Vaccination is a successful public health intervention; however, vaccine-preventable diseases continue to pose global health risks due to insufficient uptake. Expanding authority for "alternative" or complementary healthcare providers to administer vaccinations, as well as approving additional non-clinical vaccination sites, could improve access to and uptake of vaccines. The value of complementary providers and expanded sites has been documented in the United States; however, there is limited evidence in geographies outside the United States. To address this gap, we conducted a systematic literature review to identify studies that evaluated vaccination by complementary providers and/or at expanded sites outside of the United States. Of 943 identified records, 18 met our inclusion criteria and were conducted in Australia (4), Canada (6), the United Kingdom (3), Peru (2), Cameroon (1), or in multiple geographies (2). All studies demonstrated that expanding provider types and sites could positively impact vaccine uptake and/or provide additional benefits.

BACKGROUND:Expanding health care providers (HCPs) who can administer vaccines including nonphysician health professionals (NPHPs) (a registered nurse [RN]/licensed practical nurse [LPN], pharmacist, medical assistant, pharmacy technician, or dentist), along with the broader use of complementary vaccination sites, could improve vaccine access and uptake. OBJECTIVE:We investigated the attitudes and perceptions of vaccination stakeholders, including adults and HCPs, regarding leveraging NPHPs and complementary sites to improve vaccination access and uptake. METHODS:A cross-sectional quantitative online survey was administered in July 2021 to 181 HCPs and 100 US adults. Respondents were asked about challenges faced while delivering or receiving vaccines, interventions that might increase vaccination uptake, and the likelihood that individuals would go to NPHPs for vaccinations or would use a complementary vaccination site. RESULTS:The top challenge reported by HCPs in vaccine delivery was patient receptiveness (62.4%), whereas the top challenge in vaccine receipt was patients' perception that a vaccine was not safe or effective (selected by 81.2% of HCPs, 65.0% of adults). Top interventions were patient or community incentives (selected by 52.5% of HCPs) and recommendations by the HCP (selected by 28.0% of adults). Adults rated their overall likelihood of receiving vaccination from an NPHP as 5.1 (standard deviation [SD] 1.7) on the 7-point scale. HCPs rated their patients' comfort level and adults rated their own comfort level with receiving a vaccine from an NPHP highest for RNs/LPNs (6.0 and 5.7, respectively), followed by pharmacists (5.7 and 5.2), medical assistants (5.0 and 5.2), pharmacy technicians (4.2 and 4.7), and dentists (3.7 and 4.1). The likelihood of vaccination at a complementary site was rated as 5.4 (SD 1.4) by HCPs and 4.9 (SD 1.8) by adults. CONCLUSION:U.S. adults are generally comfortable with receiving vaccines from NPHPs and at complementary sites. Education regarding the safety and effectiveness of vaccines remains essential.

Background: Approaches best suited for encouraging adults to vaccinate themselves may differ from those for encouraging parents to vaccinate their children. Objectives: To describe vaccine hesitancy and literacy among the US adult population. Methods: This cross-sectional survey assessed vaccine hesitancy and literacy among the US adult population (aged 18-60), grouped by their role as decision makers (parents for their children aged <18 vs. adults for themselves). Results were also examined among adults without children aged <18 by race and by household income. Data were collected using multiple-choice questions, which are reported as numbers and percentages, or a 5-point Likert scale. Results: Respondents included 1875 adults: 1183 adults without children aged <18 (63.1 %) and 692 parents of children aged <18 (36.9 %). Respondents generally agreed that vaccines are safe, effective, and a good way to protect themselves or their families. Respondents generally disagreed that vaccines are dangerous and overused and were neutral to claiming religious exemptions from vaccination. Most respondents trusted vaccines that had been available for two years or less (59.7 %). Respondents received most vaccine information from doctors' offices, public health sources, or pharmacies. Comparing parents with other adults, parents followed advice from friends, family, and colleagues more than other adults (p < 0.001) and parents felt they understood vaccine information better than other adults (p < 0.001). Parents were also more comfortable researching vaccine information than were other adults (p = 0.005). Adults reported pharmacies were most convenient of all points of care, and parents reported them second most convenient. Conclusions: Education about vaccine safety and the importance of childhood vaccinations among social networks may increase acceptance among vaccine-hesitant parents. Strategies focusing on increasing vaccine promotion at pharmacies may be effective for reducing vaccine hesitancy for all adults.

BackgroundPharmacies can increase access to vaccines. This study aimed to describe trends in the proportion of adolescent and adult vaccinations administered in pharmacies in the United States from 2018 to 2024.Research design and methodsThis was a retrospective cross-sectional analysis of medical and pharmacy claims from commercial health insurance enrollees. We recorded vaccinations received by enrollees >= 9 years of age from 2018 to 2023 (routine vaccines) or 2024 (seasonal vaccines). We calculated the annual proportion of vaccinations occurring in pharmacies and the accumulated percent change in vaccination rate during each year from 2020 onward compared to 2018-2019.ResultsThe proportion of routine vaccinations occurring in pharmacies was higher among adults than among adolescents. For most routine vaccines, this proportion increased during the study period. The lowest proportion was observed for adolescent human papillomavirus vaccination in 2018 (0.2%), and the highest for herpes zoster vaccination among adults >= 65 years of age in 2023 (88.6%). For all age groups, pharmacy-based vaccination was more common for seasonal influenza and SARS-CoV-2 vaccines than for all routine vaccines except herpes zoster.ConclusionsPharmacy-based vaccination is increasingly common in the United States, particularly among adults and for seasonal vaccines, and can help increase the overall level of vaccine uptake.

Introduction‘Shocks’ or external stressors to vaccination programmes can lead to decreased vaccination coverage rates. The capacity of vaccination ecosystems to effectively respond and adapt to shocks demonstrates programme resilience. This study sought to describe components that contribute to resilience in national immunisation programmes.MethodsMixed-methods study comprising in-depth interviews and surveys with n=30 vaccination programme experts in eight countries (Brazil, Costa Rica, Greece, Japan, Nigeria, Philippines, Spain and the USA). We elicited data on country-specific shocks, associated effects and factors that facilitated or impeded programme resilience. Interviews and open-ended survey responses were analysed qualitatively, with closed-ended survey questions analysed using descriptive statistics.ResultsExperts described immediate effects of shocks including decreased vaccine uptake and negative perceptions of vaccination from the public and media. Late emerging impacts included increased vaccine hesitancy and vaccine-preventable disease (VPD) rates. Stakeholder education, immunisation information systems (IIS) and programme financing were key factors to strengthening programme resilience. Appropriately trained frontline healthcare personnel can counter vaccine misinformation that otherwise erodes trust and contributes to hesitancy. The COVID-19 pandemic also exposed structural weaknesses in programme resilience, with experts highlighting the need for robust IIS and workforce support to mitigate burnout and strengthen resilience when a shock occurs.ConclusionsOur findings provide preliminary insights into factors that experts believe to be associated with vaccination programme resilience. Anticipating, adapting and responding to shocks is central to strengthening systems, ensuring ecosystem resilience and protecting against current and future VPD threats.

Despite vaccines being instrumental in reducing vaccine-preventable disease, adult vaccination rates in the United States (US) are below optimal levels. To better understand factors affecting vaccination rates, we analyzed trends in adult vaccination coverage using data from the Behavioral Risk Factor Surveillance System (BRFSS) and conducted a targeted literature review (TLR) on interventions to improve adult vaccination rates in the US. Both the BRFSS analysis and the TLR focused on influenza; pneumococcal disease; tetanus and diphtheria or tetanus, diphtheria, and acellular pertussis; herpes zoster; and human papillomavirus vaccination for US adults aged 18-64 years. The TLR additionally included hepatitis A and hepatitis B vaccination. Vaccination coverage rates (VCRs) and changes in VCRs were calculated using the 2011-2019 BRFSS survey data. For the TLR, the MEDLINE and MEDLINE In-Process databases were searched for articles on vaccination interventions published between January 2015 and June 2021. The BRFSS analysis showed that changes in VCRs were generally modest and positive for most states over the study period. The TLR included 32 articles that met the eligibility criteria; intervention strategies that improved adult vaccination outcomes incorporated an educational component, vaccination reminders or reinforcement at the point of care, or authorized non-clinician members of the healthcare team to vaccinate. Furthermore, interventions combining more than one approach appeared to enhance effectiveness. The strategies identified in this TLR will be valuable for policymakers and stakeholders to inform the development and implementation of evidence-based policies and practices to improve adult vaccination coverage.

Vaccine uptake is suboptimal among adult Medicaid beneficiaries. To evaluate factors affecting vaccine uptake among adult Medicaid beneficiaries and/or affecting healthcare providers who vaccinate adult Medicaid beneficiaries, we conducted a systematic literature review in Embase, Medline, Database of Abstracts of Reviews of Effects, and the Cochrane Library for articles published from January 2005 through July 2022 and relevant conferences. For included studies, data were extracted on the study characteristics, patient and provider cost barriers, patient and provider perceived risks/benefits, and other barriers faced by patients and providers. Quality assessments were conducted using a checklist from the Joanna Briggs Institute. Twenty-one studies analyzed patient-related factors (14 studies) and/or provider-related factors (8 studies). Reviewed studies indicate that vaccine uptake is influenced by insurance benefit and cost-coverage policies, including cost-sharing, access to vaccination services, and vaccine education and awareness. Financial factors, including reimbursement for vaccine acquisition and administration, influence providers' vaccination practices for Medicaid beneficiaries. Our findings suggest that reducing or eliminating vaccination cost-sharing, promoting vaccine education and awareness about the importance and safety of vaccines, increasing access, and exploring reimbursement rates equivalent with other public or private insurance plans could mitigate barriers to vaccination for the adult Medicaid population.

Background: Although vaccines are an effective solution for preventing infectious disease, some vaccination rates remain below national targets, creating a need to increase vaccination access and uptake. A potential solution to improve vaccination rates is the implementation of policies that allow for more convenient vaccination access, such as the expansion of vaccination delivery by nonphysician healthcare providers (NPHPs) outside of traditional clinical settings. Objective: To understand perspectives on vaccine administration at complementary sites (such as pharmacies, mobile clinics, and pop-up clinics) by NPHPs, and the barriers surrounding administration. Methods: We performed interviews with healthcare providers and vaccination policy experts to elicit perspectives on including vaccination program scope, facilitators and barriers to NPHPs administering vaccines, and recommendations for improvement of vaccine administration. Eligible participants were required to either work directly in vaccination administration or work in vaccination policy. Results: Thirty-eight participants completed interviews. Participants reported that U.S. individuals have a positive view of vaccination at complementary sites and by NPHPs, especially since the COVID-19 pandemic, where vaccination was often performed by NPHPs at complementary sites. Concerns expressed by participants included language barriers, out-of-pocket costs, and mistrust among marginalized communities. Participants described the complexity of state and local regulations, particularly scope of practice laws, as a barrier to implementation of NPHP vaccination programs at complementary sites. Conclusion: NPHPs and vaccination advocates report that complementary sites represent a potentially important step to ensuring broader, more equitable vaccination service in the United States. (c) 2024 American Pharmacists Association (R). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Objectives Identifying whether a country is ready to deploy a new vaccine or improve uptake of an existing vaccine requires knowledge of a diverse range of interdependent, context-specific factors. This scoping review aims to identify common themes that emerge across articles, which include tools or guidance that can be used to establish whether a country is ready to deploy a new vaccine or increase uptake of an underutilised vaccine.Design Scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines.Data sources Embase, CINAHL, Cochrane Library, Google Scholar, MEDLINE, PsycINFO and Web of Science were searched for articles published until 9 September 2023. Relevant articles were also identified through expert opinion.Eligibility criteria Articles published in any year or language that included tools or guidance to identify factors that influence a country’s readiness to deploy a new or underutilised vaccine.Data extraction and synthesis Two independent reviewers screened records and performed data extraction. Findings were synthesised by conducting a thematic analysis.Results 38 articles met our inclusion criteria; these documents were created using methodologies including expert review panels and Delphi surveys and varied in terms of content and context-of-use. 12 common themes were identified relevant to a country’s readiness to deploy a new or underutilised vaccine. These themes were as follows: (1) legal, political and professional consensus; (2) sociocultural factors and communication; (3) policy, guidelines and regulations; (4) financing; (5) vaccine characteristics and supply logistics; (6) programme planning; (7) programme monitoring and evaluation; (8) sustainable and integrated healthcare provision; (9) safety surveillance and reporting; (10) disease burden and characteristics; (11) vaccination equity and (12) human resources and training of professionals.Conclusions This information has the potential to form the basis of a globally applicable evidence-based vaccine readiness assessment tool that can inform policy and immunisation programme decision-makers.

Background Vaccines serve as a crucial public health tool, although vaccine hesitancy continues to pose a significant threat to full vaccine uptake and, consequently, community health. Understanding and tracking vaccine hesitancy is essential for effective public health interventions; however, traditional survey methods present various limitations. Objective This study aimed to create a real-time, natural language processing (NLP)–based tool to assess vaccine sentiment and hesitancy across 3 prominent social media platforms. Methods We mined and curated discussions in English from Twitter (subsequently rebranded as X), Reddit, and YouTube social media platforms posted between January 1, 2011, and October 31, 2021, concerning human papillomavirus; measles, mumps, and rubella; and unspecified vaccines. We tested multiple NLP algorithms to classify vaccine sentiment into positive, neutral, or negative and to classify vaccine hesitancy using the World Health Organization’s (WHO) 3Cs (confidence, complacency, and convenience) hesitancy model, conceptualizing an online dashboard to illustrate and contextualize trends. Results We compiled over 86 million discussions. Our top-performing NLP models displayed accuracies ranging from 0.51 to 0.78 for sentiment classification and from 0.69 to 0.91 for hesitancy classification. Explorative analysis on our platform highlighted variations in online activity about vaccine sentiment and hesitancy, suggesting unique patterns for different vaccines. Conclusions Our innovative system performs real-time analysis of sentiment and hesitancy on 3 vaccine topics across major social networks, providing crucial trend insights to assist campaigns aimed at enhancing vaccine uptake and public health.

Objectives The COVID-19 pandemic highlighted the fragility of immunisation programmes and resulted in a significant reduction in vaccination rates, with increasing vaccine-preventable disease outbreaks consequently reported. These vulnerabilities underscore the importance of resilient immunisation programmes to ensure optimal performance during crises. To date, a framework for assessing immunisation programme resilience does not exist. We conducted a scoping review of immunisation programmes during times of crisis to identify factors that characterise resilient immunisation programmes, which may inform an Immunisation Programme Resilience Tool.Design Scoping review design followed the Arksey and O’Malley framework, and manuscript reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines.Data sources CINAHL, CENTRAL, Embase, Google Scholar, MEDLINE, PsycINFO and Web of Science and databases were searched between 1 January 2011 and 2 September 2023. Citation searching of identified studies was also performed.Eligibility criteria We included primary empirical peer-reviewed studies that discussed the resilience of immunisation programme to crises, shocks or disruptions.Data extraction and synthesis Two independent reviewers screened records and performed data extraction. We extracted data on study location and design, crisis description, and resilience characteristics discussed, and identified evidence gaps in the literature. Findings were synthesised using tabulation and an evidence gap map.Results Thirty-seven studies met the eligibility criteria. These studies captured research conducted across six continents, with most concentrated in Africa, Asia and Europe. One study had a randomised controlled trial design, while 36 studies had observational designs (15 analytical and 21 descriptive). We identified five characteristics of resilient immunisation programmes drawing on the Health System Resilience Index (Integration, Awareness, Resource Availability and Access, Adaptiveness and Self-regulation) and several evidence gaps in the literature.Conclusions To our knowledge, no immunisation programme resilience tool exists. We identified factors from the Health System Resilience Index coupled with factors identified through primary empirical evidence, which may inform development of an immunisation programme resilience tool.

Background Healthcare providers' (HCPs') beliefs and practices regarding vaccination influence vaccine acceptance in patients. Objective To describe HCPs' beliefs and practices regarding vaccines and perceptions of patient perspectives related to vaccine hesitancy. Methods This was a non-interventional, cross-sectional, online survey administered to 1213 HCPs based in the United States from December 2021 through January 2022. HCPs provided responses regarding their demographic and professional characteristics, beliefs about vaccine safety and effectiveness, vaccination practices, and their views regarding patients' willingness to receive vaccination. Results Study participants included doctors (55.4 %); physician assistants (11.2 %); pharmacists (11.7 %); nurse practitioners (11.1 %); and registered nurses (10.6 %) from across the United States (West, 35.6 %; Midwest, 27.0 %; South, 25.6 %; Northeast, 11.9 %). HCPs belonged to group practices or clinics (34.5 %), private practices (31.9 %), hospital-based practices (21.9 %), or pharmacies (11.7 %). Most HCPs strongly believed it was their duty to promote vaccination (78.1 %) and used in-person conversations to educate patients about vaccines (85.0 %); 95.1 % had been vaccinated against COVID-19. HCPs reported that 54.9 % of patients accept all vaccines without hesitation, 21.0 % accept all vaccines but hesitate, 16.8 % accept only select vaccines, and 7.2 % reject all vaccines. Reasons commonly cited by patients for being hesitant to accept vaccines or refusal included negative media (hesitancy: 64.6 %; refusal: 73.2 %), the influence of friends or family (hesitancy: 60.5 %; refusal: 68.7 %), distrust of the government (hesitancy: 45.8 %; refusal: 68.4 %), concerns over long-term side effects (hesitancy: 56.1 %; refusal: 68.3 %), and worries about vaccine-related autism or infertility (hesitancy: 49.7 %; refusal: 71.9 %). HCPs reported that the largest contributors to vaccine misinformation among patients were social media (91.0 %), celebrities/TV personalities (63.5 %), and mass media (61.1 %). Conclusions Despite most HCPs being active proponents of vaccination, misconceptions about vaccination and vaccine hesitancy persists. Consideration should be given to HCP training to support their efforts to promote vaccine acceptance.

Introduction: Effective from October 2023, federal law requires Medicaid programs to cover all recommended adult vaccines administered by physicians with no cost sharing for all eligibility groups. However, uniform coverage does not always translate to optimal uptake. Rather, other factors such as Medicaid reimbursement rates influence vaccine access and ultimately patient uptake. This study reviewed Medicaid policies to understand vaccine coverage and reimbursement, for both physicians and pharmacists, in all 50 U.S. states; Washington, DC; and Puerto Rico (collectively referred to as states). Methods: Between March and September 2022, the researchers reviewed states’ public Medicaid policies regarding adult vaccines, focusing on the service of injectable vaccine administration and 3 products: hepatitis A, 9-valent human papilloma virus, and 23-valent pneumococcal polysaccharide. Results: Among 50 states with available data, 7 (14%) restricted Medicaid coverage for hepatitis A, 9-valent human papilloma virus, and/or 23-valent pneumococcal polysaccharide administered by physicians, and 15 (30%) did so for pharmacists. Median physician reimbursement rate was below the private sector rate for hepatitis A (89%) and 9-valent human papilloma virus (94%) but above the rate for 23-valent pneumococcal polysaccharide (108%). Median physician reimbursement for vaccine administration during an office visit was $11.86; the median pharmacist administration fee was $10.67. Conclusions: Although federal law now requires all state Medicaid programs to cover, without cost sharing, all recommended adult vaccines administered by physicians, equitable vaccine access may be hindered by state coverage restrictions for pharmacists and by relatively low reimbursement rates relative to Medicare and commercial coverage for both physicians and pharmacists.

Background Immunization information systems (IIS) are confidential, population-based computerized databases that record vaccination doses administered to persons residing within a given geopolitical area. We sought to highlight the evolution of IIS policy over the last two decades, as IIS play a pivotal role in achieving equitable and high vaccine uptake. Methods Legal epidemiological research methods were used to assess relevant IIS statutes and administrative codes across all 50 states, the District of Columbia, Philadelphia, and New York City. Where relevant, laws were cross-checked or supplemented with state and local health department resources. Comparisons to previous legal studies enabled evaluation of trends in IIS laws over time. Results The compilation of current laws provides an updated overview of the diverse interstate and intrastate policies within the US that govern the capabilities and implementation of IIS. The findings of this study show the progress that has been made in the past decade in improving policies that enable IIS to be utilized across the life-course. Conversely, gaps in IIS data collection, limited interoperability with local and national health information systems, and inconsistent access to view or utilize IIS records due to existing policies, continue to limit the full potential of IIS. Conclusions In the United States (US), IIS are implemented and managed at the state and local level, creating variability in IIS policies and implementation. Findings from this study serve as a comprehensive benchmark of current IIS laws that may aid policy stakeholders who are exploring amendments to jurisdictional IIS laws.

Objective We evaluated the public health impact and return on investment of Belgium’s pediatric immunization program (PIP) from both healthcare-sector and societal perspectives. Methods We developed a decision analytic model for 6 vaccines routinely administered in Belgium for children aged 0–10 years: DTaP-IPV-HepB-Hib, DTaP-IPV, MMR, PCV, rotavirus, and meningococcal type C. We used separate decision trees to model each of the 11 vaccine-preventable pathogens: diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type b, measles, mumps, rubella, Streptococcus pneumoniae , rotavirus, and meningococcal type C; hepatitis B was excluded because of surveillance limitations. The 2018 birth cohort was followed over its lifetime. The model projected and compared health outcomes and costs with and without immunization (based on vaccine-era and pre–vaccine era disease incidence estimates, respectively), assuming that observed reductions in disease incidence were fully attributable to vaccination. For the societal perspective, the model included productivity loss costs associated with immunization and disease in addition to direct medical costs. The model estimated discounted cases averted, disease-related deaths averted, life-years gained, quality-adjusted life-years gained, costs (2020 euros), and an overall benefit–cost ratio. Scenario analyses considered alternate assumptions for key model inputs. Results Across all 11 pathogens, we estimated that the PIP prevented 226,000 cases of infections and 200 deaths, as well as the loss of 7,000 life-years and 8,000 quality-adjusted life-years over the lifetime of a birth cohort of 118,000 children. The PIP was associated with discounted vaccination costs of €91 million from the healthcare-sector perspective and €122 million from the societal perspective. However, vaccination costs were more than fully offset by disease-related costs averted, with the latter amounting to a discounted €126 million and €390 million from the healthcare-sector and societal perspectives, respectively. As a result, pediatric immunization was associated with overall discounted savings of €35 million and €268 million from the healthcare-sector and societal perspectives, respectively; every €1 invested in childhood immunization resulted in approximately €1.4 in disease-related cost savings to the health system and €3.2 in cost savings from a societal perspective for Belgium’s PIP. Estimates of the value of the PIP were most sensitive to changes in input assumptions for disease incidence, productivity losses due to disease-related mortality, and direct medical disease costs. Conclusion Belgium’s PIP, which previously had not been systematically assessed, provides large-scale prevention of disease-related morbidity and premature mortality, and is associated with net savings to health system and society. Continued investment in the PIP is warranted to sustain its positive public health and financial impact.

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Abstract Objectives The COVID-19 pandemic highlighted the fragility of immunization programs and resulted in a significant reduction in vaccination rates, with increasing vaccine preventable disease outbreaks consequently reported. These vulnerabilities underscore the importance of resilient immunization programs to ensure optimal performance during crises. To date, a framework for assessing immunization program resilience does not exist. We conducted a scoping review of immunization programs during times of crises to identify factors that characterize resilient immunization programs, which may inform an Immunization Program Resilience Tool. Design Scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines. Data Sources CINAHL, CENTRAL, Embase, Google Scholar, MEDLINE, PsycINFO and Web of Science, databases were searched between 01-Jan-2011 to 02-Sep-2023. Citation searching of identified studies was also performed. Eligibility Criteria We included primary empirical peer-reviewed studies that discussed the resilience of immunization program to crises, shocks, or disruptions. Data extraction and synthesis Two independent reviewers screened records and performed data extraction. We extracted data on study location and design, crisis description, and resilience characteristics discussed, and identified evidence gaps in the literature. Findings were synthesized using tabulation and an evidence gap map. Results Thirty-seven studies met eligibility criteria. These studies captured research conducted across six continents, with most concentrated in Africa, Asia, and Europe. One study had a Randomized controlled trial (RCT) design, while 36 studies had observational designs (15 analytical and 21 descriptive). We identified five characteristics of resilient immunization programs drawing on the Health System Resilience Index (Integration, Awareness, Resource Availability and Access, Adaptiveness, and Self-regulation) and several evidence gaps in the literature. Conclusions To our knowledge, no immunization program resilience tool exists. We identified factors from the Health System Resilience Index coupled with factors identified through primary empirical evidence, which may inform development of an immunization program resilience tool.

Policies and programs to increase vaccine coverage rates among adults 50 years of age or older are limited and vaccine uptake is often suboptimal. Our review evaluated evidence on the effectiveness and success of adult-targeted vaccination interventions and identified literature gaps. Literature was retrieved (2021) from PubMed, Embase, and Google Scholar databases. Outcomes assessed included data on an intervention's effectiveness and impact on vaccine uptake. Interventions were characterized thematically: affordability (n = 9), awareness (n = 25), and vaccination access (n = 6); and included influenza, pneumococcal, tetanus-containing, and herpes zoster vaccines. Interactive interventions directed toward patients, including provider-led educational initiatives and provider recommendations showed more positive associations than less interactive interventions, such as posters and reminder-recall letters. Provider interventions, including awareness campaigns, incentives, affordability efforts, or vaccination site expansion generally showed positive associations. Combining interventions was found to be successful across several studies. Barriers and interventions varied for population subgroups, therefore, tailoring programs is critical.