Facilitate acceptance and adoption of COVID-19 vaccination in the EU / EEA



This technical report presents considerations for European Union / European Economic Area (EU / EEA) countries when diagnosing barriers to acceptance and adoption of COVID-19 vaccination, and design and delivery. implementing interventions to increase adoption. The report uses the “5C” model to organize and explain the various causes of low uptake and uptake of immunization, and to rank potential interventions. The key concepts included in the 5C model are trust, restraint, complacency, calculation and collective responsibility. In addition to discussing the facilitation of COVID-19 vaccination for the general population in this setting, specific population groups were also included in the report, such as healthcare workers and socio-economically vulnerable groups. Since immunization eligibility has been extended to children and adolescents in many countries, parents are also included as a group.

The report stresses the importance of diagnosing the factors of acceptance and uptake of suboptimal vaccines in a given population to ensure that appropriate interventions are implemented in response. It also presents examples of interventions that have been implemented in the EU / EEA, each of which could be adapted for use in other settings where similar factors of low vaccination rates have been identified. Finally, the report examines the importance of evaluating interventions to increase uptake of the COVID-19 vaccine, as well as some of the challenges associated with such evaluations. Resources for diagnosis, implementation and evaluation that can be used by EU / EEA countries are also included in the report.


Key messages

  • A successful COVID-19 vaccination program can only be built on an understanding and appropriate response to the beliefs, concerns and expectations of individuals and communities regarding the vaccine and the disease. The “5Cs” model – Confidence, Constraints, Complacency, Compassion and Collective Responsibility – can be used as a framework to understand these concerns and design strategies to facilitate acceptance and uptake of COVID-19 vaccination.
  • Taking the 5C model as a basis, the factors of low vaccine uptake and uptake can be diagnosed by analyzing cross-sectional data at the population level. The World Health Organization Regional Office for Europe has developed a COVID-19 Behavioral Information Survey Tool that can be used for this purpose. Collaboration with civil society can also provide the opportunity to tap into operational data – quantitative and / or qualitative – that can provide information on the beliefs, concerns and expectations of individuals and communities about immunization.
  • Immunization efforts in many countries are currently aimed at reaching pockets of unvaccinated people in older age groups and socially vulnerable populations, while also facilitating adoption among younger age groups ( including children and adolescents eligible for vaccination). Health professionals have a key role to play in this work. The specific challenges that each of these groups face in accepting, accessing (and, for healthcare workers, facilitating) immunization need to be properly understood and addressed.
  • This document presents examples of some of the measures countries are implementing to increase vaccine uptake and uptake, based on factors identified in a given context. They may need to be adapted at the subnational or local level – there is no “one size fits all” approach. Drivers can also change over time, meaning diagnoses may need to be repeated on a regular basis.
  • Many of the interventions reviewed for this report focused on providing accessible services, often combined with risk communication strategies. Some countries have also opted for measures based on incentives and sanctions. Fewer strategies were identified that aimed to build confidence in the health system and engage with communities.
  • Establishing the effectiveness of an intervention in facilitating acceptance and uptake of vaccination is a methodological challenge. Good evaluations of these interventions can still be carried out, using both quantitative and qualitative data, although the findings of process evaluations are generally easier to interpret than those of impact evaluations.

Read more


ECDC helps Member States increase acceptance and adoption of COVID-19 vaccination in EU / EEA

On October 15, the ECDC released the report ‘Facilitating the acceptance and adoption of COVID-19 vaccination in the EU / EEA’, which aims to further assist Member States in identifying barriers to the adoption of vaccination against COVID-19, and to design and implement interventions aimed at increasing vaccination coverage.


Infographic: Facilitating Acceptance and Adoption of COVID-19 Vaccination

This infographic shows the barriers to getting vaccinated against COVID-19.


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