Research Article: Childhood Vaccine Acceptance and Refusal among Warao Amerindian Caregivers in Venezuela; A Qualitative Approach

Date Published: January 20, 2017

Publisher: Public Library of Science

Author(s): Jochem Burghouts, Berenice Del Nogal, Angimar Uriepero, Peter W. M. Hermans, Jacobus H. de Waard, Lilly M. Verhagen, Ray Borrow.


Acceptance of childhood vaccination varies between societies, affecting worldwide vaccination coverage. Low coverage rates are common in indigenous populations where parents often choose not to vaccinate their children. We aimed to gain insight into reasons for vaccine acceptance or rejection among Warao Amerindians in Venezuela.

Based on records of vaccine acceptance or refusal, in-depth interviews with 20 vaccine-accepting and 11 vaccine-declining caregivers were performed. Parents’ attitudes were explored using a qualitative approach.

Although Warao caregivers were generally in favor of vaccination, fear of side effects and the idea that young and sick children are too vulnerable to be vaccinated negatively affected vaccine acceptance. The importance assigned to side effects was related to the perception that these resembled symptoms/diseases of another origin and could thus harm the child. Religious beliefs or traditional healers did not influence the decision-making process.

Parental vaccine acceptance requires educational programs on the preventive nature of vaccines in relation to local beliefs about health and disease. Attention needs to be directed at population-specific concerns, including explanation on the nature of and therapeutic options for side effects.

Partial Text

Immunization is a proven tool for prevention of some of the most deadly childhood diseases. However, vaccines are underutilized, especially in developing countries. Around 1.5 million children die each year from vaccine-preventable infectious diseases [1]. Suboptimal vaccine coverage rates are often observed in ethnic minorities [2–5]. The dynamics of vaccine uptake are complicated and depend on both social factors and cultural perceptions. This includes not only perceptions of vaccinations and diseases, but also perceptions of vulnerability and protection and the role of medicines in producing and maintaining health [6]. Qualitative and quantitative studies addressing concerns about vaccination often fail to provide recommendations for interventions [7].

We performed a qualitative survey exploring parental decision-making about childhood vaccines. In total, 67 caregivers residing in the nine study communities (Fig 2) were eligible. Of these, 42 (63%) had accepted vaccination with PCV13 while 25 (37%) had declined one, several or all vaccines. Approximately half of the caregivers in each group were interviewed, resulting in 20 and 11 interviews respectively. Of the 11 vaccine-declining mothers, 9 had declined all vaccines and 2 had accepted the first dose but refused follow-up doses. Of the total of 31 included caregivers, 30 were the mother of the child and one primary caregiver was the child’s grandmother.

This study demonstrates which ideas about vaccination and diseases influence the acceptance or refusal of vaccines in Amerindian mothers of young children in the Orinoco Delta in Venezuela. All participants, both vaccine-accepting and vaccine-declining, claimed to see the benefits of vaccination on the grounds that it “prevents diseases” or “prevents the deterioration of diseases”. However, three main themes were identified that negatively influenced vaccine acceptance. Our findings provide starting points for the improvement of vaccine education strategies.

This study provides a perspective into the low rate of vaccine acceptance among Warao Amerindian caregivers of young children in Venezuela. Three important findings emerged. First, fear of side effects was the most important immunization barrier. Second, these side effects were regarded as diseases for which they felt treatment should be offered. Finally, according to caregivers, children needed a certain level of strength to be able to handle vaccination leading to limited vaccine acceptance in young children.




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