JMIR Publications

ABSTRACT

Vaccine uptake among older adults remains below policy targets even in high-income health systems. Digital interventions, such as text reminders, patient-portal nudges, electronic letters, mobile applications, conversational chatbots, and social-media campaigns have been increasingly employed to close the behavioral and delivery gaps related to vaccination coverage. While each of these measures showed situational effects in randomized trials, population-scale evaluations have largely produced null findings when these tools are deployed to populations whose dominant barrier is mistrust, hesitancy, or service inaccessibility. Here, we propose Digital Vaccine Prescription (DVP) as a testable, hypothesis-generating framework that adds value to the empirically established existing reminder/recall systems, immunization information systems, and digital outreach tools. The framework links six components - eligibility identification, trusted recommendation, tailored communication, actionable access, reminder/recall, and verification - into a recurrent immunization pathway supported by four implementation pillars: data infrastructure, clinical workflow, equity safeguards, and governance. For older adults, the framework's most distinctive commitment is that digital identification is paired with human-supported follow-up. This is because older adults represent an at-risk population with challenges in terms of trust, multimorbidity, sensory impairment, and caregiver dependence that cannot be addressed by digital deployment alone. A research agenda is also proposed to test whether DVP as a coherent intervention improves vaccination coverage more than its individual components.