Behavioural and social drivers of vaccination

Lisa Menning

This page provides a package of tools and guidance to support programmes and partners to assess and address behavioural and social drivers (BeSD) of vaccination. The content and guidance on this page is curated and maintained by the Demand and Behavioural Sciences team, within the Essential Immunization Programme, WHO Department of Immunization, Vaccines and Biologicals. 

This page consists of the following sections:

What drives vaccine uptake?

To achieve high uptake, it is vital to systematically understand reasons why uptake is low or stagnating. To support countries to measure the reasons for low uptake, WHO established the Behavioural and Social Drivers (BeSD) of Vaccination global working group in October 2018, linked to the Demand Hub. The working group developed a new framework on BeSD of vaccination with 4 domains: thinking and feeling, social processes, motivation, and practical issues, including the experiences people have when trying to get vaccinated (Figure 1). 

For gathering and use of data on BeSD, the working group developed a package of tools and guidance, including surveys and qualitative interview guides for both childhood vaccination and COVID-19 vaccination. Following a rigorous field-testing and validation process, priority indicators were also identified, corresponding to 5 questions, to support regular monitoring.

The BeSD tools and guidance for childhood vaccination and COVID-19 vaccination are available here.  The related WHO Position Paper on BeSD is here.

The BeSD tools and guidance enable programmes and partners to collect, analyze and use data on BeSD to understand reasons for low uptake and to inform planning priorities, implementation, and standardized monitoring and evaluation.

Figure 1. Behavioural and social drivers of vaccination framework

The full range of outputs of the BeSD working group (evidence reviews, and findings from the field testing and validation of tools) were presented to the WHO Strategic Advisory Group of Experts on immunization (SAGE) at its meeting in October 2021. SAGE’s recommendations on use of the BeSD tools and data were published in a WHO Position Paper in May 2022.

SAGE recommended that countries regularly collect standardized data using BeSD validated surveys and priority indicators, focusing on districts and populations with coverage gaps and inequities. To complement this data, BeSD interview guides may be used for prioritized populations to ensure an in-depth understanding of beliefs and experiences.

To support and enhance the use of the BeSD tools and guidance for childhood vaccination and COVID-19 vaccination, a range of materials are available, as listed below.

Resources on behavioural and social drivers (BeSD)

The resources listed below will soon be available in other languages (Arabic, French, Portuguese, Russian, and Spanish), so please check back again in coming weeks.

General resources on BeSD

BeSD overview presentation (summary slides)Lisa Menning2022PresentationEnglish
Codebook for BeSD survey data (for childhood and COVID-19 vaccination)Lisa Menning2022ToolEnglish, French
Data analysis and reporting Excel template (for childhood and COVID-19 vaccination surveys)Lisa Menning2023ToolEnglish, French, Russian, Spanish

Tools on BeSD of childhood vaccination

Tools on BeSD of COVID-19 vaccination

Are you using or planning to use the BeSD tools?

We would like to hear from you. Please let us know where and how you’re using the tools, and tell us a little about your experience. Indicate if any added technical support is needed. Please let us know using the form here.