Enhancing Acceptance and Demand for Vaccination in the Western Pacific Region

"The facilitation of broad stakeholder engagement and cross-sectoral support for vaccination will ultimately help to reinforce positive social norms and shape many factors that contribute to vaccination demand and uptake."

Factors such as poor demand for, and hesitancy about, vaccines among some population groups in the Western Pacific region pose challenges to meeting global and regional vaccination goals. Given that vaccine hesitancy and its determinants are often highly context specific, the World Health Organization (WHO) Regional Office for the Western Pacific notes that targeted and tailored approaches are required (the same applies for clustered areas of under-vaccination). Thus, this regional guide is intended to support Member States to:

• increase awareness and understanding of concepts related to demand and vaccine hesitancy;
• determine the reasons for non-vaccination and vaccine hesitancy;
• inform the assessment of behavioural and social drivers for vaccination;
• advocate for investment in evidence-informed strategies to enhance acceptance and demand for vaccination, leading to vaccination uptake; and
• build social science capacity to support the application of a more people-centred approach.

The main intended users of the guide are national and subnational government health authorities, members of National Immunization Technical Advisory Groups (NITAGs), medical associations, other government stakeholders (education ministry, occupational health, etc.), private sector immunisation providers, development partners, and civil society.

The guide is structured as follows:

• Sections 1, 2, and 3 provide background information, including definitions and determinants, as well as specific case study examples from within the region.
• Section 4 focuses on determining and addressing the reasons for under-vaccination and vaccine hesitancy for specific population groups, to the end of encouraging and supporting countries to gather data to inform the design and evaluation of strategies to address hesitancy and boost acceptance. WHO advises that "the process must first begin by assessing the full range of behavioural and social drivers of vaccination. These involve the thoughts and feelings of individuals, social processes, and practical or access-related factors." Mostly drawing on the WHO-developed Tailoring Immunization Programmes (TIP) approach, this section also introduces initial scales and survey tools that may be adapted and used to assess hesitancy in a population. These scales may be used within the research phase of a TIP project or as a standalone assessment.
• Section 5 outlines a series of strategies to be implemented on an ongoing basis to enhance acceptance and demand for vaccination and vaccination uptake, with a focus on: policy and political frameworks; planning and preparedness; partnerships; people-centred services; proactive actions on safety; and programme research and evaluation. As noted here, "supporting populations to overcome hesitancy and accept vaccination is not simply a matter of information dissemination: knowledge and awareness, although important, are rarely adequate for acceptance of vaccination. A variety of other strategies and interventions should also be considered - for example, service access and quality improvements, policy or structural changes, or community engagement - all of which help to create a supportive environment, shape behaviours, and make a positive impact on acceptance and vaccination uptake (Annex III)."
• Section 6 outlines roles and responsibilities of various stakeholder groups across a health system, including: ministry of health and respective authorities at different levels of the system; health workers; professional and academic institutions and associations; school managers and teachers; private sector health and immunisation service providers; the media; development partners; civil society organisations; and manufacturers. "Close collaboration among stakeholders is essential to ensure that their efforts are effective."
• The Annexes provide additional tools:
  1. How to communicate about vaccination to reinforce positive social norms;
  2. How to respond to myths, misinformation, and rumours about vaccination; and
  3. Strategic activities to address hesitancy based on the Working Group of the WHO Strategic Advisory Group of Experts on Immunization (SAGE) on Determinants of Vaccine Hesitancy Matrix.