The European Centre for Disease Prevention & Control (ECDC) is responsible for strengthening Europe’s defences against infectious diseases. As an EU body, it collects data from Member States, identifies health threats and publishes expert advice.
One area of public health that has progressed in recent years is the growing influence of social sciences. In particular, behavioural research can be applied to understand what drives people to accept vaccination – and the barriers that lead a minority of people to opt out.
We asked ECDC experts how the agency is supporting European countries and healthcare professionals in protecting the public against vaccine-preventable diseases. This is the first of two articles on this topic.
Vaccines Today: How is ECDC helping national authorities and healthcare professionals to use evidence-based tools for improving vaccine uptake?
ECDC: ECDC has published Tools and methods for promoting vaccination acceptance and uptake, a social and behavioural science approach. The report incorporates the latest social and behavioural science approaches, with usable and adaptable formats that fit the real-life contexts of public health authorities and vaccination programmes.
Barriers and facilitators of vaccination acceptance are complex, context-specific, and vary across time, place and type of vaccine. Social and behavioural sciences can help us to diagnose these barriers and facilitators through understanding individual and population level:
- Perceptions and attitudes,
- Questions and concerns (about the disease and the vaccine),
- Habits and capabilities,
- Social, cultural and environmental structures and influences.
How can this inform action?
Tailored strategies and interventions can be built on insights from social and behavioural research. To support this work, the report includes:
- A survey tool to collect social and behavioural data on vaccination acceptance and uptake, and support the diagnosis of barriers and facilitators to vaccination in specific populations.
- Methods for addressing behavioural barriers to vaccination, including a library of interventions to increase vaccination acceptance and instructions on how to use the World Health Organization (WHO)’s ‘5 Steps for the application of behavioural science’ framework.
What has ECDC done to help authorities apply this information?
Further to the report, ECDC has offered capacity building support to EU/EEA national public health authorities based on these tools and methods. So far, we have held a two-day workshop with six countries. Follow-up capacity building activities are discussed on a bilateral basis with the participating countries, based on their needs, for example, a workshop to take place in Romania in the autumn of 2026.
For this year’s European Immunization Week, we are planning an ECDC Lighthouse webinar targeting broader audiences that will specifically address how these tools and methods can support the tailored vaccination campaigns and communication.
Is the set of operational tools launched last year primarily for immunisation managers or could HCPs use it too?
This report is primarily directed towards national and regional public health authorities and vaccination programme managers. However, it is also relevant to all audiences that have a role in ensuring that the population has appropriate and equitable access to vaccination programmes, and that people fully understand the benefits of being vaccinated.
As the most trusted sources of information on vaccination, healthcare providers have unique insights into the questions and concerns that people have for themselves and their children prior to accepting an offer of vaccination.
As such, HCPs are specifically involved in some of the interventions described in the report, and are often the target audiences for social and behavioural surveys, interviews and focus groups by the public health authorities and vaccination programmes to understand and diagnose barriers and facilitators of vaccination amongst the population. Social and behavioural studies also look at HCPs own attitudes and perceptions, as this in turn has an impact on their recommendations.
HCPs may also be asked to participate in the co-design of evidence-based public health interventions to increase vaccination acceptance and uptake, as they best understand both the audiences and the context for these interventions.
Is there an example which illustrates this approach in practice?
A very good example of this approach in practice is a project done by UNICEF’s Refugee Response in Poland in collaboration with the Mother and Child Institute Foundation, Yale School of Medicine and ECDC.
Project overview:
- Identify barriers Ukrainian refugee mothers in Poland face with routine child vaccination.
- Understand challenges and attitudes of medical workers toward caring for refugee children.
- Design a behavioral intervention to promote vaccination and address these barriers.
- Dates: June-August 2023
Read more:
Vaccinating a child during an emergency is more important than ever (UNICEF)
ECDC’s collated resources onpromoting vaccination acceptance and uptake.
What are the 5Cs of vaccination acceptance?