Economists use the term demand to refer to a consumer’s desire to purchase goods and services at given prices at a given time. Changing the features or placement of a product might increase or decrease demand. If all other factors are constant, an increase in price will decrease demand.
Adapting the concept to public health, vaccine demand refers to people’s intent to get a specific shot (such as a Covid-19, flu or shingles vaccine), and their willingness and ability to do so given the vaccine’s features, availability, reputation and price. For example, some people might be more eager to get a vaccine via a nasal spray instead of an injection. Some people might want the vaccine if it is delivered close to home. Some people might seek a shot if a family member recommends it. Some people might get a shot because they recently got health insurance, or found a doctor they trust.
In economic frameworks, supply and demand are deeply intertwined. Companies have a keen understanding of how changes to the design of a product or its delivery time might impact demand.
In public health, supply and demand are often disconnected from each other.
Based on our work with communities, researchers and public health practitioners, we categorize three main drivers of vaccine demand:
Information: What information people have access to, and in what ways this information meets their media consumption habits, literacy levels and learning profiles. What misinformation people are exposed to, and in what ways this misinformation targets their emotions, identities and lived experiences.
Social & Behavioral Factors: What people think, feel and do about vaccinations based on factors such as lived experiences, biases, attitudes, identities and social norms.
Structures: What stands in the way, literally and figuratively, of vaccination, from lack of supplies to lack of transportation to having to work multiple jobs to discrimination to lack of access to healthcare to institutions acting in untrustworthy ways.
A recent CDC field guide similarly describes structural, behavioral and information barriers to vaccination.
Driving Vaccine Demand
The conversations, funding streams and literature on issues such as setting up distribution through pharmacies (the supply) are largely separate from those on issues such as who has access to healthcare or what motivates people to get vaccinated (demand). Recognizing the importance of trust in vaccine demand, and the role of physicians, nurses and other healthcare workers as trusted sources of health information, for example, could have led to an earlier investment in enlisting primary care providers in the vaccination effort.
Moreover, a vaccine demand framework honors the agency and dignity of unvaccinated and undervaccinated Americans at a time when they are often dismissed, degraded and disempowered. It acknowledges that people’s choices are shaped by complex psychological, social, structural and other interacting factors.
As a concept in public health, vaccine demand incorporates all drivers that contribute to a person getting vaccinated. These include everything from low-quality information and misinformation, to what people think and feel about vaccines due to social factors such as politics and social norms, to structural issues such as transportation, timing, and access to healthcare. The “price” to be paid for the shot includes financial, social and other costs — lost wages due to missed work because of side effects, or a rift with loved ones who are distrustful of authorities and the vaccines they promote.
“If you look at the landscape, and the specific communications that are needed and the trusted individuals on the ground within those communities, that’s a mammoth undertaking to make sure that we’re reaching all communities.”
The key to understanding vaccine demand is that diverse behavioral and social, information and structural drivers overlap and interact. Decisions about our health, not unlike major purchasing decisions, involve a complex web of incentives, availability, knowledge, attitudes, biases, friction, tradeoffs and complexities based on lived realities.
For some Americans, vaccination is also closely connected to individual, collective and intergenerational memory: the experiences of Black, Indigenous, Hispanic/Latinx, Asian and other people of color with healthcare and other social institutions are different from those of white Americans. Instead of being offered life-saving vaccines or treatments, Black Americans have been coerced into serving as test subjects in medical experiments. To this day, we see stark disparities in the quality of health services offered and delivered by race, as chapter 3.c will explain in more detail.
Institutions and individuals in medicine and public health have urgent work to do better and earn the trust of these communities. Addressing these and other barriers to vaccine demand is essential to America’s ability to move past the current vaccination crisis; it is equally essential in efforts to vaccinate the world.