Building and Sustaining Vaccine Confidence and Uptake

Date: May 19, 2022
Time to read: 4 minutes.

The Centers for Disease Control and Prevention (CDC) provides an array of educational resources and guidance to help support confidence in and access to COVID-19 vaccines. These approaches may be especially helpful for health plans serving people dually eligible for Medicare and Medicaid. These members have been disproportionately impacted by COVID-19, but express vaccine hesitancy at about the same rate as those who are not dually eligible.1 The CDC suggests that health plans and providers be prepared to recommend both routine and COVID-19 vaccines in all conversations with members. In addition, these strategies may be useful as health plans encourage uptake of other vaccines recommended for these and other members of their plans.

Steps in building vaccine uptake:

  1. Accessibility and ease of getting the vaccination are essential first steps and groundwork for other efforts.
  2. Education and information-sharing that promotes the benefits of the vaccine and that shows the health benefits outweighing the risks of illness or side effects is the next step.
  3. Beyond access, convenience is then an important factor in creating motivation to receive the vaccine. This involves reducing financial, social and any other costs involved with vaccination.
  4. The final point in building demand includes making the vaccine necessary and seen as indispensable for getting back to activities that are desired. The vaccine then can be presented as desirable and appealing, and vaccination promoted as a social default or expectation.

An important piece of education and information sharing is building vaccine confidence, the trust that members have in:

  • Recommended vaccines;
  • Providers who administer vaccines; and
  • Processes and policies that lead to vaccine development, licensure, manufacturing, and recommendation for use.2

Building and sustaining vaccine confidence requires consistent messaging over time. Every conversation about vaccines imparts additional confidence. See our prior blog posts related to vaccine confidence Improving Vaccine Confidence for People with Intellectual and Developmental Disabilities and Outreach to Racial and Ethnic Minorities to Promote COVID-19  Vaccination.

Willingness to accept a vaccine. Vaccine confidence is one component in high uptake of any vaccine, including the COVID-19 vaccines. Willingness to get vaccines generally falls on a continuum from refusal to demand, with a midpoint of passive acceptance. People in the middle of that continuum are not opposed to the vaccine but are also not motivated to seek vaccination. They may have questions and may need more information in order to make the decision to receive a vaccine. This group may be delaying vaccination, taking a “wait and see” approach.

Both social and behavioral factors influence the motivation to receive a COVID-19 vaccine. Those who have confidence in the benefits of the vaccine and confidence in vaccine safety are more likely to see beyond any negative information or misinformation that they encounter and more likely to seek vaccination. Similarly, those who perceive a risk to themselves or others if they are not vaccinated also are more likely to seek vaccination. In addition to these more personal beliefs, people are influenced by their social settings. Norms and expectations in the workplace or the social environment support motivation for vaccination, as does the presence of visible influential individuals promoting vaccination.1, 2 Further, adults who have previously accepted routine vaccines, such as flu or pneumonia vaccines, are more likely to seek COVID-19 vaccination.

But motivation—the intention to seek a COVID-19 vaccine or to recommend it to others—is not sufficient. Practical issues related to information and access also impact vaccine uptake. Ease of access to a preferred vaccination site promotes uptake, as does on-site vaccination in locations where individuals live or congregate.3, 4 Visit the CDC webpage to view the most recent information for promoting COVID-19 vaccinations.


1Overhage, J.M. & Agrawal, S. (2021). Covid-19 Vaccination Perceptions Among Socially Vulnerable Medicare and Medicaid Members: Experience from a National Health Plan Outreach Program. NEJM Catalyst. Retrieved from: https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0219.

2World Health Organization. (2020). Development of tools to measure behavioral and social drivers of vaccination: a progress report. Retrieved from: https://cdn.who.int/media/docs/default-source/immunization/besd_progress_report_june2020.pdf?sfvrsn=10a67e75_3#:~:text=In%20November%202018%2C%20a%20global,oversee%20development%20of%20these%20tools.

3 The BeSD Working Group. Increasing Vaccination Model. Based on: Brewer NT, Chapman GB, Rothman AJ, Leask J, and Kempe A (2017). Increasing vaccination: Putting psychological science into action. Psychological Science for the Public Interest. 18(3): 149-207.

4 World Health Organization. (2020).

5 The BeSD Working Group.

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