Expanding Vaccination Provider Types and Administration Sites Can Increase Vaccination Uptake: A Systematic Literature Review of the Evidence Outside of the United States

Abstract

Background: Although vaccination is considered one of the most successful public health interventions, vaccine-preventable diseases continue to pose risks around the world due to low vaccine uptake. Expanding authority for “alternative” (non-physician) or complementary healthcare providers to administer vaccinations, as well as increasing the types of non-clinical sites, could improve access to and uptake of vaccination. Researchers sought to identify initiatives related to these delivery strategies and their corresponding impact in global settings outside of the United States.

Methods: A systematic literature review (SLR) was conducted using PubMed and Embase to identify studies (January 2000 - September 2022) that evaluated vaccination by alternative or complementary providers and at expanded sites. Included articles measured impact on vaccine uptake, and barriers and facilitators to these initiatives. 

Results: Of 943 identified records, 18 were included. Studies were conducted in Australia (4), Canada (6), the United Kingdom (3), Peru (2), Cameroon (1), or multiple geographies (2). Vaccines of focus included influenza (12), HPV (3), maternal pertussis (1), or multiple vaccines (2). Studies evaluated providers including pharmacists, midwives, and community health workers, and sites included residential care facilities, pharmacies, and community-based vaccination. Target populations included general vaccine-eligible populations, and special populations including: women in rural and low-income urban communities, older adults, pregnant people, and employees. All studies demonstrated that expanding provider types and sites may positively impact uptake. Notable barriers included logistical challenges and perceived concerns by general practitioners. Facilitators included convenience, positive direct and indirect economic impact, patient acceptance, and alternative provider attitudes toward expanded role. 

Conclusion: Expanding vaccination provider types and administration sites positively impacts vaccine uptake and can increase access to broader populations; these strategies complement existing vaccination pathways and should be considered to best meet patients where they are and improve vaccine equity for underutilized vaccines in historically under-vaccinated communities.

Note: This conference abstract was presented at the 17th Vaccine Conference organized by the journal Vaccine. This abstract has not been screened by SSRN for potential for public harm and should not be used to inform any clinical decision making. No competing interests or funding statements have been declared.