Abstract

Childhood immunisation is one of the most effective and cost-efficient public health interventions, preventing an estimated 3.5 to 5 million deaths annually from vaccine-preventable diseases. Despite the global expansion of immunisation programmes, significant disparities in vaccine uptake persist, particularly in low- and middle-income countries where millions of children remain under-immunised or entirely unvaccinated. This narrative review examines the multifactorial barriers to childhood vaccine uptake across individual, socio-cultural, economic, health system, policy, geographic, and religious domains, and synthesises evidence-based strategies for bridging the gap between vaccine availability and utilisation. A narrative review of peer-reviewed literature, policy documents, and global health reports was conducted using PubMed, CINAHL, Scopus, and WHO/UNICEF databases. Studies and reports published between 2019 and 2025 were prioritised, with seminal earlier works included where relevant. Seven intersecting categories of barriers were identified: individual and parental factors including vaccine hesitancy and knowledge gaps; socio-cultural norms and gender dynamics; economic constraints; health system weaknesses including cold chain failures and workforce shortages; policy and governance gaps; geographic and access barriers; and religious influences on vaccine acceptance. Consequences of low uptake include resurgence of vaccine-preventable diseases, increased health system burden, antimicrobial resistance, and long-term disability. Evidence-based strategies include community engagement, health system strengthening, conditional cash transfers, digital health tools, and policy reform. Improving childhood vaccine uptake requires a multi-level, context-sensitive approach that simultaneously addresses demand-side hesitancy, supply-side system failures, and structural inequities. Nursing professionals are uniquely positioned to lead community-based immunisation advocacy, defaulter tracing, and caregiver education within this integrated response.

Keywords: childhood vaccination, vaccine uptake, immunisation barriers, vaccine hesitancy, health system strengthening, nursing practice,

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