Increasing Vaccine Uptake Interventions: Lessons Learnt from South Asia

Abstract

Background: Vaccinations are arguably the most effective tool for preventing infectious diseases and reducing mortality. Pakistan reports some of the highest numbers in the world for unvaccinated children. The low vaccine uptake is attributable to numerous factors, such as illiteracy, vaccine hesitancy, and lack of resources. Given these challenges, effective policymaking is crucial for improving uptake and reducing childhood mortality. This study aims to review the data on vaccine uptake interventions in South Asia and provide insight into their effectiveness and impactfulness in guiding future endeavors in the country. Objective: To assess various vaccine uptake interventions aimed at Pakistani and other South Asian communities. To compare their effects in terms of increased vaccine awareness and coverage and decrease in disease prevalence, especially of communicable diseases. Methodology: The study systematically assessed literature related to vaccine uptake interventions using the PubMed and Google Scholar electronic databases. Articles were systematically screened and checked for eligibility according to PRISMA guidelines. They were assessed for quality and risk of bias, and finally added to the review. Statistical analysis was performed for available data, odds ratio and % increase in outcome were calculated for interventions, and forest plot was plotted where possible. P-values were calculated to check for significance, and heterogeneity was assessed using chi-square, tau, and I² tests. Results: The search yielded a total of 434 results, and after screening and eligibility check, 14 remaining studies were included in the review. Interventions were classified as either educational, vaccine delivery based, incentive based, and reminder based interventions. 8 studies reported educational interventions. The highest vaccine coverage odds were reported for DPT-3 coverage (Andersson, 2009) as a result of Focused Group Discussion Intervention (OD 95% CI = 3.46 [2.62, 4.58] p<0.0001) and BCG vaccine (Anjum, 2004) with House-to-House health messages (OD 95% CI = 3.10 [1.55, 6.19, p<0.001), with more than three times odds of vaccination as compared to no intervention (Control). There were 4 studies in the Delivery-based intervention group and two each in incentive and reminder groups. Upon comparison, multifaceted interventions targeted at vaccine awareness and delivery show the greatest odds of increasing vaccine coverage. Conclusions: The current systematic review includes the first quantitative analysis of vaccine uptake interventions specific to the South-Asian population. The significance of multifaceted interventions targeting vaccine literacy and delivery is evident from the results and should be considered during state-level decision-making. Further research with better resources and broader scope should be conducted to gather critical evidence on the topic.