Abstract The success of every vaccination program is dependent upon reaching and sustaining the target coverage rates. Vaccination programs are currently facing coverage gaps where target coverages are never reached and may also see erosion of coverage owing to, for example, loss of public confidence in vaccinations. The conference “From package to protection: how do we close global coverage gaps to optimize the impact of vaccination?” gathered a multidisciplinary group of experts to explore the best options to address these gaps by challenging assumptions with evidence and focusing on impact. Within the broad challenge of increasing vaccine acceptance, there are many different circumstances depending on the disease, population demographics, culture and differences in health care systems. A basic requirement for addressing the coverage gap is to determine the relative contribution of each factor and to understand the underlying psychology of decision-making. Studies that aim at identifying and measuring drivers and barriers of vaccination, approaches to better understand the relative contribution of all possible determinants of vaccination uptake and evidence-based approaches to effective communication on vaccine risk and benefits were reviewed and discussed. The panel concluded that vaccination behaviour is a continuum phenomenon ranging from active demand to complete refusal of all vaccines and can vary through time, place and vaccine. Communication and interventional strategies should therefore be tailored by vaccine and population. Standardized and validated tools to measure the barriers and drivers of vaccine acceptance should be developed/tested and put together in a repository or "Matrix" of interventions to investigate the impact of intervention.
Keywords: Vaccine uptake; Immunization; vaccine coverage; barriers of vaccination; global coverage gaps; conference report