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Extensive research has examined the diffusion of innovations for products that can be trialed, and where the most adverse outcome, if a product fails, is a financial loss. However, less research has explored consumer responses to innovations in highly uncertain contexts characterized by health losses, lack of trialability, and the opportunity to free ride on other's adoption. This research focuses on vaccine decision making as a unique case within such contexts and extends the findings to other domains. Four studies (Ntotal = 1,796; five supplementary studies, Ntotal = 643) test the propositions of a formal model that incorporates uncertainty and others' choices into the adoption decision. The results show that consumers are surprisingly averse to products that are described as employing a new technology (e.g., mRNA technology) and require an "efficacy premium" to compensate for higher perceived uncertainty. However, considerable heterogeneity exists due to individual differences in technology readiness, trust in government, and risk attitudes. Notably, despite the prominent threat of free riding, a social proof nudge (communicating increasing population adoption) effectively reduces aversion to new technology. In this context, social proof information does not merely drive conformity or social learning, but instead increases adoption of new technology by alleviating perceived uncertainty. [ABSTRACT FROM AUTHOR]

Immunisation is a high priority for improving health outcomes. Yet, in many low-income and middle-income countries, achieving coverage targets independently is hindered by lack of domestic resources and reliance on partners support. Both the 2001 Abuja Declaration and 2016 Addis Declaration were key political commitments to improving immunisation coverage; however, many signatories have yet to meet international targets. Despite signing the Global Vaccine Action Plan and Addis Declaration, the Democratic Republic of the Congo (DRC) was unable to fully disburse its portion of allocated funds to cover vaccines without support from Gavi, the Vaccine Alliance and the World Bank between 2017 and 2019. Additionally, during the same time, vaccine coverage outcomes indicated negative trends, with over 750 000 children considered zero-dose in 2018. In 2019, a primary focus of the then newly elected Presidents agenda was universal healthcare. In collaboration with development partners and stakeholders, the first Presidential Forum was held as a public commitment to increasing childhood immunisation and ensuring the country remains polio-free. This article seeks to highlight the key outcomes of the Forum such as the signing of the Kinshasa Declaration, which formally set targets and specified national, provincial and community-level commitments to vaccination and polio eradication. As of 2023, three Forums have been conducted to reiterate political commitment to routine immunisation in the DRC. This type of high-level commitment could serve as a template for other countries struggling to have high engagement as targets for polio eradication and strengthened routine immunisation are set for 2025-2030.

BACKGROUND: In 2022-2023, 15- and 20-valent pneumococcal conjugate vaccines (PCV15/PCV20) were recommended for infants. We aimed to estimate the incidence of outpatient visits and antibiotic prescriptions in US children (≤17 years) from 2016-2019 for acute otitis media, pneumonia, and sinusitis associated with PCV15- and PCV20-additional (non-PCV13) serotypes to quantify PCV15/20 potential impacts. METHODS: We estimated the incidence of PCV15/20-additional serotype-attributable visits and antibiotic prescriptions as the product of all-cause incidence rates, derived from national health care surveys and MarketScan databases, and PCV15/20-additional serotype-attributable fractions. We estimated serotype-specific attributable fractions using modified vaccine-probe approaches incorporating incidence changes post-PCV13 and ratios of PCV13 versus PCV15/20 serotype frequencies, estimated through meta-analyses. RESULTS: Per 1000 children annually, PCV15-additional serotypes accounted for an estimated 2.7 (95% confidence interval, 1.8-3.9) visits and 2.4 (95% CI, 1.6-3.4) antibiotic prescriptions. PCV20-additional serotypes resulted in 15.0 (95% CI, 11.2-20.4) visits and 13.2 (95% CI, 9.9-18.0) antibiotic prescriptions annually per 1000 children. PCV15/20-additional serotypes account for 0.4% (95% CI, 0.2%-0.6%) and 2.1% (95% CI, 1.5%-3.0%) of pediatric outpatient antibiotic use. CONCLUSIONS: Compared with PCV15-additional serotypes, PCV20-additional serotypes account for > 5 times the burden of visits and antibiotic prescriptions. Higher-valency PCVs, especially PCV20, may contribute to preventing pediatric pneumococcal respiratory infections and antibiotic use.