Peer-reviewed article
Initiatives to increase childhood vaccination coverage: an international comparison
Madelon W. Kroneman, Alfons Fermin, Bernd Rechel, Sara M. Allin, Anders Anell et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study surveyed vaccination policy experts from 22 countries across Europe, Israel, the USA, and Canada to identify measures introduced between 2014 and 2019 to increase childhood vaccination coverage. Researchers found four main types of interventions: restrictive measures limiting unvaccinated children's access to services, financial incentives for healthcare providers, logistical improvements like using schools as vaccination sites, and vaccination promotion campaigns. Most countries focused on communication and knowledge improvement, but the study found limited evidence on how effective these measures actually are at increasing vaccination rates.
Key points
- Four main intervention types were identified: restrictive measures, financial incentives, logistical support, and promotion campaigns
- Restrictive measures often expanded mandatory vaccination policies or limited pre-school access for unvaccinated children
- Financial incentives for healthcare providers showed some positive effects
- Schools were used as alternative vaccination sites in several countries, though this presented organizational challenges
- Most countries invested in improving knowledge among healthcare professionals and parents, but evidence on impact is limited
Limitations
The study relied on expert reports rather than rigorous outcome data, so the actual effectiveness of interventions is unclear. The survey collected information only on measures introduced between 2014-2019 and may not capture all interventions or their longer-term impacts on vaccination coverage.
Abstract
Background Childhood vaccination rates fluctuate over time and do not always meet the levels recommended by the WHO. Objective This study aims to provide an overview of measures countries have introduced to increase vaccination rates. Methods We developed a structured data collection template that was completed by country experts from Europe, Israel, the USA, and Canada. Experts were identified using the European Observatory on Health Systems and Policies' HSPM (Health Systems and Policy Monitor) network. We approached experts from 32 countries and received responses from 22 countries. In the template we asked for measures introduced between 2014 and 2019. The experts were asked to indicate the type of intervention, the target population, possible positive and negative effects, and evidence on effectiveness. The information was collected between September 2019 and January 2020. Results We identified four main types of interventions: restrictive measures for the unvaccinated, financial incentives, measures supporting the logistics of vaccination, and vaccination promotion campaigns. Restrictive measures often involved expanding existing mandatory vaccination policies or limiting access to pre-school activities for unvaccinated children. Financial incentives for healthcare providers showed some positive effects. Regarding logistical support, several countries used schools as alternative vaccination sites, though this presented organisational challenges. Many countries invested in improving knowledge among both healthcare professionals and parents to encourage vaccine uptake. Conclusions Most initiatives implemented in the countries covered focussed on communication and knowledge enhancement. However, there is limited evidence on the impact of these measures on vaccination coverage.