As the first vaccination campaign for COVID-19 could begin as early as next week, following the UK’s approval Pfizer and BioNTech’s mRNA vaccine, the World Health Organisation (WHO) technical advisory group (TAG) has published a series of guidelines and behavioural insights to improve vaccine acceptance and uptake across all populations.

The report, published on Friday, details the recommendations made during a 15 October meeting between TAG members and WHO Department of Immunization, Vaccines and Biologicals.

TAG identified three categories of drivers of vaccine uptake, based on existing behavioural research: enabling environments, social influences and motivation.

Political decision-makers, health workers, media outlets and community leaders may all influence vaccine uptake, the report says.

Enabling Environment

Reducing barriers and making the process of getting vaccinated simple and straightforward – especially for large populations who are not deliberately avoiding vaccination – can improve uptake, the report says.

It cited that what appears to be reluctance, resistance or even opposition among a group might be a response to the inconvenience of getting a vaccine. Environmental factors include:

• Location of the vaccination.
• Costs: including for the vaccine, for travel, or by missing work.
• Time: booking should be accessible, and vaccines should be delivered at convenient times of day.
• Quality of care: health workers should be informed and able to answer questions.
• Information: relevant details should be provided ahead of time, with benefits outlined.
• Regulations: vaccination may be mandatory for employment, education or social activities.

The report says that making vaccines available from familiar and convenient locations, like drop-in services, can encourage uptake. It also noted, however, that fears of contracting COVID-19 in a health facility might impede immunization efforts, and so safety measures should be implemented visibily.

Social Influences

Social influences that affect vaccination decision-making include family members, friends, members of a broader community, and digital or media outlets. The TAG report notes that “[harnessing] social influences” can be used to “promote favourable behaviours”. This can be achieved by:

• Improving communication efforts to promote the perception that “most people are getting vaccinated”. Making uptake visible, either via social media or by enabling ways for people to signal they have been vaccinated, can normalise vaccination.
• Amplifying endorsements from community members.
• Supporting health professionals to encourage engagement. Motivational interviewing, designed to explore the reasons behind an individual’s hesistancy, has ben found to facilitate vaccination.

Increasing Motivation

Motivation towards getting vaccinated is the results of risk perception and severity of illness or infection, the report says. Some groups may believe they are at low risk, and so are reluctant to be vaccinated, for example, while others may be wary of the safety of the vaccine. Key strategies to remove motivational barriers include:

• Building trust in vaccines before vaccination. Evidence indicates that strategies designed to change attitudes towards vaccination are not always successful. Building up trust ahead of the decision to receive a vaccine is vital.
• Emphasizing the social benefits. Communicating the benefits of vaccination, such as restored engagement with the community and family members, has been found to increase vaccination intention.
• Leveraging regret. Anticipated regret – the fear of regetting a future action – is a strong barrier. Highlighting the consequences of inaction – for instance, by asking people how they would feel if they do not get vaccinated and end up contracting COVID-19 or transmitting it to loved ones – may encourage vaccination.

Image Credits: Keystone/ Hans Pennick.