Multi-disciplinary approach to Explaining Differential Immunization Coverage

Although there exist effective vaccines for many life-threatening diseases, access to these technologies remains limited in many low and middle income countries. The proposed project address the question: Why are some low-income countries and communities therein far more successful than others in immunizing children - despite unfavourable political and economic circumstances? There are broad variations in uptake of and demand for (new) vaccines at national, community and individual level. The reasons for this are only sketchily understood. The major focus of research until now has been on quality of supply and availability, often neglecting social and political factors, both in local communities and throughout the system as a whole. Our project focuses on the interface between demand and supply, placing social and political factors at the centre of analysis. The concepts of power and trust, largely ignored in immunization research to date, will be central to our analysis of the demand for immunization. We approach the system at different levels - building detailed empirical knowledge of the community level; and exploring the policy process from global agendas and agreements, through national policy ?formulation? and ?implementation? at local level. A cent ral aim is to develop a methodology for identifying and addressing drivers and barriers to coverage, taking into account the social and political context of the immunization system. An enhanced understanding can lead to improvements in current approaches to immunization and the implementation of new vaccine strategies, so that resources available can be used effectively and equitably. Our multidisciplinary team brings together perspectives from across the social sciences in a comparative research study, i n two countries: Malawi and India. The research targets fundamental questions relevant to global health, the academic study of development, and the policy community.