2023-2024 Case Studies

Summary of Key Insights: Immunization Uptake in Childhood and Across the Lifecourse

The following emerged as high-level insights from the projects in Ethiopia, Nigeria, Pakistan, and Sierra Leone which focused on the factors affecting immunization uptake in childhood and across the lifecourse.

On interventions:

• Targeted interventions are required to address the identified concerns, misinformation, and low confidence in vaccines among parents/child caregivers of zero-dose children. Some examples include:
  • Community volunteers using referral slips to refer parents/caregivers to health extension workers at health posts can be utilized as part of house-to-house educational outreach (Ethiopia)
  • Embedding wellness team members into mobile vaccination units ensures the wellbeing of health care staff in high-demand settings (Sierra Leone)
  • Integrated family-based vaccination programs delivered via mobile vaccination units can support childhood and life-course vaccine uptake in vaccine-hesitant populations (Sierra Leone)
  • Broader use of mobile vaccination units in rural and hard-to-reach areas can help increase vaccination coverage and improve health equity (Sierra Leone)
  • Multi-vaccine outreach programs are more cost-effective than single-vaccine campaigns
  • Design thinking can be incorporated into microplanning to substantially improve immunization micro-plans in urban poor and conflict-affected settlements (Nigeria)
• Gender and socioeconomic status are critical factors to consider in the development of tailored strategies within primary health care and immunization program micro-plans

Leveraging communities and health workers:

• Directly addressing concerns can help boost full immunization coverage rates
• Health workers, including community health workers (CHWs), need enhanced training on how to effectively talk with community members about vaccines
• Engaging local leaders and influencers who share cultural and social ties with caregivers in vaccine campaigns can help build credibility
• Programs can encourage community members and volunteers to actively engage in vaccination programs

Summary of Key Insights: Operationalizing the BeSD Framework in Diverse Settings

The following emerged as high-level insights across the country-level projects in Bangladesh and Melanesia (including Papua New Guinea, Solomon Islands, and Vanuatu) that focused on operationalizing the BeSD framework in diverse settings for each key domain:

Thinking & Feeling

• Communities report general awareness of the benefits of vaccination
• Gaps in knowledge were reported, alongside fears and skepticism of vaccination

Social Processes

• Family and friends, as well as religious and community leaders, were reported as key vaccination influencers
• Vaccine delivery needs to directly address local gender norms and dynamics
• Motivation
• While communities generally displayed initial willingness to vaccinate, they were hamstrung by practical barriers and overall mistrust of health systems

Practical Issues

Barriers or challenges to uptake included:

• Transportation and distance between communities and health/vaccination centers
• Limited access to health care services and insufficient staffing,
• Limited information, including information on local vaccine availability
• Costs — particularly out-of-pocket costs of transport and/or vaccination