Analysis of the Legal Feasibility of Cooperative Pharmacies in Africa: The Cases of Cameroon and Kenya

### **Strategies to Promote COVID-19 Vaccination**

**Sara Taheri<sup>1</sup> , Mahnaz Afshari<sup>2</sup> , Fatemeh Kazemi<sup>3</sup> , Maryam Saadati<sup>3</sup> , Zahra Abdoli 4 , Alireza Jafari Azad<sup>3</sup> , and Leila Eslambolchi<sup>3</sup>**

<sup>1</sup> European University of Lefke, Lefke, Turkey

<sup>2</sup> Saveh University of Medical Sciences, Iran

<sup>3</sup> Tehran University of Medical Sciences, Tehran, Iran

<sup>4</sup> Islamic Azad University, Tehran, Iran

The reluctance of individuals to receive the COVID-19 vaccine has raised concerns about the collective immunization of communities and the management of the COVID-19 epidemic worldwide. Different countries have used various strategies for vaccination. However, their effectiveness is questionable.

Aims: The aim of this study was to identify and classify effective strategies and provide a model to increase the desire of individuals to receive the COVID-19 vaccine. This research was conducted using a mixed methods approach (archival data, scoping review, and Delphi method). The current status of COVID-19 vaccination was examined using archival data. Then, using a scoping review, strategies for persuading people to get the COVID-19 vaccine were searched in the Embase, PubMed, Medline, Web of Science, and Scopus databases, and Google Scholar search engine up to November 21, 2021. Screening and evaluation of 1728 identified articles resulted in 197 eligible documents.

Thematic content analysis was used to identify and classify strategies. These strategies were presented to 30 experts using the modified Delphi technique and an online questionnaire for evaluation using the "FAME" criteria. Finally, a model was developed to increase the willingness of individuals to receive the vaccine. A total of 131 strategies were identified to increase the desire of individuals to receive the COVID-19 vaccine. They were classified into five groups: "educational", "social", "media", "governance" and "economic". Improving access to vaccines and the safety and effectiveness of vaccines, enacting vaccination card regulations, developing vaccination social campaigns, correcting misconceptions about vaccines, and promoting national media and financial incentives were among the interventions used to promote the desire for the Covid vaccine. A comprehensive intervention model of "6Ps" (Provision, Precondition, Promotion, Public Awareness, People, and Prize) was developed to encourage individuals to receive COVID-19 vaccination.

Addressing the skepticism of the COVID-19 vaccine requires an understanding of the underlying reasons and applying a systemic intervention approach consisting of economic incentives, behavioral interventions, and assuring the safety of vaccines.

Sara Taheri1, Mahnaz Afshari2, Fatemeh Kazemi3, Maryam Saadati3, Zahra Abdoli <sup>4</sup>, Alireza Jafari Azad3, and Leila Eslambolchi<sup>3</sup>


Background: The reluctance of some individuals to receive the COVID-19 vaccine has raised concerns about collective immunization and the management of the current pandemic. Different countries have used various strategies for vaccination. However, their effectiveness is questionable. This creates a need for designing effective evidence-based interventions for the promotion of vaccination, well-suited for the context of each country.

Aims: This study aimed to identify and classify effective strategies and provide a model to promote COVID-19 vaccination.

Methods: This research was conducted using a mixed-method approach. First, evidence-based strategies were defined through archival data and scoping review. Strategies for persuading people to take the vaccine were researched in Embase, PubMed, Medline, Web of Science, Scopus databases and the Google scholar search engine up to Nov. 21, 2021. Screening and evaluation of 1728 identified articles resulted in 197 eligible documents. Thematic content analysis was used to identify and classify strategies.

Then, 30 health experts were purposefully chosen to participate in the study. Participants expressed their views on the evidence-based strategies via an online questionnaire in the first phase of Delphi. In the second phase, strategies were verified using the "FAME" framework. The feasibility, acceptance, meaningfulness and efficacy of each strategy were scored from 1 to 5, using a Likert scale. Strategies with a mean score of 3.5 or higher were considered valid.

Results: In total, 131 valid strategies to promote COVID-19 vaccination were identified. Valid strategies were classified in six groups, including Provision, Precondition, Promotion, Public Awareness, People and Prize.

*Figure 2. The six Ps to promote COVID-19 vaccination.*

Provision, Precondition and Promotion scored the highest. Public Awareness, People and Prize had the lowest scores.

*Table 1. The results of ranking solutions from the perspective of experts based on the average scores given.*


Conclusions: Addressing the skepticism towards the COVID-19 vaccine requires an understanding of the underlying reasons and the application of a systemic interventional approach consisting of:


References: French J, Deshpande S, Evans W, Obregon R. Key guidelines in developing a pre-emptive COVID-19 vaccination uptake promotion strategy. International journal of environmental research and public health. 2020 Jan;17(16):5893. Salali GD, Uysal MS. Effective incentives for increasing COVID-19 vaccine uptake. Psychological Medicine. 2021 Sep 20:1-3. Jose S. COVID vaccine and generation Z-a study of factors influencing adoption. Young Consumers. 2021 Aug 25. Volpp KG, Cannuscio CC. Incentives for immunity-strategies for increasing Covid-19 vaccine uptake. New England Journal of Medicine. 2021 Jul 1;385(1):e1. Liu S, Liu J. Understanding behavioral intentions toward COVID-19 vaccines: Theory-based content analysis of tweets. Journal of Medical Internet Research. 2021 May 12;23(5):e28118.

*Figure 1. Evidence-based strategies.*
