Vaccine access and uptake
This briefing note explores factors influencing the access and uptake of vaccines; the different approaches taken by public health authorities to promote vaccines; and the ethical considerations that arise in this context.
Strategies to increase vaccine uptake
Measures aiming to promote vaccine uptake can be implemented by both public bodies and private players, and can include education, information campaigns and community engagement, or policies that aim to incentivise vaccination or penalise those who do not get vaccinated.
Education and information campaigns
Public education and information campaigns can aim to support informed choice about vaccines, to address misinformation or concerns, and promote positive messaging around vaccination.
Healthcare workers can play a key role in delivering information, guidance, and advice about vaccines. However, this group themselves can also have concerns about vaccines and surveys have found that many healthcare staff report a lack of confidence in addressing concerns raised by patients. Time pressures and workload can also prevent healthcare professionals from being able to develop a trusting relationship with patients and discuss concerns in depth.
Some religious organisations have taken an active role in promoting vaccination. An example is the campaign run by the British Islamic Medical Association (BIMA) to promote the influenza vaccine in Muslim communities.
There have been attempts to enrol celebrities to influence vaccination uptake in the general population or in particular groups, and some evidence that this can be influential in groups that are undecided about vaccination. In the UK, high-profile British Black and Asian individuals, including comedians Adil Ray OBE and Sir Lenny Henry, have appeared in videos and signed an open letter encouraging Black, Asian, and minority ethnic communities to get the COVID-19 vaccine.
Incentivised and mandatory vaccination
Most countries provide vaccines free of charge or the costs may be covered through health insurance schemes. Some countries give parents incentives for vaccinating their children, for example, cash rewards or increased welfare benefits, or give health professionals incentives relating to their vaccine coverage rates. The Nuffield Council on Bioethics has previously noted that incentives could be appropriate provided their financial value is not so high that they might lead people to take decisions they might not otherwise have taken.
In some cases, vaccination might be required for travel, or to access private or public institutions. For example, some countries only allow entry to those who have a certificate to prove they have received a yellow fever vaccine. In a number of countries, parents are required to have their child vaccinated against certain diseases unless they qualify for an exemption. The penalties for those who do not comply vary from restrictions on school attendance for unvaccinated children to fines or prison sentences for their parents.
While the UK Government has stated that it is not planning to make COVID-19 vaccines compulsory, in February 2021 it announced a review of proposals to introduce immunity or vaccine passports as a condition of access to cultural venues or events, or a condition of employment - for example, for care and healthcare workers. It is likely that proof of a COVID-19 vaccination will be required by some countries for entry. The ethical issues raised by immunity certification have been explored separately in a policy briefing and discussion paper by the Nuffield Council on Bioethics.
There is some evidence that local and community engagement initiatives can help reveal and overcome practical barriers to vaccination (see box 1), and enable trusted individuals and local authorities to evaluate claims and misinformation that circulate about vaccines. Involving citizens in vaccine review and approval processes, or even at the stage of identifying priorities for research, could help to address the concerns of historically marginalised communities and promote trust in vaccine development.