Background and objective:
Vaccine hesitancy is a global public health threat. As the COVID-19 pandemic progressed, vaccines, particularly mRNA vaccines, have reduced overall disease severity and death but population coverage has fallen short and uncertainty about vaccination grown. Miscommunication, neglect of health inequities, failure to address vaccine access and other concerns sufficiently have affected trust between populations and healthcare systems. We built on existing models of increasing vaccine acceptance to develop a more comprehensive explanatory model for testing and evaluation.

Methods:
We reviewed the literature on vaccine hesitancy/acceptance models in English and French from PUBMED, ScienceDirect and Google Scholar. We grouped search terms as disease (COVID-19), issue (Vaccine hesitancy) and timeline (COVID-19 pandemic). We explored their application using the Irish case study, including the Irish tailored communication model, and used the findings to build our model.

Results:
Previous models had gaps in issues considered, planning and implementation. Many neglected wider determinants or health system responsibilities, treating vaccine acceptance as a one-dimensional issue not a continuum. While the need for vaccination programmes to be redesigned to counter known health inequities, gaps in health literacy, access difficulties, exclusionary practices and mistrust of authorities was recognised, few studies addressed these issues. Our analysis also identified the importance of co-creating delivery models with communities. The resulting model supports prioritisation of communities and individuals in line with need, exposure risk and barriers to immunisation, regardless of their nature or source. Ongoing communication provides space for people to move from vaccine hesitancy to shared understanding while authorities tackle barriers and concerns actively.

Conclusion:
Emergency vaccination programmes require greater depth of shared communication and decision making between populations, practitioners, and policy makers. Our model, which incorporates tailored communication, provides a framework for building vaccine acceptance, widening and welcoming participation in development, design, delivery, and improvement.