Beyond Nudges: Integrating Behavioral Economics and Structural Determinants to Advance Pediatric Immunization Equity.

Abstract

Behavioral economics provides tools to understand and influence decision-making; however, its application to immunization equity remains limited. This analytic essay examines how behavioral frameworks such as EAST (Easy, Attractive, Social, Timely) and MINDSPACE (Messenger, Incentives, Norms, Defaults, Salience, Priming, Affect, Commitments, Ego) can inform pediatric immunization strategies. Behavioral insights can simplify decisions and motivate vaccine uptake through design elements such as defaults, reminders, and trusted messengers. However, these approaches operate within broader social and structural contexts that shape whether families can act on their intentions. Integrating behavioral strategies with structural investments in maternal and early childhood health increases the effectiveness of health spending by improving the marginal efficiency of investment. Linking motivation with opportunity provides a practical framework for designing immunization policies that move beyond isolated nudges toward sustainable and equitable public health impact. (<i>Am J Public Health</i>. 2026;116(S3): S229-S234. https://doi.org/10.2105/AJPH.2026.308518).