Childhood Vaccination Uptake in the Arab Region: A Comparative Review of Behavioral, Social and Practical Determinants Based on the WHO BeSD Framework

Abstract

Childhood vaccination remains one of the most effective public-health interventions; however, achieving and sustaining high vaccination uptake continues to be challenged by parental hesitancy, misinformation, social influences, and practical barriers to vaccination services. In the Arab region, existing evidence remains fragmented across countries, vaccine types, measurement instruments, and explanatory factors, while the specific interaction between behavioral and health-system determinants remains insufficiently integrated. This study aimed to comparatively examine patterns of childhood vaccination uptake across Arab countries, assess the influence of parental perceptions, vaccine confidence and motivation, analyses the role of social and practical determinants, and identify similarities, differences, and research gaps, with particular attention to the Libyan context. A descriptive, critical, and comparative literature review was conducted using previous studies from Arab countries and relevant international evidence. The WHO Behavioral and Social Drivers of Vaccination (BeSD) framework was adopted as the principal analytical framework, covering four domains: thinking and feeling, social processes, motivation, and practical issues. The findings demonstrate substantial regional consistency in the importance of vaccine safety perceptions, effectiveness, misinformation, social influence, health-worker communication, and parental motivation. However, the Libyan context reveals a stronger structural dimension, in which vaccine stock-outs, service disruption, population mobility, transportation difficulties, and geographical inequalities may contribute to incomplete vaccination alongside parental hesitancy. The study concludes that under-vaccination should not be interpreted solely as a behavioral problem. Effective improvement requires an integrated approach combining confidence-building, misinformation management, community engagement, health-worker communication, reliable vaccine availability, improved accessibility, and health-system strengthening. The findings support the use of the WHO BeSD framework as a context-sensitive basis for future comparative research and vaccination policy across the Arab region.