Low immunization rates among vulnerable populations

Context

Vaccination coverage in Lebanon has generally been high. The WHO EPI Cluster survey indicates that on a national level, completed vaccination rates (three doses at least) are at 90.1% for polio, 87.3% for DTP (diphtheria, pertussis, and tetanus), 88.7% for haemophilus influenza type B, and 89.9% for Hepatitis B. However, the Syrian conflict has hindered access to quality immunization services in Lebanon. The influx of Syrian refugees into Lebanon has increased the risk and exposure to communicable diseases, including those which were previously eradicated in the country, such as polio.

Despite having access to free healthcare, there remains a significant number of refugee children who have not received the required three doses of pentavalent vaccine (diphtheria, tetanus, whooping cough, hepatitis B, haemophilus influenza type B). The same applies to MMR and measles vaccinations. In 2016, the Vulnerability Assessment of Syrian Refugees (VASyR) survey was conducted in Lebanon, which revealed that the immunization coverage among 12-23 month old Syrian children is 57.4% for pentavalent vaccine (PENTA3), 54% for MMR and 59% for the measles vaccine. Additionally, a small scale district level survey was conducted by the MoPH and ICRC in 2015, which found that among 12 to 59 months old Syrian children, there was an overall coverage rate of 70.5% for pentavalent vaccine (PENTA3), 65.7% for MMR1 and 31.5% for MMR2. More importantly, only 32.9% of the surveyed children were fully vaccinated. Notably, 39.1% of the survey respondents reported that they did not immunize their children because they lacked the knowledge needed to pursue these vaccinations.

Source: UNICEF report: Unicef in Lebanon and Immunization Campaigns, 2017; VASyR Survey, 2015, Lebanon.

Examples of Behavioral Biases and Bottlenecks

Optimism bias: People might underestimate the likelihood of contracting a viral or infectious disease, which can prevent them from seeking out vaccinations.

Social norms: If the norm within a community is to refuse vaccinations, then residents of that community are likely to have low vaccination rates.

Procrastination: People might not view vaccination as a priority and would rather allocate their time to other pressing issues.

Hassle & Inconvenience: People are likely to procrastinate getting vaccinated, especially if the process is inconvenient, time consuming and/or complicated.

Confirmation bias: People who uphold false beliefs, such as “vaccinations are linked to autism”, are likely to look for evidence that confirms such beliefs.

Omission bias: People prefer passive harm to active harm, and are therefore likely to believe that the potential harm done through vaccination is harder to accept than the potential harm done through avoiding vaccination.