How to increase and maintain high immunization coverage: Vaccination Demand Resilience (VDR) framework

Sachiko Ozawa; Holly B Schuh; Tomoka Nakamura; Tatenda T Yemeke; Yi-Fang Ashley Lee; Noni E MacDonald

doi:10.1016/j.vaccine.2023.09.027

How to increase and maintain high immunization coverage: Vaccination Demand Resilience (VDR) framework

Vaccine. 2023 Oct 26;41(45):6710-6718. doi: 10.1016/j.vaccine.2023.09.027. Epub 2023 Oct 3.

Authors

Sachiko Ozawa¹, Holly B Schuh², Tomoka Nakamura³, Tatenda T Yemeke⁴, Yi-Fang Ashley Lee⁴, Noni E MacDonald⁵

Affiliations

¹ Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Maternal Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
² Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: hschuh1@jhu.edu.
³ Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom; Nagasaki University, School of Tropical Medicine and Global Health, Nagasaki, Japan.
⁴ Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁵ Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.

PMID: 37798209
DOI: 10.1016/j.vaccine.2023.09.027

Abstract

Background: Resilience in vaccination demand is ever more critical as the COVID-19 pandemic has increased our understanding of the importance of vaccines on health and well-being. Yet timid demand for COVID-19 vaccines where available and reduced uptake of routine immunizations globally further raise the urgent need to build vaccination resilience. We demonstrate the complexity of vaccination demand and resilience in a framework where relevant dimensions are intertwined, fluid, and contextual.

Methods: We developed the Vaccination Demand Resilience (VDR) framework based on a literature review on vaccination demand and expert consultation. The matrix framework builds on three main axes: 1) vaccination attitudes and beliefs; 2) vaccination seeking behavior; and 3) vaccination status. The matrix generated eight quadrants, which can help explain people's levels of vaccination demand and resilience. We selected four scenarios as examples to demonstrate different interventions that could move people across quadrants and build vaccination resilience.

Results: Incongruence between individuals' attitudes and beliefs, vaccination behavior, and vaccination status can arise. For example, an individual can be vaccinated due to mandates but reject vaccination benefits and otherwise avoid seeking vaccination. Such incongruence could be altered by interventions to build resilience in vaccination demand. These interventions include information, education and communication to change individuals' vaccination attitudes and beliefs, incentive programs and reminder-recalls to facilitate vaccination seeking, or by strengthening healthcare provider communications to reduce missed opportunities.

Conclusions: Vaccination decision-making is complex. Individuals can be vaccinated without necessarily accepting the benefits of vaccination or seeking vaccination, threatening resilience in vaccination demand. The VDR framework can provide a useful lens for program managers and policy makers considering interventions and policies to improve vaccination resilience. This would help build and sustain confidence and demand for vaccinations, and help to continue to prevent disease, disability, and death from vaccine-preventable diseases.

Keywords: Confidence; Coverage; Hesitancy; Immunization; Resilience; Vaccine.

MeSH terms

COVID-19 Vaccines
COVID-19* / prevention & control
Humans
Immunization
Pandemics
Receptors, Calcitriol
Vaccination
Vaccination Coverage*

Substances

COVID-19 Vaccines
Receptors, Calcitriol
VDR protein, human