Vaccine hesitancy is a complex global problem that requires ongoing monitoring. The WHO definition of vaccine hesitancy is as follows: Vaccine hesitancy refers to delay in acceptance or refusal of vaccines despite availability of vaccination services. Vaccine hesitancy is complex and context specific varying across time, place and vaccines. It includes factors such as complacency, convenience and confidence. Understanding hesitancy Addressing vaccine hesitancy requires an understanding of the magnitude and setting of the problem, diagnosis of the root causes, tailored evidence-based strategies to address the causes, and monitoring and evaluation to determine the impact and sustainability of the intervention. When understanding vaccine hesitancy, it must be noted that there can be many inter-related determinants. These should be assessed in a systematic manner to explore the individual, group, and contextual influences, as well as any vaccine/vaccination specific issues. In addition, a diagnosis of the underlying reasons for hesitancy should adequately differentiate between barriers related to acceptance and access. Resources for assessing and addressing hesitancy There is no single intervention that addresses all instances of vaccine hesitancy. Based on the systematic review of strategies to address vaccine hesitancy conducted by the SAGE working group (please see report below) the most effective interventions are multi-component versus single-component. In most cases, interventions should be dialogue based and directly targeted to a specific under-vaccinated population group. By engaging collaboratively with health workers, service-users, and their families and communities, national authorities can generate the insights to develop better quality health services, systems, policies, and communication strategies that support and enable recommended vaccination behaviours. Tailoring Immunization Programmes To equip Member States to better diagnose the factors influencing vaccination intentions, decisions and behaviours, WHO/Europe developed the Guide to Tailoring Immunization Programmes (TIP). It consists of proven methods and tools to: Identify populations susceptible to vaccine-preventable diseases Diagnose supply- and demand-side barriers and enablers to vaccination Recommend evidence-informed responses to build and sustain vaccination uptake. Global guidance on TIP Evaluation of the TIP tool and approach in the European Region from 2013 to 2016 Further information on TIP from the WHO Regional Office for Europe Survey questions A compendium of survey questions to assess the underlying determinants of vaccine hesitancy was developed by the SAGE Working Group, though further validation of these questions is still required. If doing so, findings should be shared with WHO to help inform future development and refinement of such tools. Areas of intervention to consider Given the potential for hesitancy to rapidly undermine vaccination coverage in specific settings, it is important that all countries take steps to understand both the extent and nature of hesitancy at a local level, on a continuing basis. Accordingly, each country should develop a strategy to increase acceptance and demand for vaccination, which should include ongoing community engagement and trust-building, active hesitancy prevention, regular national assessments of concerns, and crisis response planning. It should be noted that in low vaccine uptake situations, where lack of available services is the major factor impairing adequate coverage, vaccine hesitancy can be present but is not the priority and should not be the focus of investments. The critical role of health workers In the face of emerging hesitancy, health workers remain the most trusted advisor and influencer of vaccination decisions. The capacity and confidence of health workers are often stretched, though, as they are faced with time constraints, limited resources, and inadequate information and/or training to respond to any questions and discuss the risks and benefits. For health workers to be prepared for the different types of interactions they might face, a number of actions are required. To explore existing knowledge, attitudes and practices, as a basis for the design and evaluation of trainings and tools, the following guide is available: A guide for exploring health worker/caregiver interactions on immunization To build capacity in managing pain during vaccination and in engaging in difficult conversations with hesitant caregivers, two specific and adaptable trainings are available: Health worker training module: managing pain during vaccine administration Health worker training module: conversations with hesitant caregivers Community engagement Communities also need to be at the centre of drives to improve the quality of immunization and health services, access and equity. The linkages between health systems and communities are inter-dependent and thus systems should engage directly with communities in face-to-face interactions. This participatory process can play a role in improving the quality of services in such a way that builds trust and demonstrates respect, with broader benefits for immunization coverage. Source
