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Strategies to Enhance Vaccine Uptake and Immunization Among Underserved Populations/Vulnerable Groups

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

Deadline for manuscript submissions: closed (31 December 2025) | Viewed by 10954

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Special Issue Editor

Dr. Álvaro Francisco Lopes De Sousa

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Guest Editor

Instituto de Ensino e Pesquisa, Hospital Sírio-Libanês, São Paulo, Brazil
Interests: infectious diseases; global health; human exposome; vulnerable groups
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Special Issue Information

Dear Colleagues,

This Special Issue focuses on strategies to increase vaccination rates among vulnerable populations. We invite submissions investigating the complex factors contributing to vaccine hesitancy in underserved groups and the effectiveness of targeted intervention strategies. Research that addresses interventions aimed at underserved groups is also highly encouraged. This Special Issue aspires to equip public health professionals, policymakers, and healthcare providers with actionable approaches to enhance vaccine acceptance and immunization rates among populations most impacted by health disparities.

Dr. Álvaro Francisco Lopes De Sousa
Guest Editor

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

vaccine uptake
vulnerable populations
health interventions
vaccine hesitancy
public health strategies
health education and equity

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Published Papers (5 papers)

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Research

14 pages, 259 KB

Open AccessArticle

Correlates of Integrated Human Papillomavirus Vaccination and Cervical Cancer Screening Protection in U.S. Low-Income Women

by Erika B. Biederman, Victoria L. Champion, Katharine J. Head, Teresa M. Imburgia and Gregory D. Zimet

Vaccines 2026, 14(3), 251; https://doi.org/10.3390/vaccines14030251 - 9 Mar 2026

Cited by 1 | Viewed by 887

Abstract

Background/Objectives: In the United States, adult human papillomavirus (HPV) vaccination coverage remains low at 20–50%, depending on age, and cervical cancer (CC) screening rates range from 68 to 76%. Few studies have evaluated characteristics of women who are both HPV vaccinated and up to date (UTD) with screening as an integrated outcome. The purpose of the present study was to classify women into four prevention categories and examine factors associated with being double protected compared to unprotected. Methods: Data were gathered via an online survey from a sample of low-income women (household income < USD 50,000) provided by a research survey company (n = 719). Women were classified into four categories: vaccinated only, screened only, both vaccinated and screened (double protected), or neither (unprotected). Sociodemographic characteristics, healthcare access, and Health Belief Model constructs were assessed. Multivariable logistic regression compared women who were double protected with those unprotected (n = 274). Results: Most women were UTD with screening only (57.8%), while 15.5% were double protected and 22.6% were unprotected. Younger age (Odds Ratio [OR = 0.93; 95% Confidence Interval [CI]: 0.89, 0.98), having ≥1 medical visit in the past year (OR = 4.16; 95% CI: 1.74, 9.95), higher perceived CC risk (OR = 3.65; 95% CI: 1.41, 9.43), greater perceived benefits of CC screening (OR = 1.96; 95% CI: 1.45, 2.66), and higher HPV knowledge (OR = 1.09; 95% CI: 1.01, 1.17) were associated with higher odds of being double protected. Conclusions: A substantial proportion of low-income women lack comprehensive CC prevention. Integrated, bundled prevention strategies that simultaneously promote HPV vaccination and screening may be important to reduce CC disparities. Full article

(This article belongs to the Special Issue Strategies to Enhance Vaccine Uptake and Immunization Among Underserved Populations/Vulnerable Groups)

19 pages, 570 KB

Open AccessArticle

Understanding Vaccination Uptake Amongst Gay, Bisexual and Other Men Who Have Sex with Men in UK Sexual Health Services: A Qualitative Interview Study

by Tom May, Joanna M. Kesten, Hannah E. Family, Harriet Fisher, Adele Wolujewicz, Marta Checchi, Hamish Mohammed, David Leeman, Sema Mandal, Lucy Yardley, Jeremy Horwood and Clare Thomas

Vaccines 2026, 14(2), 112; https://doi.org/10.3390/vaccines14020112 - 24 Jan 2026

Viewed by 1268

Abstract

Background/Objectives: In England, gay, bisexual, and other men who have sex with men (GBMSM) are eligible for vaccination at NHS sexual health services, including human papillomavirus (HPV), hepatitis A virus (HAV), and hepatitis B virus (HBV) vaccines. However, current research shows limited understanding of the factors influencing vaccination uptake among GBMSM. This study aimed to examine the barriers and facilitators affecting the offer and uptake of these vaccination programmes. Methods: A qualitative interview study following the Person-Based Approach (a systematic method for developing and optimising health interventions) involving GBMSM and sexual health service staff from two regions of England. Purposive sampling aimed to include GBMSM with diverse backgrounds and engagement with sexual health services. Patient and public involvement shaped the study design and interview topic guides. The interviews were recorded, transcribed, and thematically analysed to identify barriers and facilitators which were interpreted using the COM-B model of behaviour change. Results: Twenty GBMSM and eleven staff took part. The findings showed that opportunistic delivery of HPV, HAV, and HBV vaccination within sexual health services is mostly acceptable and feasible for GBMSM and staff, while also highlighting areas for optimization. Despite low knowledge of these viruses and their associated risks, willingness to be vaccinated was high, with healthcare provider recommendations and the convenience of vaccine delivery during routine clinic visits acting as important facilitators. However, the reach of opportunistic models was limited, particularly for individuals underserved by sexual health services or disengaged from GBMSM social networks. System-level barriers such as complex vaccine schedules (particularly when multiple schedules are combined), inconsistent access to vaccination histories, and limited system-level follow-up processes (e.g., automated invites and reminders) were also found to act as obstacles to vaccination uptake and delivery. Conclusions: To improve equitable uptake, sexual health services should explore the feasibility of addressing both individual and structural barriers through additional strategies, including targeted and persuasive communication to increase knowledge, leveraging regular contact with GBMSM to promote uptake, and implementing enhanced approaches to support vaccination completion (e.g., automated prompts or reminders). Full article

(This article belongs to the Special Issue Strategies to Enhance Vaccine Uptake and Immunization Among Underserved Populations/Vulnerable Groups)

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18 pages, 304 KB

Open AccessArticle

HPV Vaccination Completion Among Men Who Have Sex with Men Using HIV Pre-Exposure Prophylaxis in Brazil: A Cross-Sectional Study

by Alvaro Francisco Lopes de Sousa, Lariane Angel Cepas, Isadora Silva de Carvalho, Caíque Jordan Nunes Ribeiro, Guilherme Reis de Santana Santos, Jean Carlos Soares da Silva, Talia Gomes Luz, Ruan Nilton Rodrigues Melo, Lucas Brandão dos Santos, Julia Bellini Sorrente, Gabriela Amanda Falsarella, Antonio Luis Ferreira Calaço and Ana Paula Morais Fernandes

Vaccines 2026, 14(1), 92; https://doi.org/10.3390/vaccines14010092 - 18 Jan 2026

Viewed by 1672

Abstract

Background: Men who have sex with men (MSM) using HIV pre-exposure prophylaxis (PrEP) experience a high burden of human papillomavirus (HPV) infection and related diseases, yet data on HPV vaccination among this group in Brazil remain limited. Aims: The aims of this study were to estimate the prevalence of complete HPV vaccination and to identify factors associated with vaccination completion among MSM using PrEP in Brazil. Methods: We conducted a cross-sectional online survey between May and September 2025 among MSM aged ≥18 years, residing in Brazil and currently using oral PrEP. Participants were recruited through virtual snowball sampling and targeted advertisements on social media and a gay geosocial networking application. Data were collected using a structured, self-administered questionnaire hosted on REDCap^®. Complete HPV vaccination was defined as self-reported receipt of all doses recommended according to the participant’s age and clinical condition. Sociodemographic characteristics, relationship patterns, sexual behaviors, lubricant use during sexual activity, and history of sexually transmitted infections (STIs) were assessed. Adjusted prevalence ratios (aPRs) and 95% confidence intervals (95% CIs) were estimated using Poisson regression with robust (sandwich) variance. Results: A total of 872 MSM using PrEP were included, of whom 59.4% reported complete HPV vaccination. In adjusted analyses, complete vaccination was more frequent among participants reporting both steady and casual partners (aPR = 1.90; 95% CI: 1.36–2.65) or only casual partners (aPR = 1.72; 95% CI: 1.24–2.39), those reporting lubricant use during sexual activity (aPR = 1.41; 95% CI: 1.23–1.61), and those with a diagnosis of chlamydia and/or gonorrhea in the previous 12 months (aPR = 1.22; 95% CI: 1.08–1.36). Conclusions: Although HPV vaccination coverage among MSM using PrEP in Brazil is higher than that reported for MSM in general, it remains incomplete in a population with regular contact with specialized health services. Integrating systematic assessment and delivery of HPV vaccination into PrEP care may help increase vaccination completion and reduce missed opportunities for prevention. Full article

(This article belongs to the Special Issue Strategies to Enhance Vaccine Uptake and Immunization Among Underserved Populations/Vulnerable Groups)

16 pages, 335 KB

Open AccessArticle

Parental Barriers and Sociodemographic Disparities in Childhood Vaccination Post-COVID-19 in Tennessee

by Sanjaya Regmi, Elizabeth Sowell, Chenoa D. Allen, Benjamin E. Jones, Nan M. Gaylord and Victoria Niederhauser

Vaccines 2025, 13(5), 452; https://doi.org/10.3390/vaccines13050452 - 24 Apr 2025

Cited by 2 | Viewed by 4124

Abstract

Introduction: The COVID-19 pandemic disrupted routine childhood vaccinations schedules, posing significant challenges among underserved communities. Understanding how different sociodemographic groups in Tennessee perceive and navigate childhood vaccination barriers is critical for developing strategies to improve vaccination rates and reduce vulnerability to vaccine-preventable diseases. Methods: A cross-sectional survey was conducted to explore barriers to vaccination across diverse sociodemographic groups in Tennessee. Data were collected from caregivers/parents of children aged 18 years and younger across all 95 counties in Tennessee at community events and through partnerships with schools and other local organizations. Parental responses were analyzed to identify barriers in access, concern, and importance domains. The distribution of barriers across different sociodemographic groups such as race, income, education level, and insurance status was identified. Descriptive statistics, non-parametric tests, and log-binomial regressions were used to address the research objectives. Results: This study found that the most prominent barriers to childhood vaccination were concerns regarding vaccine safety and side effects. Significant differences in vaccine barriers were observed across racial and ethnic groups for access barriers (p < 0.001), concern barriers (p = 0.006), and importance barriers (p < 0.001). Parents with lower education levels, children without health insurance, and lower-income families faced disproportionate challenges across two of the three barrier domains studied (access and perceived importance of vaccines). Additionally, concern barriers (aPR = 0.998, p < 0.001) and importance barriers (aPR = 0.997, p < 0.001) were strongly associated with the parent-reported prevalence of up-to-date vaccination status. Conclusions: Addressing parental vaccination barriers related to concern, access, and perceived importance is crucial, particularly for underserved populations including low-income families, uninsured parents, racial/ethnic minorities, and those with limited education. A sustained, equity-focused approach integrating scientific communication, community engagement, and policy interventions is essential for increasing vaccine uptake and ensuring equitable vaccination access. Full article

(This article belongs to the Special Issue Strategies to Enhance Vaccine Uptake and Immunization Among Underserved Populations/Vulnerable Groups)

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11 pages, 409 KB

Open AccessArticle

Vaccination Coverage in Hematopoietic Stem Cell Transplant Patients

by Angeles Bouzas-Rodríguez, Germán Molina-Romera, Juan Manuel Vázquez-Lago, Olalla Vázquez-Cancela and Cristina Fernández-Pérez

Vaccines 2025, 13(3), 257; https://doi.org/10.3390/vaccines13030257 - 28 Feb 2025

Cited by 1 | Viewed by 2141

Abstract

Background/Objectives: Patients undergoing hematopoietic stem cell transplantation (HSCT) experience profound immunosuppression, increasing their risk of infections. Revaccination is essential to reduce morbidity and mortality. This study aimed to evaluate post-transplant vaccination coverage among patients treated at a specialized reference center. Methods: We conducted a cross-sectional, retrospective study including patients who underwent HSCT between 1 January 2018 and 31 May 2021. Vaccination coverage was assessed for each recommended vaccine, and full compliance was defined according to the Spanish Ministry of Health guidelines. A competing risk survival analysis was performed to account for loss to follow-up due to death. Data analysis was carried out using STATA v15. Results: Among 138 included patients, 22.46% (31/138) died, and 11.59% (16/138) relapsed. Of the 107 patients who remained in follow-up at 19 months, 41.12% (44/107) (95% CI: 32.26–50.59) had completed the full vaccination schedule, while only 1.87% (2/107) (95% CI: 0.51–6.56) achieved temporal compliance. No significant association was observed between sex and vaccination status or competing risks (p > 0.05). Conclusions: Post-HSCT vaccination coverage remains suboptimal, highlighting the need for improved vaccination programs, multidisciplinary patient support, and enhanced public and professional awareness to ensure timely immunization in this high-risk population. Full article

(This article belongs to the Special Issue Strategies to Enhance Vaccine Uptake and Immunization Among Underserved Populations/Vulnerable Groups)

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