Barriers and enablers to vaccine uptake: evidence from a systematic literature review

Jumana Issa Haddad
Dr. Jumanah Essa-Hadad

Health Promotion, Lead Researcher River-EU, Bar Ilan University (BIU), Israel

Vaccinations have been shown to reduce health inequality worldwide. However, wide gaps in vaccine uptake remain among different population groups. In Europe, childhood vaccine uptake is typically and substantially lower in most minority or ethnic communities compared to the general European population.

As part of the RIVER-EU project, our focus is on increasing the uptake of two vaccinations – Measles, Mumps, Rubella (MMR) and the Human Papilloma Virus (HPV) – among disadvantaged populations in Europe.

To create effective interventions that specifically address the needs of underserved populations, it is essential to first understand the health system barriers and enablers that prevent access to care services. We conducted a thorough assessment of previous research to collect a set of comprehensive data, specifically relating to the health system barriers and enablers around the MMR and HPV vaccination among disadvantaged communities to understand the effects.

Using five different research databases that covered publications from 2010-2021, we uncovered 1,658 search results from five databases and 24 from reference lists. However, 1,556 titles were screened (excluding duplications) which resulted in 496 being eligible. All in all, 86 full texts were assessed for eligibility with 28 articles meeting all the inclusion criteria. Barriers and enablers were mapped according to the World Health Organization Health System Building Blocks Framework and were related to service delivery, health workforce, health information systems, medical products, financing, and leadership and governance.

Service delivery (limited time to offer and discuss vaccine, geographic distance, lack of translated materials that are culturally appropriate, difficulties navigating health care system, health care workforce (language and poor communication skills), financial costs and feelings of discrimination were the predominant factors that affected MMR and HPV vaccine uptake among disadvantaged populations.

By understanding and evaluating the health system level factors, we can create effective future strategies and approaches to increase MMR and HPV uptake for all.