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Vaccines
Special Issues
Factors Influencing Vaccine Uptake and Immunization Outcomes
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Factors Influencing Vaccine Uptake and Immunization Outcomes

A special issue of Vaccines (ISSN 2076-393X). This special issue belongs to the section "Vaccines and Public Health".

Deadline for manuscript submissions: 31 January 2027 | Viewed by 3625

Special Issue Editors

Dr. Sitong Luo

E-Mail Website
Guest Editor
1. Vanke School of Public Health, Tsinghua University, Beijing 100084, China
2. Institute for Healthy China, Tsinghua University, Beijing 100084, China
Interests: behaviors in preventing and controlling infectious diseases; vaccination epidemiology
Dr. Meiqi Xin

E-Mail Website
Guest Editor
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
Interests: persuasive communication for promoting changes in health behavior; digital self-help interventions; psychosocial models of health/illness behaviors; primary healthcare
Dr. Zixin Wang

E-Mail Website
Guest Editor
The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
Interests: inter-disciplinary behavioral health research; mental health research
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Immunization is one of the most cost-effective public health interventions. It is a fundamental component of universal health coverage, contributing to the prevention of mortality and disease. Despite remarkable advances in vaccine development and distribution, disparities in immunization coverage remain persistent worldwide. Enhancing global vaccination coverage is crucial, particularly in the post-pandemic era, when vaccine hesitancy continues to raise public concern. Determinants associated with vaccine uptake and the subsequent outcomes of immunization are complex, covering biological, psychological, behavioral, socio-economic, and environmental aspects. Hence, it is essential to identify and understand these factors to develop and implement effective strategies and approaches that improve vaccine uptake and immunization coverage.

This Special Issue aims to explore the factors that shape vaccine uptake and their subsequent impact on individual and population-level immunity. We welcome contributions that are within the scope of Vaccines, including aspects of epidemiology, health policy, management, and immunology. By integrating global perspectives and insights, we aim to inform interventions that enhance vaccine uptake and reduce disparities in immunization coverage, thereby informing targeted strategies and approaches to close immunization gaps and strengthen pandemic preparedness on a global scale.

We look forward to receiving your contributions.

Dr. Sitong Luo
Dr. Meiqi Xin
Dr. Zixin Wang
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Vaccines is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • vaccination
  • vaccine uptake
  • immunization

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Published Papers (4 papers)

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Research

19 pages, 277 KB  
Article
Understanding the Behavioural and Social Drivers of Childhood Vaccination Uptake Among Caregivers: A Qualitative Study in Cape Town, South Africa
by Lindi Mathebula, Charles S. Wiysonge and Sara Cooper
Vaccines 2026, 14(4), 320; https://doi.org/10.3390/vaccines14040320 - 3 Apr 2026
Viewed by 412
Abstract
Background: Childhood vaccination remains the cornerstone of public health strategies, substantially reducing global morbidity and mortality, yet suboptimal uptake persists in many settings. In South Africa, the challenge is evident, with persistent outbreaks of vaccine-preventable diseases. Addressing localised immunisation shortfalls requires elucidating [...] Read more.
Background: Childhood vaccination remains the cornerstone of public health strategies, substantially reducing global morbidity and mortality, yet suboptimal uptake persists in many settings. In South Africa, the challenge is evident, with persistent outbreaks of vaccine-preventable diseases. Addressing localised immunisation shortfalls requires elucidating the complex interplay of factors beyond conventional access barriers. This qualitative study provides context-specific insights into the behavioural and social drivers influencing childhood vaccination uptake among caregivers in Cape Town, South Africa. Methods: Utilising an exploratory qualitative research design, thematic analysis was applied to interview data (n = 25 caregivers) collected via a purposive sampling strategy designed to capture maximum variation in experiences within targeted low-uptake subdistricts. Interpretation of the data was systematically guided by the World Health Organization’s Behavioural and Social Drivers (BeSD) framework. The latter consists of four domains, namely, “Thinking and Feeling”, “Social Processes”, “Motivation”, and “Practical Factors”. Findings: Analysis across BeSD domains reflected a pattern of the intention–behaviour gap, where caregivers are motivated for vaccination but face structural and practical barriers affecting timely uptake. In the Thinking and Feeling domain, widespread conviction regarding the vital benefits of vaccination co-existed with significant anxiety concerning minor side effects (e.g., pain and fever), which sometimes precipitated missed subsequent appointments. Caregivers frequently accept immunisation as a social routine despite having limited knowledge of the diseases it prevents. Social Processes demonstrated that while decision-making authority rested primarily with mothers, compliance relied on the delegation of logistical responsibilities to extended family members. Critically, reports of poor communication, judgment, or negative attitudes among healthcare workers undermined trust and acted as barriers to sustained engagement. Within the Practical Factors domain, structural constraints frequently overshadowed high intent, with pervasive issues such as long waiting times and financial costs cited as the main reasons for missed appointments. Conclusions: Participants generally expressed strong acceptance of vaccination, but attainment of optimal coverage is constrained by systemic failures in patient–provider communication and persistent logistical barriers within the public healthcare delivery system. Strategic public health interventions must therefore move beyond addressing only attitudinal opposition to prioritise targeted efforts that mitigate structural constraints and reinforce personalised, empathetic communication to sustain caregiver confidence and adherence. Full article
(This article belongs to the Special Issue Factors Influencing Vaccine Uptake and Immunization Outcomes)
21 pages, 1483 KB  
Article
Assessing Readiness for Future Maternal Malaria Vaccines: Knowledge, Practices, and Vaccine Attitudes Among Women of Reproductive Age in Malawi
by Mandeep Kaur, Flavia D’Alessio, Marion Chirwa Kajombo, Mzati Nkolokosa and Ole F. Olesen
Vaccines 2026, 14(4), 316; https://doi.org/10.3390/vaccines14040316 - 31 Mar 2026
Viewed by 894
Abstract
Background: Placental malaria (PM) is a serious complication of malaria in pregnancy (MiP). It has major repercussions for mothers’ and neonates’ health, particularly in sub-Saharan Africa (SSA). As current preventive measures lose efficacy due to drug resistance, malaria vaccines can play a crucial [...] Read more.
Background: Placental malaria (PM) is a serious complication of malaria in pregnancy (MiP). It has major repercussions for mothers’ and neonates’ health, particularly in sub-Saharan Africa (SSA). As current preventive measures lose efficacy due to drug resistance, malaria vaccines can play a crucial role in malaria control. The main objective of this study was to generate evidence that can guide the design of social and behaviour change interventions to raise awareness of PM and improve vaccine acceptance. Methods: A facility-based cross-sectional survey was conducted; five dichotomised indicators were constructed; multivariate logistic regression was adjusted for age, education, and districts; and prespecified sensitivity analyses were done. Results: General malaria knowledge and preventive practices were high. Many women (53.4%) reported having had experienced fever during pregnancy. Prevention behaviour was not significantly associated with age or education. Both high knowledge (aOR 0.30, 95% CI 0.16–0.57) and perceived risk awareness (aOR 0.35, 95% CI 0.18–0.68) were lower for Mpemba than for Thyolo. Biomedical healthcare services were less likely utilised by women in Madziabango as compared to Thyolo (aOR 0.47, 95% CI 0.23–0.96). Although 92% acknowledged possible harm, nearly all of them (97%) reported willingness to accept a future maternal malaria vaccine. Conclusions: There was a high level of maternal malaria vaccine acceptability; however, these findings suggest that local context-specific delivery strategies could be useful for effective future PM vaccine introduction. Full article
(This article belongs to the Special Issue Factors Influencing Vaccine Uptake and Immunization Outcomes)
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14 pages, 237 KB  
Article
The Impact of a Dedicated In-Hospital Vaccination Clinic on Adherence to Herpes Zoster Vaccination Among Immunocompromised and Frail Adults: Findings from an Italian Quasi-Experimental Study
by Alessandra De Pasquale, Adele Sarcone, Mariangela Cassadonte, Iole Camilla Iocca, Gabriella Di Giuseppe, Carmelo G. A. Nobile and Claudia Pileggi
Vaccines 2026, 14(4), 306; https://doi.org/10.3390/vaccines14040306 - 28 Mar 2026
Viewed by 523
Abstract
Background: Principal aims of this study were to evaluate, in frail immunocompromised patients, the willingness to receive the herpes zoster (HZ) vaccination and the impact of the in-hospital vaccination dedicated clinic on HZ vaccination adherence. Materials and methods: A non-randomized quasi-experimental intervention study [...] Read more.
Background: Principal aims of this study were to evaluate, in frail immunocompromised patients, the willingness to receive the herpes zoster (HZ) vaccination and the impact of the in-hospital vaccination dedicated clinic on HZ vaccination adherence. Materials and methods: A non-randomized quasi-experimental intervention study was conducted in Southern Italy among immunocompromised patients. Patients enrolled in the in-hospital vaccination dedicated clinic were included in the experimental group, while the control group consisted of patients recruited in the General Practitioners clinics. Results: From April 2024 to March 2025, 369 patients were recruited, 183 of whom were included in the experimental group and 186 in the control group, The willingness to receive HZ vaccination was declared by 46.3% of subjects, and among those, 28.5% underwent vaccination. Logistic regression results showed that participants in the experimental group were significantly more likely to both declare willingness to receive vaccination (OR = 6.32; 95% CI 3.05–13.10) and to adhere to HZ vaccination (OR = 64.63; 95% CI 14.78–282.62). Conclusions: Our findings have shown that both willingness and adherence to HZ vaccination in immunocompromised subjects remain inadequate with respect to international targets and provide an effective model of integration between different professionals capable of promoting greater accessibility and adherence to HZ vaccination. Full article
(This article belongs to the Special Issue Factors Influencing Vaccine Uptake and Immunization Outcomes)
14 pages, 512 KB  
Article
Vaccination Recommendation Patterns and Associated Factors Among Children with Special Health Care Needs: A Cross-Sectional Study in District-Level Immunization Services in China
by Chenglian Wang, Li Zhang, Binyue Xu, Xiaolan Fu, Li Fu, Bowen Li, Wang Ju, Qingyu Li and Sitong Luo
Vaccines 2025, 13(11), 1145; https://doi.org/10.3390/vaccines13111145 - 7 Nov 2025
Cited by 1 | Viewed by 1201
Abstract
Background: Children with special health care needs (CSHCN) are at heightened risk of delayed or missed vaccinations because of clinical complexity and provider uncertainty. Although China has issued expert consensus guidelines and established immunization advisory services, little is known about vaccination decision-making [...] Read more.
Background: Children with special health care needs (CSHCN) are at heightened risk of delayed or missed vaccinations because of clinical complexity and provider uncertainty. Although China has issued expert consensus guidelines and established immunization advisory services, little is known about vaccination decision-making within routine district-level immunization services. This study examined vaccination recommendation patterns and factors associated with deferral or non-recommendation among CSHCN in these settings. Methods: This cross-sectional study was conducted between 1 April 2023, and 31 March 2024, in Changshou District, Chongqing, China, encompassing 18 primary health centers, five general hospitals and one special hospital. Children aged 0–18 years identified by physicians as having conditions potentially affecting vaccination decisions and with at least one documented vaccination-related consultation were included. Clinical characteristics and physician recommendations (“recommended,” “temporarily deferred,” “not recommended”) were recorded via the national Epidemiological Dynamic Data Collection (EDDC) system; subsequent vaccination uptake was verified using the Chongqing Immunization Information Management System. Logistic regression identified factors associated with deferral or non-recommendation. Results: A total of 761 participants were included in the analysis, with a median age of 12 months (IQR: 1–47). Among all vaccine-specific recommendations, 55.2% were classified as “recommended,” 43.4% as “temporarily deferred,” and 1.5% as “not recommended”. Deferral proportions varied markedly, highest in respiratory (73.6%) and immunologic (42.1%) conditions and lowest in neonatal disorders (4.0%). Compared with 0–6-month-olds, children aged 7–12 months (adjusted odds ratio [aOR] = 5.26, 95% CI 2.30–12.33) and >13 months (aOR = 13.48, 95% CI 6.69–28.34) were more likely to receive deferral or non-recommendation; multimorbidity also increased odds (aOR = 20.68, 95% CI 11.26–40.10). Consultations at primary health centers were associated with a lower likelihood of deferral or non-recommendation (aOR = 0.26, 95% CI 0.15–0.45). Conclusion: Vaccination recommendations for CSHCN vary considerably across clinical profiles and facility types in routine immunization settings. Despite national initiatives, many vaccine doses remain deferred or not recommended. Disease-specific guidelines, enhanced provider training, and context-adapted decision-support tools are needed to promote timely and equitable immunization for this medically vulnerable population. Full article
(This article belongs to the Special Issue Factors Influencing Vaccine Uptake and Immunization Outcomes)
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