination framework 

Source: The BeSD working group. Based on Brewer et al. Psychol Sci Public Interest. (2017). 

2. Engage with communities

Because the drivers of uptake are contextual, assessing and addressing low uptake requires engaging with communities to generate insights on their needs and perspectives, and to guide the development of better quality vaccination services, systems, policies, and other programme strategies.

Human Centred Design for Tailoring Immunization Programmes (HCD-TIP) is an approach for working with communities to systematically overcome hurdles to vaccination in four stages: Diagnose, Design, Implement and Evaluate.

HCD-TIP can be used for any priority group or vaccine across the life course and enhances the ability of programmes to listen and learn to better respond to community needs. 

Human-centred design for tailoring immunization programmes: a practical guide

3. Strengthen the quality of services

Very often it is practical issues, and not a lack of confidence or motivation, that is the cause of low uptake. Practical issues include the experiences that people have in trying to get vaccinated, including barriers faced, e.g., accessing the health facility, or costs of transport.

The Quality Immunization Services Planning Guide highlights key actions at different levels of the health system to monitor, strengthen, and maintain the quality and convenience of services.

Benefits of strengthening immunization service quality include enhanced health service and system performance, improved vaccination coverage and efficiency, and more equitable access to services to reduce gaps for disadvantaged populations.

Quality immunization services: a planning guide

4. Support health workers

As the most trusted influencer of vaccination decisions, it is important health workers are well prepared and supported in the demands of their role. The capacity and confidence of health workers are often stretched as they are faced with time constraints, limited resources, and inadequate information and/or training to respond to questions and discuss the benefits and rare risks of vaccination.

To strengthen health workers’ confidence and skills in communicating about vaccination, the following training modules are available:

• Conversations to support vaccine uptake (pptx, 3.6 MB) 
• Managing pain during vaccine administration (pptx, 4.1 MB)
• Communicating on vaccine safety and contraindications (pptx, 2.8 MB)

French, Spanish and Portuguese versions of the modules are also available and can be downloaded from the  TechNet-21 Demand and Uptake page.