Investigator(s)
| Submitter |
Cheten Zangmo Ministry of Health Cheten Zangmo 
|
| Principal Investigator |
Cheten Zangmo Ministry of Health Cheten Zangmo
|
| Co-Investigator(s) |
Tashi Dawa Ministry of Health Tashi Dawa
|
| Co-Investigator(s) |
Mimi Lhamu Mynak National Medical Services Mimi Lhamu Mynak
|
| Co-Investigator(s) |
Guru Prasad Dhakal Jigme Dorji Wangchuck National Referral Hospital Guru Prasad Dhakal
|
| Co-Investigator(s) |
Dhrupthob Sonam Jigme Dorji Wangchuck National Referral Hospital Dhrupthob Sonam
|
| Co-Investigator(s) |
Deki Yangzom Ministry of Health Deki Yangzom
|
| Co-Investigator(s) |
Thinley Yangzom Jigme Dorji Wangchuck National Referral Hospital Thinley Yangzom
|
| Co-Investigator(s) |
Namgay Dawa Punakha Dzongkhag Health Administration Namgay Dawa
|
| Co-Investigator(s) |
Kinzang P Tshering NITAG Kinzang P Tshering
|
Title(s) and abstract
| Scientific title | BEHAVIORAL, SOCIO-ECONOMIC AND CULTURAL FACTORS INFLUENCING VACCINE ACCEPTANCE AND UPTAKE IN BHUTAN |
| Public title | BEHAVIORAL, SOCIO-ECONOMIC AND CULTURAL FACTORS INFLUENCING VACCINE ACCEPTANCE AND UPTAKE IN BHUTAN |
| Background | Vaccination saves over 5 million lives every year from diseases like diphtheria, pertussis, tetanus, influenza, measles, etc. It is proven to be the most successful and cost-effective public health interventions. Today, vaccines prevent about 30 live-threatening diseases and infections, invariably enhancing overall health and longevity of populations in the world. Besides, the vaccination program is a key to primary health care as well as a key driver of advancement towards attaining Universal Health Coverage.(1) However, the COVID-19 pandemic jolted the healthcare systems and laid bare their critical weaknesses across countries and continents that disrupted healthcare service delivery. This affected immunization programs as well. For instance, over 20 million children missed their routine first dose of measles vaccine in 2024. In South-East Asia, countries like India, Nepal, Sri Lanka and Thailand have reported of measles outbreaks, and the zero-dose children rose to 2.7 million in 2023.(2) Although significant gains have been made globally in eliminating vaccine-preventable diseases, challenges still persist in sustaining high coverage, including coverage disparities, and introducing new vaccines. Vaccine hesitancy, documented in the health literature globally for decades, is a critical public health concern that is primarily driven by factors such as mistrust in health systems, safety concerns (mostly related to AEFIs), and limited awareness of vaccine-preventable diseases. It poses a significant threat to public health as it undermines vaccination efforts that are important for controlling and preventing infectious diseases and outbreaks. Increased rates of non-medical exemptions and recurrent outbreaks of preventable illnesses in many countries highlights persistent public uncertainty about the vaccine benefits, which impede the uptake of both routine and new vaccines. |
| Objectives | To examine the key social, cultural, and behavioural drivers that shape public confidence in vaccine acceptance and uptake. To identify both enabling factors and systemic barriers that either enhance or hinder vaccine uptake among the population, particularly floating communities and those living in far-flung areas. To determine the influence of community’s attitude on vaccine hesitancy, especially for the introduction of new vaccines. To find out the trusted sources of health information for communities that enable them to make health choices, including for vaccinations. To provide recommendations to inform policy-makers, planners and service providers for developing effective social behavioural change interventions to drive vaccine acceptance and uptake in communities with lower immunization coverage. |
| Study Methods | A well-designed methodology is essential to achieve the purpose of this study. The use of mix-methods will ensure that the study generates not only comprehensive and accurate data but also provides balanced perspectives on vaccine acceptance by triangulating numerical data with qualitative narratives. The qualitative data will help find why various factors influence vaccine behaviours of communities. The following procedures will be followed to conduct the study: 2.1 Study design The study will employ a cross-sectional descriptive design to capture the data on factors that affect the acceptance and uptake of vaccines among the population, including those living in highlands and remote Gewogs. It will allow the assessment of current socio-cultural, behavioural and health system factors (exposures) resulting in vaccine acceptance and uptake (outcome). 2.2 Study participants All aged 18 years and above will form the study population, encompassing a diverse cross-section of society to obtain a comprehensive understanding of vaccine acceptance and uptake in the country. This study population will include mothers, youth, rural-urban communities, highlanders, members of the business sector, as well as representatives of religious institutions. A representative sample will help capture a wide range of insights, experiences and dynamics of decision-making pertaining to vaccine acceptance and uptake, reflecting an interplay of factors collectively influencing vaccine-related behaviours across the population. The sampling frame will be based on the annual household health surveillance database and local government’s administrative household records. |
| Expected outcomes and use of results | The findings of this study will generate evidence to guide targeted, data-driven, and educational strategies to improve and sustain vaccination uptake among health workers. These insights will help policymakers design context-specific interventions, optimize resource allocation, and strengthen vaccination programs. |
| Keywords | Vaccine acceptance, vaccine hesitancy, socio-cultural factors, behavioral determinants |
Research Details
| Student research | No |
| Start Date | 15-Dec-2025 |
| End Date | 31-Mar-2026 |
| Key Implementing Institution | Ministry of Health |
| Multi-country research | No |
| Nationwide research | Yes, with randomly selected geographical areas |
| Bhutan, Bhutan, Bhutan, Bhutan, Bhutan, Bhutan | |
| Research Domain(s) | Communicable Disease Research |
| Research field(s) | Immunization/Vaccine Preventable Disease |
| Involves human subjects | Yes |
| Operational Research | |
| Data Collection | Primary data |
| Proposal reviewed by other Committee | No |