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

• Type of Material: Article
• Authors: Kyra A Hester, Emory University; Zoe Sakas, Emory University; Emily Awino Ogutu, Emory University; Sameer Dixit, Center for Molecular Dynamics Nepal; Anna S Ellis, Emory University; Chenmua Yang, Emory University; Chama Chanda, Center for Family Health Research in Zambia; Matthew C Freeman, Emory University; Walter Orenstein, Emory University; Moussa Sarr, Institut de Recherche en Santé de Surveillance Epidemiologique et de Formation (IRESSEF); Robert A Bednarczyk, Emory University
• Language: English
• Date: 2023-08-01
• Publisher: Elsevier B.V
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Authors
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jvacx.2023.100341
• Title of Journal or Parent Work: Vaccine: X
• Volume: 14
• Start Page: 100341
• End Page: 100341
• Grant/Funding Information: This work was supported by the Bill & Melinda Gates Foundation, Seattle, WA (OPP1195041) with a planning grant from Gates Ventures, LLC, Kirkland, WA.
• Keywords: Global intent to vaccinate; Childhood immunization; 5C psychological antecedents of vaccination; Vaccine delivery; Intent and demand for vaccine; Vaccine demand
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health; Health Sciences, Medicine and Surgery

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.