Factors influencing the hesitancy and refusal of vaccines in India: A study-using tool developed by WHO SAGE Working Group

Mohamed Bilal Moosa, Devayani Josh, Reshma Bobby, Besty Biju, Juny Sebastian, Sheba Baby John, Mandyam Dhati Ravi

Article ID: 3310
Vol 8, Issue 1, 2024

VIEWS - 316 (Abstract) 182 (PDF)

Abstract


Objectives: This study aimed to assess the hesitancy towards vaccination and to identify the factors and predictor variables within the study population. Methodology: This was a cross-sectional study conducted via a web-based platform where a validated questionnaire was circulated among the public to understand their hesitancy towards vaccination. WHO SAGE Working Group Questionnaire was used to collect the data. The predictors for hesitancy were determined by using bivariate logistic regression analysis and the prevalence of vaccine hesitancy was identified. Results: A total of 353 subjects enrolled in the study during the 6 months of the study. Among them, 133 (37.67%) subjects showed vaccine hesitancy. On performing the bi-variate analysis, it was found that among the subsets studies those who were more hesitant to receive vaccines were females (OR: 1.476); individuals who are widowed/separated/divorced (OR: 3.109), age 40–49 yrs (OR: 3.710); from a rural (OR: 1.277) and not graduated (OR: 1.077). These subsets were predictors identified for vaccine hesitancy. Among the vaccines, maximum hesitancy was observed for the chicken pox vaccine [47 (13.31%)], followed by TCV [25 (7.08%)] and Rota [24 (6.79%), whereas the minimum hesitancy was observed for BCG [2 (0.56%)], OPV [4 (1.13%)] and IPV [8 (2.26%)]. Reasons provided for the hesitancy observed were mainly (i) Did not think it was needed [163 (46.17%)], (ii) Did not think the vaccine was safe [41 (11.61%)] and (iii) Did not know where to get vaccinated [24 (6.79%)]. Conclusion: The study observed less vaccine hesitancy among vaccines included in the EPI program. A major contributing factor for VH among the study population was their wrong perception about vaccines as that is not needed and not safe. Hence, there is a real need for education to the population to improve vaccine confidence among the general population.


Keywords


vaccine; vaccine hesitancy; WHO SAGE working group model

Full Text:

PDF


References


1. Immunization Agenda 2030. Available online: https://cdn.who.int/media/docs/default-source/immunization/strategy/ia2030/ia2030-draft-4-wha_b8850379-1fce-4847-bfd1-5d2c9d9e32f8.pdf?sfvrsn=5389656e_69&download=true (accessed on 14 October 2020).

2. Dubé E, Gagnon D, MacDonald N, et al. Underlying factors impacting vaccine hesitancy in high income countries: a review of qualitative studies. Expert Review of Vaccines. 2018, 17(11): 989-1004. doi: 10.1080/14760584.2018.1541406

3. Strategic Advisory Group of Experts on Immunization (SAGE). Available online: https://www.who.int/news-room/events/detail/2017/10/17/default-calendar/strategic-advisory-group-of-experts-on-immunization-(sage)---october-2017 (accessed on 29 November 2022).

4. MacDonald NE, Harmon S, Dube E, et al. Mandatory infant & childhood immunization: Rationales, issues and knowledge gaps. Vaccine. 2018, 36(39): 5811-5818. doi: 10.1016/j.vaccine.2018.08.042

5. Weekly epidemiological records, Meeting of the Strategic Advisory Group of Experts on Immunization, November 2011-conclusions and recommendations, World Health Organizaton, Switzerland, 6 November 2012. Available online: http://www.who.int/wer/2012/wer8701.pdf (accessed on 20 January 2021).

6. Larson HJ, Jarrett C, Eckersberger E, et al. Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007–2012. Vaccine. 2014, 32(19): 2150-2159. doi: 10.1016/j.vaccine.2014.01.081

7. Weekly epidemiological records, Meeting of the Strategic Advisory Group of Experts on Immunization, April 2011-conclusions and recommendations, World Health Organizaton, Switzerland, 20 May 2011. Available online: http://www.who.int/wer/2011/wer8621.pdf (accessed on 12 December 2020).

8. Bernstein L. Authorities Still Trying to Determine How Measles Outbreak began at Disney Parks. The Washington Post. Available online: http://www.washingtonpost.com/news/to-your-health/wp/2015/02/17/authorities-still-trying-to-determine-how-measles-outbreak-began-at-disney-theme-parks/ (accessed on 16 June 2021).

9. Wilson R, Paterson P, Larson HJ. The HPV Vaccination in Japan; Issues and Options. A Report of the CSIS global Health Policy Center. Washington: CSIS; 2014. pp. 1-19.

10. Immunization, vaccines and Biologicals, SAGE working group dealing with vaccine hesitancy (March 2012 to November 2014), World Health Organizaton. Available online: http://www.who.int/immunization/sage/sage_wg_vaccine_hesitancy_apr12/en/ (accessed on 17 June 2021).

11. Benin AL, Wisler-Scher DJ, Colson E, et al. Qualitative Analysis of Mothers’ Decision-Making About Vaccines for Infants: The Importance of Trust. Pediatrics. 2006, 117(5): 1532-1541. doi: 10.1542/peds.2005-1728

12. Opel DJ, Taylor JA, Mangione-Smith R, et al. Validity and reliability of a survey to identify vaccine-hesitant parents. Vaccine. 2011, 29(38): 6598-6605. doi: 10.1016/j.vaccine.2011.06.115

13. Government of India. Ministry of Health and Family Welfare. Immunization handbook for medical officers. WHO, 2016. Available online: http://www.searo.who.int/india/publications/immunization_handbook2017/en/ (accessed on 9 November 2020).

14. Lakh Children Die Every Year in India Due to Vaccine Preventable Diseases. Business world. 2018. Available online: http://www.businessworld.in/article/-5-Lakh-Children-Die-Every-Year-In-IndiaDue-To-Vaccine-Preventable-Diseases-/01-05-2018-147945/ (accessed on 21 April 2021).

15. Lahariya C. A brief history of vaccines & vaccination in India. Indian J Med Res. 2014, 139: 491-511.

16. Vashishtha VM. Status of immunization and need for intensification of routine immunization in India. Indian Pediatrics. 2012, 49(5): 357-361. doi: 10.1007/s13312-012-0081-x

17. International Institute for Population Sciences (IIPS) and ICF. National family health survey (NFHS-4), 2015-16: India. IIPS, 2017. Available online: https://dhsprogram.com/pubs/pdf/FR339/FR339.pdf (accessed on 16 June 2021).

18. Laxminarayan R, Ganguly NK. India’s Vaccine Deficit: Why More Than Half of Indian Children Are Not Fully Immunized, And What Can—And Should—Be Done. Health Affairs. 2011, 30(6): 1096-1103. doi: 10.1377/hlthaff.2011.0405

19. Kumar C, Singh PK, Singh L, et al. Socioeconomic disparities in coverage of full immunisation among children of adolescent mothers in India, 1990–2006: a repeated cross-sectional analysis. BMJ Open. 2016, 6(8): e009768. doi: 10.1136/bmjopen-2015-009768

20. Taneja G, Sagar KS, Mishra S. Routine immunization in India: a perspective. Indian J Community Health. 2013, 25: 188-192. Available online: https://www.iapsmupuk.org/journal/index.php/IJCH/article/view/311 (accessed on 19 March 2021).

21. Mort M, Baleta A, Destefano F, et al. Vaccine safety basics: learning manual. World Health Organization; 2013.

22. Strategic Advisory Group of Experts (SAGE). Report of the SAGE working group on vaccine hesitancy. World Health Organization.

23. Mohd Saleem S. Modified Kuppuswamy socioeconomic scale updated for the year 2019. Indian Journal of Forensic and Community Medicine. 2019, 6(1): 1-3. doi: 10.18231/2394-6776.2019.0001

24. Benin AL, Wisler-Scher DJ, Colson E, Shapiro E. Qualitative analysis of mother’s decision-making about vaccines for infants: the importance of trust. Pediatrics, Pediatrics-Official Journal of the American Academy of Pediatrics. Available online: https://www.researchgate.net/publication/7130710_Qualitative_Analysis_of_Mothers’_Decision-Making_About_Vaccines_for_Infants_The_Importance_of_Trust (accessed on 26 May 2021).

25. Dutta A, Barman D. Access and Barriers to immunization in West Bengal, India: Quality Matters. Journal of Health, Population and Nutrition. 2013, 31(4): 510-522.

26. Gust D, Brown C, Sheedy K, et al. Immunization Attitudes and Beliefs Among Parents: Beyond a Dichotomous Perspective. American Journal of Health Behavior. 2005, 29(1): 81-92. doi: 10.5993/ajhb.29.1.7

27. Costa JC, Weber AM, Darmstadt GL, et al. Religious affiliation and immunization coverage in 15 countries in Sub-Saharan Africa. Vaccine. 2020, 38(5): 1160-1169. doi: 10.1016/j.vaccine.2019.11.024

28. Priya P K, Pathak VK, Giri AK. Vaccination coverage and vaccine hesitancy among vulnerable population of India. Human Vaccines & Immunotherapeutics. 2020, 16(7): 1502-1507. doi: 10.1080/21645515.2019.1708164

29. Pottinger HL, Jacobs ET, Haenchen SD, et al. Parental attitudes and perceptions associated with childhood vaccine exemptions in high-exemption schools. PLOS ONE. 2018, 13(6): e0198655. doi: 10.1371/journal.pone.0198655

30. Agarwal A, Sengar A, Gupta P, Gupta R. A Study of Vaccine Hesitancy among Mother and Care Providers during MR Vaccine Caammpaign, Nationa Journal of Community Medicine. 2019, 109(11): 605-611.

31. Bertoncello C, Ferro A, Fonzo M, et al. Socioeconomic Determinants in Vaccine Hesitancy and Vaccine Refusal in Italy. Vaccines. 2020, 8(2): 276. doi: 10.3390/vaccines8020276

32. Hoest C, Seidman JC, Lee G, et al. Vaccine coverage and adherence to EPI schedules in eight resource poor settings in the MAL-ED cohort study. Vaccine. 2017, 35(3): 443-451. doi: 10.1016/j.vaccine.2016.11.075

33. Emmanuel V, Stanley A. Plotkin, Poliovirus Vaccine-Inactivated, Role of IPV in poliomyelitis eradication, Vaccines, 6th ed. 2013.

34. Pihl GT, Johannessen H, Ammentorp J, et al. “Lay epidemiology”: an important factor in Danish parents’ decision of whether to allow their child to receive a BCG vaccination. A qualitative exploration of parental perspective. BMC Pediatrics. 2017, 17(1). doi: 10.1186/s12887-017-0944-3

35. Bardenheier B, González IM, Washington ML, et al. Parental Knowledge, Attitudes, and Practices Associated with Not Receiving Hepatitis A Vaccine in a Demonstration Project in Butte County, California. Pediatrics. 2003, 112(4): e269-e269. doi: 10.1542/peds.112.4.e269

36. Ramsay M, Yarwood J, Lewis D, et al. Parental confidence in measles, mumps and rubella vaccine: evidence from vaccine coverage and attitudinal surveys. Br J Gen Prac. 2002, 52: 912–916.

37. Napolitano F, Ali Adou A, Vastola A, et al. Rotavirus Infection and Vaccination: Knowledge, Beliefs, and Behaviors among Parents in Italy. International Journal of Environmental Research and Public Health. 2019, 16(10): 1807. doi: 10.3390/ijerph16101807

38. Sjögren E, Ask LS, Örtqvist Å, et al. Parental conceptions of the rotavirus vaccine during implementation in Stockholm: A phenomenographic study. Journal of Child Health Care. 2017, 21(4): 476-487. doi: 10.1177/1367493517734390

39. Verma R, Bairwa M, Chawla S, et al. Should the chickenpox vaccine be included in the national immunization schedule in India? Human Vaccines. 2011, 7(8): 874-877. doi: 10.4161/hv.7.8.15685

40. Bhave SY. Controversies in chicken–pox immunization. The Indian Journal of Pediatrics. 2003, 70(6): 503-507. doi: 10.1007/bf02723143

41. Zhang S, Yin Z, Suraratdecha C, et al. Knowledge, attitudes and practices of caregivers regarding Japanese encephalitis in Shaanxi Province, China. Public Health. 2011, 125(2): 79-83. doi: 10.1016/j.puhe.2010.10.011

42. Tozzi AE, Ravà L, Stat D, et al. Attitudes towards HPV immunization of Italian mothers of adolescent girls and potential role of health professionals in the immunization program. Vaccine. 2009, 27(19): 2625-2629. doi: 10.1016/j.vaccine.2009.02.050




DOI: https://doi.org/10.24294/ti.v8.i1.3310

Refbacks

  • There are currently no refbacks.


Copyright (c) 2024 Mohamed Bilal Moosa, Devayani Josh, Reshma Bobby, Besty Biju, Juny Sebastian, Sheba Baby John, Mandyam Dhati Ravi

License URL: https://creativecommons.org/licenses/by-nc/4.0/

This site is licensed under a Creative Commons Attribution 4.0 International License.