The 5As: A practical taxonomy for the determinants of vaccine uptake

Angus Thomson; Karis Robinson; Gaëlle Vallée-Tourangeau

doi:10.1016/j.vaccine.2015.11.065

The 5As: A practical taxonomy for the determinants of vaccine uptake

Angus Thomson, Karis Robinson, Gaëlle Vallée-Tourangeau

Research output: Contribution to journal › Article › peer-review

Abstract

Suboptimal vaccine uptake in both childhood and adult immunisation programs limits their full potential impact on global health. A recent progress review of the Global Vaccine Action Plan stated that "countries should urgently identify barriers and bottlenecks and implement targeted approaches to increase and sustain coverage". However, vaccination coverage may be determined by a complex mix of demographic, structural, social and behavioral factors. To develop a practical taxonomy to organise the myriad possible root causes of a gap in vaccination coverage rates, we performed a narrative review of the literature and tested whether all non-socio-demographic determinants of coverage could be organised into 4 dimensions: Access, Affordability, Awareness and Acceptance. Forty-three studies were reviewed, from which we identified 107 different determinants of vaccination uptake. We identified a fifth domain, Activation, which captured interventions such as SMS reminders which effectively nudge people towards getting vaccinated. The 5As taxonomy captured all identified determinants of vaccine uptake. This intuitive taxonomy has already facilitated mutual understanding of the primary determinants of suboptimal coverage within inter-sectorial working groups, a first step towards them developing targeted and effective solutions.

Original language	English
Pages (from-to)	1018-1024
Journal	Vaccine
Volume	34
Issue number	8
DOIs	https://doi.org/10.1016/j.vaccine.2015.11.065
Publication status	Published - 17 Feb 2016

Bibliographical note

Impact: Previous research on vaccine uptake has identified a multitude of potential determinants. As a result, it is difficult to decide which determinant should be targeted when designing interventions to improve uptake. The 5As taxonomy effectively captured all of the determinants of vaccine uptake identified in this literature review. Future research may use this taxonomy to systematically compare and weight the importance of each of the 5As in explaining a vaccination gap for different vaccines or for one vaccine in different socio-cultural contexts. This in turn, would allow targeted, research-informed, interventions aiming to increase coverage rates. This taxonomy is currently being tested in pilots of an integrated approach to diagnose and improve a vaccination gap. It has already effectively facilitated a mutual understanding of the primary determinants of suboptimal coverage among inter-sectorial working groups in four countries, a first step towards them developing targeted and effective solutions.

Keywords

Allied health professions and studies
immunisation rates
vaccination coverage
vaccine acceptance
vaccine hesitancy
vaccine uptake

Access to Document

10.1016/j.vaccine.2015.11.065

Vallée-Tourangeau-G-33629-AAMAccepted author manuscript, 483 KBLicence: CC BY-NC-ND
Vallee-Tourangeau-G-33629-VoRFinal published version, 436 KBLicence: CC BY-NC-ND

http://dx.doi.org/10.1016/j.vaccine.2015.11.065

Cite this

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title = "The 5As: A practical taxonomy for the determinants of vaccine uptake",

abstract = "Suboptimal vaccine uptake in both childhood and adult immunisation programs limits their full potential impact on global health. A recent progress review of the Global Vaccine Action Plan stated that {"}countries should urgently identify barriers and bottlenecks and implement targeted approaches to increase and sustain coverage{"}. However, vaccination coverage may be determined by a complex mix of demographic, structural, social and behavioral factors. To develop a practical taxonomy to organise the myriad possible root causes of a gap in vaccination coverage rates, we performed a narrative review of the literature and tested whether all non-socio-demographic determinants of coverage could be organised into 4 dimensions: Access, Affordability, Awareness and Acceptance. Forty-three studies were reviewed, from which we identified 107 different determinants of vaccination uptake. We identified a fifth domain, Activation, which captured interventions such as SMS reminders which effectively nudge people towards getting vaccinated. The 5As taxonomy captured all identified determinants of vaccine uptake. This intuitive taxonomy has already facilitated mutual understanding of the primary determinants of suboptimal coverage within inter-sectorial working groups, a first step towards them developing targeted and effective solutions.",

keywords = "Allied health professions and studies, immunisation rates, vaccination coverage, vaccine acceptance, vaccine hesitancy, vaccine uptake",

author = "Angus Thomson and Karis Robinson and Ga{\"e}lle Vall{\'e}e-Tourangeau",

note = "Impact: Previous research on vaccine uptake has identified a multitude of potential determinants. As a result, it is difficult to decide which determinant should be targeted when designing interventions to improve uptake. The 5As taxonomy effectively captured all of the determinants of vaccine uptake identified in this literature review. Future research may use this taxonomy to systematically compare and weight the importance of each of the 5As in explaining a vaccination gap for different vaccines or for one vaccine in different socio-cultural contexts. This in turn, would allow targeted, research-informed, interventions aiming to increase coverage rates. This taxonomy is currently being tested in pilots of an integrated approach to diagnose and improve a vaccination gap. It has already effectively facilitated a mutual understanding of the primary determinants of suboptimal coverage among inter-sectorial working groups in four countries, a first step towards them developing targeted and effective solutions.",

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KW - vaccine hesitancy

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JO - Vaccine

JF - Vaccine

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ER -

The 5As: A practical taxonomy for the determinants of vaccine uptake

Abstract

Bibliographical note

Keywords

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