Critical interventions for demand generation in Zambia, Nepal, and Senegal with regards to the 5C psychological antecedents of vaccination

Kyra A Hester; Zoe Sakas; Emily Awino Ogutu; Sameer Dixit; Anna S Ellis; Chenmua Yang; Chama Chanda; Matthew C Freeman; Walter A Orenstein; Moussa Sarr; Robert A Bednarczyk

doi:10.1016/j.jvacx.2023.100341

Critical interventions for demand generation in Zambia, Nepal, and Senegal with regards to the 5C psychological antecedents of vaccination

Vaccine X. 2023 Jul 7:14:100341. doi: 10.1016/j.jvacx.2023.100341. eCollection 2023 Aug.

Authors

Affiliations

¹ Rollins School of Public Health, Emory University, Atlanta, GA, USA.
² Center for Molecular Dynamics Nepal, Katmandu, Nepal.
³ Center for Family Health Research in Zambia, Lusaka, Zambia.
⁴ Emory University School of Medicine, Emory University, Atlanta, GA, USA.
⁵ Institut de Recherche en Santé de Surveillance Epidemiologique et de Formation (IRESSEF), Dakar, Senegal.

Abstract

Introduction: Childhood vaccination is an effective intervention for lowering the burden of infectious disease. Vaccine coverage has increased globally, but vaccine hesitancy and refusal threatens these gains. The 5C psychological antecedents of vaccination ("5C") provides a validated measure of "vaccine hesitancy or confidence" to assess individual thoughts and behaviors behind vaccination. We investigated population-level factors that contributed to high and sustained vaccination coverage in Zambia, Nepal, and Senegal, and alignment with the 5Cs.

Methods: Data was collected in the larger Exemplars in Vaccine Delivery study, from focus group discussions (FDGs) and key informant interviews (KIIs) at the national, regional, district, health facility, and community levels of health systems in Zambia, Nepal, and Senegal. We assessed the demand environment, as relayed by participants, and identified interventions reported as successful for demand generation, then retroactively aligned the interventions with the 5C constructs.

Results: Demand was positively correlated with high confidence and collective responsibility. Psychological constraints sometimes impacted demand. Physical constraints created barriers in some communities, particularly difficult to access (i.e., mountainous). Occasionally, physical constraints did not affect vaccination behavior - parents believed the benefits of vaccination worth pursuing. Factors negatively correlated with demand and intent, complacency and calculation, had limited impact. Critical interventions were: targeted and tailored health education activities (media partnerships, school outreach); community engagement; community ownership; and community involvement (community health workers, leaders, religious figures).

Conclusion: We found similar interventions used to generate demand, with strategies aligned with the 5C constructs. Categorizing interventions by drivers of demand may help strategic planning and the division of resources; decision makers may choose to implement our suggested interventions. Assessing the 5Cs allows decision-makers to operationalize demand generation into concrete interventions and policies, and determine the individual impact of these constructs on the population and focus efforts on interventions tailored to a specific need.

Keywords: 5C psychological antecedents of vaccination; Childhood immunization; Global intent to vaccinate; Intent and demand for vaccine; Vaccine delivery; Vaccine demand.