Critical Public Health

Beyond Vaccine Hesitancy: Equity and Missed Opportunities Across the Life Course

Vaccination is increasingly recognized as a life-course intervention, extending well beyond childhood to adolescence, pregnancy, adulthood, older age, and people living with chronic or immunocompromising conditions. Despite the availability of effective vaccines and increasingly detailed evidence-based recommendations, substantial gaps remain between recommended vaccination and its actual delivery and uptake. These gaps cannot be explained by vaccine hesitancy alone. Barriers may arise from limited awareness or health literacy, socioeconomic inequalities, difficulties in accessing services, fragmented healthcare pathways, lack of healthcare professional recommendations, organizational constraints, and missed opportunities within healthcare settings.

This Collection aims to broaden the perspective on vaccination by moving beyond vaccine hesitancy and examining immunization as a multidimensional public health, health-system, and health-equity issue across the life course.

People who are most likely to benefit from vaccination are often those who face the greatest barriers to receiving it. Older adults, individuals with chronic or immunocompromising conditions, pregnant women, socially vulnerable populations, and patients receiving hospital or specialist care may encounter multiple missed opportunities for vaccination. Healthcare encounters, including hospitalization, specialist consultations, primary care visits, and transitions between healthcare settings, may provide valuable opportunities to identify vaccination needs, recommend appropriate vaccines, and facilitate or deliver vaccination. However, these opportunities are frequently underused. Understanding where and why vaccination opportunities are missed is therefore essential for designing effective and equitable immunization strategies. A life-course perspective can help identify critical points at which vaccination can be integrated into routine clinical care and can highlight the roles of healthcare professionals, health systems, digital tools, communication strategies, and public health policies. Importantly, examining inequities in vaccination should also consider structural and organizational determinants, rather than attributing low uptake primarily to individual attitudes or behaviours.

The Collection therefore welcomes interdisciplinary evidence that can contribute to understanding, measuring, and reducing gaps between vaccination recommendations, opportunities, and actual uptake. Particular interest will be given to research with clear implications for clinical practice, health-system organization, implementation, and vaccination policy. Vaccine hesitancy, confidence, acceptance, and intention across the life course; health and vaccine literacy, risk perception, and communication; missed vaccination opportunities and determinants of under-vaccination; health inequalities and vaccine equity; adult and life-course immunization strategies; vaccination of older, frail, immunocompromised, and chronically ill adults; hospital- and specialist-based vaccination; integration of immunization into clinical pathways and care transitions; healthcare professionals’ knowledge, recommendations, and practices; maternal, pregnancy, and infant immunization; implementation of national and regional programmes; organizational, digital, and health-system approaches; shared decision-making and counselling; policy approaches to improve equity; comparative, cross-country, and interdisciplinary perspectives on life-course immunization. We welcome original research, qualitative and mixed-methods studies, systematic and scoping reviews, implementation research, health-system and policy analyses, and critical commentaries. Studies evaluating interventions, vaccination pathways, healthcare-system innovations, and strategies to reduce inequities and missed opportunities are particularly encouraged.

Keywords: Life-course immunization, Vaccine hesitancy, Vaccine equity, Missed opportunities for vaccination, Immunization strategies

Dr. Manuela Chiavarini is a researcher in General and Applied Hygiene at the University of Florence. Her research focuses on infectious and chronic disease prevention, with particular attention to vaccination, health promotion, and health inequalities. She has authored over 55 peer-reviewed publications and serves as Guest Editor for several international scientific journals.

Prof. Angela Bechini is an Associate Professor of General and Applied Hygiene at the University of Florence. Her research focuses on infectious disease surveillance, vaccination strategies, seroepidemiology, and antimicrobial resistance. She coordinates research activities in applied microbiology and molecular epidemiology and has contributed to over 170 peer-reviewed scientific publications.

Prof. Sara Boccalini is an Associate Professor of Hygiene at the University of Florence, with over 20 years of research experience in the epidemiology and prevention of infectious diseases. Her work focuses particularly on the impact of vaccination programmes on vaccine-preventable diseases. She has authored over 100 scientific publications and served on Italy’s National Vaccination Advisory Technical Group (NITAG).

Prof. Paolo Bonanni is Full Professor of Hygiene and Public Health at the University of Florence, where he directed the Department of Health Sciences from 2020 to 2024. An internationally recognised expert in vaccinology and public health, he has contributed to major European vaccination research projects and serves on international immunisation advisory bodies. He has authored over 350 scientific publications.

All manuscripts submitted to this Article Collection will undergo desk assessment and peer review if they can pass the desk assessments as part of our standard editorial process; the Guest Advisor for this Collection will not be handling the manuscripts (unless they are an Editorial Board member).
The deadline for submitting manuscripts is 6th August 2027.
Please contact Saniya Qureshi at saniya.qureshi@taylorandfrancis.com with any queries and discount codes regarding this Article Collection.