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 23 primary 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.
authors.affiliation: Sanofi Pasteur, Lyon, France. Electronic address: angus.thomson@sanofipasteur.com.
authors.forename: Angus
authors.initials: A
authors.lastname: Thomson
authors.affiliation: Department of Psychology, Kingston University, Kingston upon Thames, UK.
authors.forename: Karis
authors.initials: K
authors.lastname: Robinson
authors.affiliation: Department of Psychology, Kingston University, Kingston upon Thames, UK. Electronic address: G.Vallee-Tourangeau@kingston.ac.uk.
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Vallée-Tourangeau
mesh_terms: D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D017589:Immunization Programs; D010342:Patient Acceptance of Health Care; D011634:Public Health; D017010:Reminder Systems; D014611:Vaccination / Q000706:statistics & numerical data*; D014612:Vaccines / Q000008:administration & dosage*
chemical_list: D014612:Vaccines
keywords: Immunisation rates; Vaccination coverage; Vaccine acceptance; Vaccine hesitancy; Vaccine uptake