Conceptual Framework for Epidemics and Vaccination Dilemma

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DOI: 10.21522/TIJPH.2013.10.01.Art006

Authors : Odis Adaora Isabella


Outbreaks of diseases have positive and negative effects on humans. An example of the positive epidemic dilemma was seen in the 2020 lockdown across the world where families spent quality time together and couples seeking for the fruit of the womb conceived after many years, working from home was introduced, Lagosians working from home reduced stress from traffic, remote jobs were increased, online zoom, Webex webinars, online surveys, seminars, conference, Viva Voca, graduation and growth for online business and banking. Apps were available for the masses to access health online, known as Telemedicine. While the negative epidemics dilemma includes loss of jobs, slow down in economy across the world, poverty, drug abuse, self–medication, Anti-microbial resistance, child abuse, rape, divorce, shadow pandemic, death, and no access to education for those that do not have internet facilities to learn/study/school online. Vaccine’s hesitancy is an established dilemma that contributes to significant health challenges which cause a high rate of infant sickness and death. There are certain factors like cultural, social, demographic, and psychosocial factors that contribute to the vaccine dilemma. This conceptual framework illustrates the factors that drive epidemics and vaccine dilemma, which can be vaccination acceptance and hesitancy. For an intervention to be implemented successfully, we need to understand the triggers of epidemics and vaccination dilemma. The socio-demographic characteristics like age, sex, marital status, level of education, choice of hospital, employment status, level of income, health insurance status and the number of children is significantly associated with vaccine uptake among parents.


[1] Osibogun (2014) “Emerging and Remerging diseases – Stopping the spread”: Lecture delivered at the Health Week ceremony of the University of Lagos.

[2] Vaccinate your family, 2019, “Vaccines are cost savings”,

[3] De Figueiredo A et al. (2016) “Forecasted trends in vaccination coverage and correlations with socioeconomic factors: A global time-series analysis over 30 years”. Lancet Glob. Health, Vol 4, no. 10, pp., 726–735. pmid:27569362 View Article PubMed/NCBI Google Scholar.

[4] Wessel L., (2017,) “Vaccine myths”. Science 2017; 356(6336):368–372. pmid:28450594 View Article PubMed/NCBI Google Scholar.

[5] Larson HJ, Jarrett C, Eckersberger E, Smith DM, Paterson P., (2014), “Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature”, 2007-2012. Vaccine 2014; 32(19):2150–2159. PMID: 24598724 View Article PubMed/NCBI Google Scholar.

[6] Black S, Rappuoli R., (2010), “A crisis of public confidence in vaccines”. Sci. Transl. Med. 2010; Vol. 2, no. 61, pp., 61. PMID: 21148125 View Article PubMed/NCBI Google Scholar.

[7] Larson HJ., (2016) “Vaccine trust and the limits of information”. Science Vol. 353, no. 6305, pp., 1207–1208. PMID: 27634512 View Article PubMed/NCBI Google Scholar.

[8] Holme P, Saramäki J. (2012) “Temporal networks”. Phys Rep; no. 519, pp., 97–125.

[9]    Jansen VAA et al., (2003), “Measles outbreaks in a population with declining vaccine uptake”. Science Vol. 301, no. 5634, pp., 804. PMID: 12907792 View Article PubMed/NCBI Google Scholar.

[10] Feh E, Fischbacher U., (2003), “The nature of human altruism”. Nature Vol., 2003; no. 425, pp., 785–791. View Article Google Scholar.

[11] Davis L., (1977), “Prisoners, paradox, and rationality”. Am PhilosQ,Vol. 14, no. 4, pp., 319–327.View Article Google Scholar.

[12] Sharma A, Menon SN, Sasidevan V, Sinha S (2019) “Epidemic prevalence information on social networks can mediate emergent collective outcomes in voluntary vaccine schemes”. PLoSComputBiolVol. 15, no. 5, e1006977.

[13] Verelst F, Willem L, Beutels P., (2016), “Behavioural change models for infectious diseasetransmission: a systematic review (2010-2015)”. J. R. Soc. Interface 2016; 13(125):20160820. pmid: 28003528 View Article PubMed/NCBI Google Scholar.

[14] Marien González Lorenzo A, Alessandra Piatti C, Liliana Coppola C, Maria Gramegna C, Vittorio Demicheli D, Alessia Melegaro E, Marcello Tirani A, Elena Parmelli F.G, Francesco Auxilia A Lorenzo Moja A.B, the Vaccine Decision Group, 2015, Conceptual frameworks and key dimensions to support coverage decisions for vaccines, Volume 33, Issue 9, 25 February 2015, Pages 1206-1217,

[15] Saint-Victor DS, Omer SB., (2013), “Vaccine refusal and the endgame: Walking the last mile first”. Phil. Trans. R. Soc. B 2013; 368(1623):20120148. PMID: 23798696 View Article PubMed/NCBI Google Scholar.

[16] Bauch CT, Galvani AP, Earn DJD., (2003) “Group interest versus self-interest in smallpox vaccination policy”. Proc. Natl. Acad. Sci. USA Vol. 100, no.18, pp., 564–567. View Article Google Scholar.

[17] Bauch CT, Earn DJD., (2004) “Vaccination and the theory of games”. Proc. Natl. Acad. Sci. USA, Vol 101, no. 36, pp., 391–394. View Article Google Scholar.

[18] Zhang H-F, Wu Z-X, Tang M, La Y-C., (2014), “Effects of behavioral response and vaccination policy on epidemic spreading—an approach based on evolutionary-game dynamics”. Sci. Rep. 2014; 4:5666. pmid: 25011424 View Article PubMed/NCBI Google Scholar.

[19] Verelst F, Willem L, Kessels R, Beutels P., (2018), “Individual decisions to vaccinate one’s child or oneself: A discrete choice experiment rejecting free-riding motives”. Soc. Sci. Med. Vol. 2018; no. 207, pp., 106–116. pmid: 29738898.

[20] Jolley D, Douglas KM., (2014), “The effects of anti-vaccine conspiracy theories on vaccination intentions”. PLoS ONE, Vol. 9, no. 2, pp., 89 - 177. pmid:24586574 View Article PubMed/NCBI Google Scholar.

[21] Larson HJ, Ghinai I., (2011), “Lessons from polio eradication”. Nature; no. 473, pp., 446–447. pmid:21614056 View Article PubMed/NCBI Google Scholar.

[22] Eubank S, et al., (2004), “Modelling disease outbreaks in realistic urban social networks”. Nature, Vol. 429, no. 6988, pp., 180–184. pmid:15141212 View Article PubMed/NCBI Google Scholar.

[23] Moinet A, Pastor-Satorras R, Barrat Alain., (2018), “Effect of risk perception on epidemic spreading in temporal networks”. Phy. Rev. E 2018; 97(1):012313. View Article Google Scholar.

[24] Rizzo A, Frasca M, Porfiri M., (2014), “Effect of individual behavior on epidemic spreading in activity-driven networks”. Phy. Rev. E Vol. 90, no. 4, 042801. View Article Google Scholar.

[25] Massaro E, Bagnoli F., (2014), “Epidemic spreading and risk perception in multiplex networks: A self-organized percolation method”. Phy. Rev. E 2014; Vol. 90, no. 5, 052817. View Article Google Scholar.

[26] Oku, A., Oyo-Ita, A., Glenton, C. et al. Factors affecting the implementation of childhood vaccination communication strategies in Nigeria: a qualitative study. BMC Public Health 17, 200 (2017).

[27] Harapan H, Wagner AL, Yufika A, Winardi W, Anwar S, Gan AK, et al. (2020) Acceptance of a COVID-19 vaccine in Southeast Asia: a cross-sectional study in Indonesia. Front Public Health. 8:381. DOI: 10.3389/fpubh.2020.00381PubMed Abstract, CrossRef Full Text, Google Scholar.

[28] Wang J, Jing R, Lai X, Zhang H, Lyu Y, Knoll MD, et al. (2020) Acceptance of COVID-19 vaccination during the COVID-19 pandemic in China. Vaccines. 8:482. DOI: 10.3390/vaccines8030482 PubMed Abstract, CrossRef Full Text, Google Scholar.

[29] Bell S, Clarke R, Mounier-Jack S, Walker JL, Paterson P. (2020) Parents’ and guardians’ views on the acceptability of a future COVID-19 vaccine: a multi-methods study in England. Vaccine. 38:7789–98. doi: 10.1016/j.vaccine.2020.10.027 PubMed Abstract, CrossRef Full Text, Google Scholar.

[30] Reiter PL, Pennell ML, Katz ML. (2020) Acceptability of a COVID-19 vaccine among adults in the United States: How many people would get vaccinated? Vaccine. 38:6500–7. DOI: 10.1016/j.vaccine.2020.08.043PubMed Abstract,  CrossRef Full Text | Google Scholar.

[31] Guidry JPD, Laestadius LI, Vraga EK, Miller CA, Perrin PB, Burton CW, et al. (2021) Willingness to get the Covid-19 vaccine with and without emergency use authorization. Am J Infect Control. 49:137–42. DOI: 10.1016/j.ajic.2020.11.018 PubMed Abstract, CrossRef Full Text, Google Scholar.

[32] Dror AA, Eisenbach N, Taiber S, Morozov NG, Mizrachi M, Zigron A, et al. (2020) Vaccine hesitancy: the next challenge in the fight against COVID-19. Eur J Epidemiol. 35:775–9. DOI: 10.1007/s10654-020-00671-y PubMed Abstract, CrossRef Full Text, Google Scholar.

[33] Goldman RD, Yan TD, Seiler M, Cotanda CP, Brown JC, Klein EJ, et al. (2020) Caregiver willingness to vaccinate their children against COVID-19: Cross-sectional survey. Vaccine. 38:7668–73. DOI: 10.1016/j.vaccine.2020.09.084 PubMed Abstract, CrossRef Full Text, Google Scholar.

[34] Lazarus JV, Ratzan SC, Palayew A, Gostin LO, Larson HJ, Rabin K, et al. (2021). A global survey of potential acceptance of a COVID-19 vaccine. Nat Med. 27:225–8. DOI: 10.1038/s41591-020-1124-9 PubMed Abstract, CrossRef Full Text, Google Scholar.

[35] Salali GD, Uysal MS. (2020) COVID-19 vaccine hesitancy is associated with beliefs on the origin of the novel coronavirus in the UK and Turkey. Psychol Med. 1−3. DOI: 10.1017/S0033291720004067 PubMed Abstract, CrossRef Full Text, Google Scholar.

[36] Su Z, Wen J, Abbas J, McDonnell D, Cheshmehzangi A, Li X, et al. (2020) A race for a better understanding of COVID-19 vaccine non-adopters. Brain Behav Immun Health. 9:100159. doi: 10.1016/j.bbih.2020.100159 PubMed Abstract, CrossRef Full Text, Google Scholar.

[37] Joshi, A., Kaur, M., Kaur, R., Grover, A., Nash, D., & El-Mohandes, A. (2021). Predictors of COVID-
19 Vaccine Acceptance, Intention, and Hesitancy: A Scoping Review. Frontiers in public health, 9, 698111.