This is a joint post with Victoria Fan.

Vaccine uptake in several countries is stagnating or even declining (see here and here for example). What explains this poor uptake and coverage? Public health researchers have recently begun to apply the concept of  ‘vaccine hesitancy’ and ‘vaccine refusal’, largely focusing on individual knowledge, attitudes, and practices (KAP). But in a new blog post Robert Steinglass of JSI has argued that, while communications and advocacy interventions to change individual KAP are important, this person-centric view will fail to consider the context and the role of quality on the supply-side in determining uptake. He writes:

For example, when I brought my child to the vaccination session:

- was the health worker present at the appointed time?

- was one or more of the required vaccines or syringes absent?

-was I yelled at for not having “retained” a vaccination card which I might never have been given in the first place or that was damaged in the rain on the long walk home or that I perhaps did lose?

- was I reprimanded publicly for not having returned exactly four weeks after the previous dose?

- was I ridiculed for my child’s threadbare or unclean clothing?

- was I informed in my own language what the health worker was trying to say to me?

- was I made to feel ignorant for asking the health worker to explain the purpose of the vaccination or why my child needed to return yet again for another dose?

- was I told when to return for subsequent doses?

- was I requested to make unofficial payments that I could not afford?

- was I expected to wait in the hot sun without any explanation, without seats, without water?

Put differently, if donors and governments push for improved communication and advocacy in order to influence knowledge and practice of patients and people, this is likely to be an insufficient remedy if the supply of health-care is of poor quality or lacking. When will behavioral scientists start accounting for health systems and supply-side factors of health-care?