Operationalizing of the WHO BeSD Framework

The Sabin Vaccine Institute’s Vaccine Acceptance & Demand initiative is proud to provide funding to 7 grant partners awarded through the 2023-2024 Social and Behavioral Research Grants Program. This blog is the third in a series examining the selected research projects based on one of three themes: zero-dose children, zero-dose adult/life-course immunization, and operationalizing of the WHO BeSD Framework.

In 2018, the World Health Organization (WHO) established the Measuring Behavioral and Social Drivers (BeSD) of Vaccination global working group to develop tools to measure and respond to these factors. The BeSD framework seeks to understand the beliefs and experiences that are potentially modifiable to increase vaccine uptake through the development and use of  evidence-based and context-specific tools and measures.   WHO’s Strategic Advisory Group of Experts (SAGE) recommends that immunization programs use these tools to systematically gather and use data on the BeSD of vaccine uptake as part of their routine service delivery.

There are four key domains which can be used to evaluate and understand reasons for under-vaccination: thinking and feeling, social processes, motivation, and practical issues. The WHO working group developed and validated a set of tools to support programs and partners in measurement and for systemic monitoring and evaluation. The tools include quantitative surveys, qualitative interview guides, and practical implementation guidance, and they support planning for data collection and analysis as a part of program activities. The resources also include interventions to increase vaccine uptake by domain with a focus on keeping the guidance as pointed as possible.

Sabin is proud to support the following 2023-2024 Social and Behavioral Research Grant partners in their pursuit of solutions to operationalize the WHO BeSD framework. These projects conduct research and implement solutions to improve vaccination uptake within LMIC populations. The knowledge gained from these projects will have a variety of uses, including informing immunization-related policy, programming, communication campaigns, and addressing systemic barriers.

Meet Our Project Teams Focused on Operationalizing of the WHO BeSD Framework

Community Insights to Identify Determinants of Zero-dose Children in Melanesia: A BeSD Tool Adaptation

Milena Dalton, Stefanie Vaccher, and Catherine King of the Burnet Institute plan to improve routine immunization services in the Melanesian nations of Vanuatu, Papua New Guinea, and Solomon Islands by identifying context-specific barriers to uptake. Their project applies the WHO BeSD framework to identify barriers to uptake amongst zero-dose children and uses a human-centered design approach to assess the value of adapting the framework for key immunization stakeholders. It is anticipated that strengthening the analysis and identification of the determinants of zero-dose children across Melanesia will support better program design, planning, and implementation.

“Our research will identify barriers to routine immunizations, including gender-related barriers in the Melanesian region which can inform and encourage the development of appropriate programs and interventions to increase immunisation coverage and reduce incidence of vaccine-preventable disease. Results from this project will also identify wider vaccination policy and programming applications across the Indo-Pacific region.”

Reaching the Unreached: Exploring Factors affecting Vaccine Uptake and Acceptance amongst Zero-dose Children in Bangladesh using the WHO Behavioral and Social Drivers (BeSD) Framework

Sazzad Hossain Khan, Dr. Firdausi Qadri, Md Saiful Islam, and Kamal Chowdhury of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) plan to explore the key barriers impacting vaccine acceptance and uptake for children from marginalized communities in Bangladesh, particularly those living in urban slums and children with disabilities. The project aims to collate the perception, behaviors, and attitudes towards routine immunization,COVID-19 vaccination programs, and Tetanus Toxoid (Td) uptake from caregivers, vaccine providers, and community stakeholders, all of whom play a role in ensuring sustainable demand for immunization. Additionally, the team seeks to estimate the prevalence of and identify risk groups for zero-dose children, COVID-19 vaccine uptake among 11–17-year-olds, and uptake of Tetanus Toxoid vaccine among women. Application of the BeSD framework will assist with the identification of marginalized and missed communities and may provide an entry point for strengthening critical immunization services across Bangladesh.

“This research grant will help identify the proportion of zero-dose children along with the proportion of COVID-19 vaccine uptake among children aged 11-17 years. Enablers and barriers, including policy gaps and program limitations to vaccine access and delivery, will also be explored through this research. This generated evidence will be crucial for the Expanded Programme on Immunization (EPI), Bangladesh, to revise policies and strengthen program activity in urban areas, particularly focusing on pocket populations, e.g. disabled, slum dwellers etc. The findings will guide the Bangladeshi National COVID-19 Technical Advisory Committee to make decisions based on primary data.”

Adapting the WHO BeSD Framework and Survey Tool with the Transgender, Intersex and Disability Communities in India

Anant Bhan, Sunita Bandewar, Aqsa Shaikh, Harikeerthan Raghuram, and Satendra Singh of Sangath aim to adapt and validate the BeSD Framework to measure social, behavioral, and structural drivers of vaccination will explore among transgender, intersex, and disability communities in India. This mixed methods study will incorporate participatory approaches in developing an adapted set of tools based on the BeSD framework, piloting and field testing of these tools, and tool validation to develop an evidence-based, adapted behavioral, social, and structural drivers framework for COVID-19 vaccination in these communities. This project is a continuation from a previous Sabin-funded study which used lenses of equity and intersectionality to incorporate structural issues such as stigma, exclusion, and a trust deficit in the public health system to understand barriers to COVID-19 vaccine uptake in these marginalized communities. The team believes strongly in centering each community in all aspects of their project design and implementation, and plan to do this through ensuring representation from all three communities as research team members and building a Community Leadership Group, who will serve in an advisory role through a series of meetings throughout the project.

“Without identifying the barriers, it can be challenging to work towards effective solutions. The expanded BeSD tool and framework will be a key step in facilitating the development of equitable vaccine programs for the transgender, intersex and disability communities in the Global South. It will create a pathway for immunisation program managers, to gather data on the three marginalized communities and tap into and potentially address community-specific challenges that may be relevant to drive uptake and facilitate access in the communities. In line with our earlier project, in this project also, we will have a strong focus on disseminating this expanded tool and framework, and our key findings and recommendations to reach a wider group of stakeholders.”  

The Sabin Vaccine Institute is a leading advocate for expanding vaccine access and uptake globally, advancing vaccine research and development, and amplifying vaccine knowledge and innovation. Unlocking the potential of vaccines through partnership, Sabin has built a robust ecosystem of funders, innovators, implementers, practitioners, policy makers and public stakeholders to advance its vision of a future free from preventable diseases. As a non-profit with more than two decades of experience, Sabin is committed to finding solutions that last and extending the full benefits of vaccines to all people, regardless of who they are or where they live. At Sabin, we believe in the power of vaccines to change the world.