Indonesia’s immunization efforts rely on social and behavior change strategies to combat vaccine hesitancy, improve access, and close coverage gaps for zero-dose children.

The role of social and behavior change (SBC) in public health is widely recognized. Over time, field practices have demonstrated that SBC serves as a powerful strategy—engaging, empowering, educating, and facilitating positive transformations within individuals, families, and communities.

Beyond grassroots impact, it also influences policies and legislative frameworks, ensuring a more holistic approach to developmental planning. In the realm of child-centric health initiatives, SBC is increasingly being leveraged to maximize resources and drive measurable outcomes. By integrating behavioral insights into program design, SBC strategies have evolved to prioritize human-centered solutions with tangible, data-driven results.

One of its most critical applications is within Indonesia’s Expanded Programme on Immunization (EPI), where mitigating the risks of vaccine-preventable diseases (VPDs) remains a life-saving priority. Within this framework, SBC functions as a demand-generation tool, essential for improving vaccine uptake in Indonesia’s vast archipelago. Despite these efforts, many areas continue to struggle with significant gaps, including the persistent issue of zero-dose children—those who have not received a single vaccine.

Vaccine hesitancy remains a formidable obstacle to immunization coverage in Indonesia, particularly in regions like Banda Aceh. Despite concerted efforts from health and development stakeholders, misinformation, cultural beliefs, and logistical barriers continue to impede progress. SBC’s role in generating demand for routine immunization is essential, as micro-planning, community empowerment, and robust tracking tools are crucial in bridging immunization gaps.

Routine immunization is a pivotal tool in preventing infectious diseases and reducing child mortality. The World Health Organization’s Global Action Plan underscores the necessity of demand generation to enhance immunization uptake. In response to these challenges, the Indonesian government has prioritized immunization services within its public health agenda, achieving commendable progress in accessibility and outreach. However, setbacks—especially those exacerbated by the COVID-19 pandemic—have highlighted the urgent need for sustained and adaptive strategies.

In 1977, Indonesia’s EPI introduced several childhood vaccines into its National Immunization Program (NIP). While these efforts have significantly reduced disease incidence, the number of unvaccinated and partially vaccinated children remains high. To address these gaps, the government has progressively shifted from stationary primary healthcare services to mobile health centers and community-based interventions, often in collaboration with non-governmental organizations (NGOs) and civil society organizations (CSOs).

Low immunization coverage is closely tied to vaccine hesitancy, making demand-generation strategies indispensable. Successful immunization programs hinge not just on availability but also on community trust and engagement. In Indonesia, ensuring that even the hardest-to-reach children receive full immunization requires constant advocacy and outreach. Before the pandemic, routine immunization coverage had reached 90 percent, a testament to Indonesia’s proactive policies. However, lingering challenges—including vaccine myths, logistical hurdles, and socioeconomic disparities—continue to pose risks.

Despite immunization campaigns dating back to 1956, many communities remain resistant to vaccines, citing fears of adverse health effects. Additionally, intersectoral coordination challenges, financial constraints, and geographical barriers exacerbate coverage gaps, leading to outbreaks of measles, diphtheria, and other preventable diseases. Although Indonesia has made strides in reversing pandemic-related disruptions, regional disparities in vaccine coverage remain stark, reinforcing the need for stronger demand-generation approaches.

Community resistance to routine immunization has prompted Indonesia to implement robust demand-generation interventions. These efforts focus on breaking access barriers, fostering community awareness, and promoting positive attitudes toward vaccination. Such initiatives are particularly crucial in regions with persistently low immunization rates. Indonesia ranked seventh globally for zero-dose children in 2023, with an estimated 571,000 children lacking their first dose of the diphtheria-tetanus-pertussis (DTP1) vaccine. The COVID-19 pandemic further exacerbated this crisis. By 2021, approximately 25 million children worldwide had missed one or more doses of DTP3 due to service disruptions, misinformation, and logistical challenges. In Indonesia, complete basic immunization coverage dropped from 84.2 percent in 2020 to 79.6 percent in 2021, leaving millions vulnerable to preventable diseases.

Indonesia has embraced innovative approaches to counteract these challenges, incorporating immunization into COVID-19 response plans, deploying mobile clinics, and conducting targeted outreach campaigns. Catch-up campaigns have also been prioritized to immunize children who missed their scheduled doses during the pandemic. However, vaccine hesitancy is just one piece of the puzzle. Demand-generation strategies must address a spectrum of challenges, including access limitations, cultural beliefs, economic constraints, and pandemic-related disruptions.

Overcoming these barriers requires a collaborative and multi-pronged approach that integrates communication campaigns, community engagement, education, and support services. As Indonesia navigates these complexities, the collective efforts of the government, international organizations, NGOs, and local stakeholders will be instrumental in ensuring that every child has access to life-saving vaccines, thereby strengthening public health outcomes nationwide.

For Indonesia’s EPI to thrive, SBC strategies must be systematically strengthened and institutionalized. A stepwise approach should be adopted that involves enhancing behavioral research capabilities to better understand community attitudes and barriers to immunization. Health managers should be equipped with specialized skills to design and implement effective SBC initiatives, while micro-planning at the field level should be reinforced to ensure localized, data-driven approaches tailored to specific community needs. Strengthening the technical expertise of health providers is also essential, particularly in tracking SBC results through scientific monitoring and evaluation tools.

By prioritizing these elements, Indonesia can reinforce the effectiveness of its immunization program, fostering stronger community engagement and ultimately leading to a healthier population. Through evidence-based strategies and sustained advocacy, the country can bridge existing immunization gaps, ensuring equitable access to vaccines for all children, no matter where they live.