Date Published: August 3, 2017
Publisher: Public Library of Science
Author(s): Lori K. Handy, Stefania Maroudi, Maura Powell, Bakanuki Nfila, Charlotte Moser, Ingrid Japa, Ndibo Monyatsi, Elena Tzortzi, Ismini Kouzeli, Anthony Luberti, Maria Theodoridou, Paul Offit, Andrew Steenhoff, Judy A. Shea, Kristen A. Feemster, Peter A Newman.
Vaccine acceptance is a critical component of sustainable immunization programs, yet rates of vaccine hesitancy are rising. Increased access to misinformation through media and anti-vaccine advocacy is an important contributor to hesitancy in the United States and other high-income nations with robust immunization programs. Little is known about the content and effect of information sources on attitudes toward vaccination in settings with rapidly changing or unstable immunization programs.
The objective of this study was to explore knowledge and attitudes regarding vaccines and vaccine-preventable diseases among caregivers and immunization providers in Botswana, the Dominican Republic, and Greece and examine how access to information impacts reported vaccine acceptance.
We conducted 37 focus groups and 14 semi-structured interviews with 96 providers and 153 caregivers in Botswana, the Dominican Republic, and Greece. Focus groups were conducted in Setswana, English, Spanish, or Greek; digitally recorded; and transcribed. Transcripts were translated into English, coded in qualitative data analysis software (NVivo 10, QSR International, Melbourne, Australia), and analyzed for common themes.
Dominant themes in all three countries included identification of health care providers or medical literature as the primary source of vaccine information, yet participants reported insufficient communication about vaccines was available. Comments about level of trust in the health care system and government contrasted between sites, with the highest level of trust reported in Botswana but lower levels of trust in Greece.
In Botswana, the Dominican Republic, and Greece, participants expressed reliance on health care providers for information and demonstrated a need for more communication about vaccines. Trust in the government and health care system influenced vaccine acceptance differently in each country, demonstrating the need for country-specific data that focus on vaccine acceptance to fully understand which drivers can be leveraged to improve implementation of immunization programs.
Vaccines are one of the most important public health achievements in history resulting in significant decreases in the prevalence of many childhood diseases . Vaccination rates have steadily increased in both developed and developing countries through the World Health Organization’s Expanding Program on Immunization and various public-private partnerships. However, disparities in rates of new vaccine adoption and sustained vaccination rates across different regions persist. In addition, an increase in the number of communities in both developed and developing countries with low or decreasing vaccination rates has resulted in disease outbreaks [2,3]. While access to health care services can lead to disparities in vaccination rates, vaccine acceptance is another critical component of sustainable immunization programs. Studies have suggested that vaccine-hesitant individuals, who hold various degrees of indecision about specific vaccines or vaccination in general, can significantly contribute to decreases in immunization rates and slow uptake of newly introduced vaccines [4,5,6,7,8].
We conducted 37 focus groups and 14 semi-structured interviews among 96 providers and 153 caregivers across three countries (Table 2). The majority of participants received or provided care within a public sector setting. Male and female providers in different practice settings in all involved communities were recruited.
In this qualitative study, we explored the role of knowledge and communication on vaccine acceptance in countries with both resource limitations and rapidly changing immunization programs. While there is a growing body of literature investigating drivers of vaccine acceptance, few studies have focused on the impact of different methods of information dissemination on vaccination programs in middle-income countries with expanding immunization programs. Major findings from this work demonstrate that while both caregivers and immunization providers from a wide range of communities in Botswana, the DR, and Greece report high levels of support for vaccination because of knowledge of vaccines and vaccine-preventable diseases, a need still exists for increased access to accurate and reliable information about vaccines. Contrasts in responses between countries highlighted the importance of information sources including health care providers, medical literature, and the media in supporting vaccine-related knowledge. For example, while the media primarily supported positive vaccine beliefs and was viewed as a way to disseminate messages to encourage vaccination in the DR and Botswana, media messages were largely viewed as negative in Greece. There were also differences in the degree of trust in the public health system across sites. These differences highlight the influence of context on vaccine acceptance and emphasize the importance of region- or country-specific research to understand local drivers of vaccine acceptance.