In late May 2022, the World Health Organization (WHO) published its first position paper related to the behavioral and social drivers of vaccine uptake (Understanding the behavioural and social drivers of vaccine uptake WHO position paper – May 2022. Weekly Epidemiological Record [WER], 97(20), 209-224).

The publication of this report, as well as several resultant tools for researchers, followed an extensive undertaking that included reviews of existing data, initial tool development, field testing, and psychometric validation and indicator selection prior to finalization. Efforts were initially focused on childhood vaccinations but were expanded during the pandemic to assess potential uptake of adult COVID-19 vaccines. As such, two sets of tools are included in the final report.

Behavioral and social drivers (BeSD) of vaccination were defined as “beliefs and experiences specific to vaccination that are potentially modifiable to increase vaccine uptake" (WER, 2022, p. 210). Perhaps most pertinent for frontline healthcare providers is the resulting BeSD framework, which includes four measurable domains related to vaccine uptake:

  • Thinking and feeling, which includes perceptions of disease risk and vaccine confidence based on perceived benefits, safety and trust.
  • Social processes, such as social norms, healthcare worker recommendations and gender equity. Social norms are detailed to include family, friends, community leaders and religious leaders.
  • Motivation, which relates to vaccination intentions for recommended vaccines.
  • Practical issues, such as vaccine availability, affordability, accessibility, service quality, and respect from healthcare workers.

Vaccine hesitancy falls into the “motivation” domain and was redefined as a result of this project in order to separate intention and behavior, given that the model demonstrates the complexity of issues that ultimately affect behavior. The revised definition replaces the Strategic Advisory Group of Experts (SAGE) on Immunization’s 2014 definition. It defines vaccine hesitancy as “a motivational state of being conflicted about, or opposed to, getting vaccinated; this includes intentions and willingness" (WER, 2022, p. 213).

Each domain was assigned a priority question and a priority indicator. According to the resulting publication (Behavioural and social drivers of vaccination: tools and practical guidance for achieving high uptake. Geneva: World Health Organization; 2022.), “the priority questions … were the best performing questions across the domains and most strongly associated with vaccine uptake” (p. 8). For the “thinking and feeling” domain, the priority question and indicator related to confidence in vaccine benefits. For “social processes,” family norms were most important (compared with other subgroups measured). Intent to vaccinate was central to understanding motivation. Finally, both knowledge of where to get vaccinated and affordability were identified as priorities in the “practical issues” category. These indicators were consistent for both childhood vaccinations and adult COVID-19 vaccines.

In addition to sharing the tools for either quantitative (surveys) or qualitative (interviews) measurement, final materials also included guidance for completion of a three-part process that involves project planning, completing the investigation, and acting on the findings.

Even if you are not a researcher or immunization program manager, this effort is important for thinking about the complex nature of vaccine decision making. With a focus on the nature of the issues, we can all approach vaccine conversations with increased understanding and empathy.

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Materials in this section are updated as new information and vaccines become available. The Vaccine Education Center staff regularly reviews materials for accuracy.

You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family's personal health. You should not use it to replace any relationship with a physician or other qualified healthcare professional. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult your physician or, in serious cases, seek immediate assistance from emergency personnel.