Why vaccine hesitancy needs to be addressed
Vaccine hesitancy, defined by the WHO as the delay in acceptance or refusal of vaccines despite the availability of vaccination services, is a multifaceted and context-specific issue that varies across time, location, and vaccine type. While some degree of hesitancy is anticipated within any population, the significant increase following the COVID-19 pandemic is concerning. Historically, vaccine uptake, particularly for routine immunizations, was often a default behavior, requiring minimal contemplation. However, the decision to receive the novel and unfamiliar COVID-19 vaccine, especially in the uncertain and dynamic context of the pandemic, became an active and deliberate choice. Misinformation during the pandemic exacerbated public skepticism, distrust and hesitancy, affecting not only the acceptance of the COVID-19 vaccine but also other vaccines.
As new vaccines are developed and introduced, increased vaccine hesitancy among the population threatens the efficacy of vaccines in preventing infectious diseases. This hesitancy exposes vulnerable populations—such as children, individuals with pre-existing conditions, and marginalized communities—to heightened risks, undermining public health efforts and increasing susceptibility to disease outbreaks. It thus becomes crucial to work closely with Governments, donors, and implementing partners to understand the barriers and drive the uptake of vaccines and decode the impact of COVID-19 pandemic on routine immunization and other vaccines, and to understand and redirect demand for misinformation to ensure journey towards future vaccine uptake.
COVID Context
Prior to the COVID-19 pandemic, vaccination primarily concerned routine immunizations for infants and children, a default decision due to high familiarity and influential norms. However, the introduction of the novel and perceived experimental COVID-19 vaccine made adult vaccination an outlier, requiring adults to actively assess the decision to vaccinate themselves and their dependents.
The pandemic's focus on rapid vaccine development intensified these worries. While many accepted COVID-19 vaccines, concerns about their swift development and long-term effects raised doubts about their safety, Perceived insufficient testing and rapid deployment contributed to increased vaccine hesitancy. Additionally, misinformation during the pandemic further fueled public skepticism. These factors not only affected COVID-19 vaccine acceptance but also caused spillover hesitancy toward other vaccines, such as HPV and the overall feelings of emotional and cognitive risk associated with routine immunization as well.
Misinformation
The COVID-19 context highlighted misinformation. Even with trusted sources like government bodies and the education system, individuals sought information from channels like social media, peers, and religious institutions. They faced a torrent of information about risk factors, vaccine safety, mandates, cures, and more. Digital media rapidly spread false information and emphasized negatives, delaying decision-making and increasing vaccine hesitancy. This infodemic caused confusion, skepticism, and insecurity about vaccine safety for many.
Exposure to confusing and conflicting information about vaccines made people stick to the status quo and perceive action as risky. Therefore, it is crucial to manage accurate information flow and help people understand the right information to ensure vaccine uptake.
Trust
Positive interactions with trusted healthcare providers enhance vaccine confidence, while distrust from past experiences or perceived biases increases hesitancy. Trust in the health system is crucial for vaccine uptake. High trust in healthcare providers who promote vaccination boosts acceptance, while distrust leads to hesitancy and refusal. Negative past experiences with foreign-led campaigns cause resistance to new programs.
Government trust varies, affecting vaccine acceptance in different communities. The COVID-19 pandemic and government responses created numerous barriers and mistrust. This post-pandemic mistrust reduced future vaccine uptake, driven by beliefs in perverse incentives for vaccine promotion and concerns about adverse events despite roll-out.
Trust in health systems and governments, and their pandemic response, shape perceptions of vaccine benefits and trust in vaccines. Misinformation erodes this trust, leading to lower vaccine confidence. Furthermore, the post-COVID world challenged the perception of routine immunization as a default healthcare service.
General Hesitancy
Despite high reported intentions to vaccinate, adoption rates remain low due to complex behaviors, trust in the health system, beliefs about vaccine efficacy and safety, and access to resources. Vaccination involves a web of people, funding, policies, and permissions. The ideal of smooth vaccine supply meeting demand has been challenged, particularly during the COVID-19 pandemic, revealing that vaccination hesitancy exists on a continuum influenced by context, trade-off evaluations, and mental models.
Pre COVID-19 all vaccines were seen as a ‘good’ vaccine, and they were also associated with only childhood immunizations. However, during the COVID-19 pandemic, widespread misinformation on vaccine side effects led to skepticism not only towards routine immunization but also newer vaccines like HPV. Negative experiences with COVID-19 or childhood vaccines, such as falling ill after vaccination, experiencing pain during/post vaccination or perception of being unnecessary medical procedures that would make people ill, have caused some to rethink the safety, efficacy, and necessity of vaccines, and increased susceptibility to fears, leading to delays or avoidance of vaccinations.
Concerns about vaccine safety and practical barriers often lower vaccination intentions. Individuals may overemphasize potential harms from vaccination while downplaying the risks of not vaccinating. These emotional, contextual, and cognitive factors increase hesitancy towards future vaccine introductions and their uptake.
Insights and Learnings
COVID-19 Disease Appraisal
What do I feel about the COVID-19 disease?
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Seeking Mitigation Strategies
How can I cope with the
COVID-19 risk?
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COVID-19 Vaccine Appraisal
How do I feel about the COVID-19 Vaccine?
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Coping with Vaccine Risk
How can I cope with vaccine risk?
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Vaccination Uptake
How can I get this vaccine?
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Vaccination Adherence
Should I get the second dose?
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Our approach to understanding and addressing vaccine hesitancy
[1 paragraph about FM behavioral approach - then maybe 3 boxes with 1-2 sentence intros with a link to separate pages for psycho-behavioral segmentation and HCD]
Psycho-behavioral approach
Human behavior is complex, influenced by environment, emotions, and beliefs. At Final Mile, we tackle these intricate challenges using behavioral science and human-centered design. Our goal is to understand and predict the preferences of target populations across different contexts and geographies, embracing uncertainty to create effective interventions.
Traditional behavior change methods rely on persuasion. In contrast, our approach aligns product, service, and communication design with the behavioral drivers of the target population, fostering intrinsic engagement—what we call 'self-selected attention.' Due to the diversity of psycho-behavioral factors, we develop multiple, differentiated solutions to achieve this.
We start by understanding both external factors (societal context, infrastructure, policy) and internal factors (beliefs, emotions, biases, demographics) that influence behavior. Our mixed-method approach includes ethnography, gamification, and quantitative and qualitative research to capture stories and analyze behavioral segments. This comprehensive understanding helps us design solutions not just for end users, but also for all stakeholders involved. We continuously innovate our tools and methods to sustain impact and efficiency.
HCD
Human centered design (HCD) is a problem-solving approach that Final Mile uses throughout our project work. We bring mindsets of collaboration, curiosity, empathy and experimentation as we move from a place of understanding to co-creating and testing design concepts and interventions. By focusing on understanding our target users, their decision-making process, the stakeholders involved and the systems they are connected to, we develop a richer understanding that allows us to engage with end users and stakeholders to co-design impactful and sustainable interventions targeting the problem area.
We leverage HCD throughout the project as we seek to build more collaborative moderator onboarding, an empathetic research methodology, co-design of interventions and user-focused testing of design concepts. We value lived experience as much as subject-matter expertise and seek to involve both throughout the process.
Our HCD approach continues to evolve, and we see ourselves as facilitators of the HCD process, which can lead to design with others, rather than design for others. In collaborating with end users, our intention is to co-create interventions that are contextually appropriate, sustainable, and impactful.
HCD Framework To Go Here???
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Our vaccine work
[2-3 sentences as introduction to our work with links to each project - maybe 1 line description of the project with a learn more button? - projects will hopefully have publications]
COVID-19
Developing a safe and efficacious vaccine against COVID-19 in record time has been a success, but swift and comprehensive rollout of the vaccine has been marred by a number of challenges.
On the supply side, these include funding, accessibility, and the logistical complexity of transporting, storing, and administering vaccines. On the demand side, one key challenge is vaccine hesitancy and resistance. Low confidence in COVID-19 vaccines, and low willingness to receive them, is a significant and growing risk to beating the pandemic globally.
HPV
Cervical cancer, the most common manifestation of HPV, ranks as the second leading cause of female cancer and the most common cancer in African women aged 15 to 44 years. Despite the proven effectiveness of the HPV vaccine, many individuals remain hesitant to allow their children to be vaccinated or receive the vaccine themselves.
Problem statement
HPV is a significant global health concern, contributing to a high burden of preventable diseases, especially cervical cancer. Despite the effectiveness of HPV vaccines, uptake remains low, particularly in Africa, where 425.68 million women aged 15 and older are at risk. In 2020, global coverage dropped to 13% due to COVID-19 disruptions.
In Kenya, only 33% received the first dose and 16% the second dose in 2020. With similar low coverage in Côte d'Ivoire, these numbers were 34% and 41% in 2021.
Barriers to vaccine adoption include healthcare disparities, funding issues, supply shortages, and limited access to health facilities. Additionally, societal stigmas, misconceptions about vaccine safety, and religious beliefs hinder uptake.
Decision-making is further complicated by the need for parental consent and the stigma associated with sexually transmitted infections. Addressing these challenges requires a holistic approach, focusing on the social, structural, economic, and behavioral factors influencing vaccine confidence and uptake.
Methodology
Psycho-behavioral segmentation offers a targeted approach to address barriers to HPV vaccination by understanding the psychological and behavioral drivers among families of adolescent girls in Kenya and Côte d’Ivoire.
This method identifies family "archetypes" requiring tailored strategies to activate latent demand for vaccination. Insights from this approach will guide the creation of targeted messages, service delivery methods, and identify effective messengers to resonate with diverse caregivers and adolescents. By understanding user needs and co-designing interventions, this strategy aims to accelerate HPV vaccine coverage by engaging families who might otherwise choose not to vaccinate.
RI
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About Final Mile
Final Mile addresses complex behavioral challenges through a deep understanding of personal and social context, a range of mixed research methods, and a collaborative, community-based approach that supports stakeholders with the strategies and tools they need. Our approach aims for collaborative, effective and sustainable behavior change.