AN INCREASING challenge which must be squarely dealt with by numerous countries and territories which are seeking to bridge and close the immunization gap is that of groups of citizens and people who choose to delay or intentionally refuse vaccinations for themselves or for their children.
On a global scale, one in five children do not receive routine life-saving immunizations. An estimated 1.5 million children die annually from diseases that could be prevented by vaccines that already exist, according to the World Health Organization (WHO) statement. In a special issue of the journal Vaccine, guest-edited by the WHO, a number of experts studied and reviewed the role of vaccine hesitancy in limiting vaccine coverage, while at the same time explored strategies to address it.
Vaccine hesitancy was defined as “to delay in acceptance or refusal of safe vaccines despite availability of vaccination services.”
The vaccine hesitancy issue is complex and context specific, varying across time, place and vaccines. It is influenced by factors such as misinformation, complacency, convenience and confidence, the WHO said. “Vaccines can only improve health and prevent deaths if they are used, and immunization programs must be able to achieve and sustain high vaccine uptake rates. Vaccine hesitancy is an increasingly important issue for country immunization programs,” said Dr. Philippe Duclos, senior health adviser for WHO’s Immunization, Vaccines, and Biological Department. Duclos was the guest editor of the special issue, entitled “WHO recommendations regarding vaccine hesitancy.”
The journal note of the special issue said, “… as the recent Ebola crisis tragically brought to light, engaging with communities and persuading individuals to change their habits and behaviors is a lynchpin of public health success. Addressing vaccine hesitancy is no different.”
The WHO recommendations aimed to increase the understanding of vaccine hesitancy, its determinants, and challenges. It also suggested ways organizations can increase acceptance of vaccines, share effective practices, and develop new tools to assess and address hesitancy.
There are a number of factors contributing to vaccine hesitancy. The WHO said concerns about vaccine safety can be linked to vaccine hesitancy, but safety concerns are only one of many factors that may drive hesitancy. Vaccine hesitancy can be caused by other factors such as negative beliefs based on myths. An example of the myths is “vaccination of women leads to infertility.” Included in the negative factors contributing to vaccine hesitancy are misinformation, mistrust in the health care professional or health care system, the role of influential leaders, costs, geographic barriers, and concerns about vaccine safety.
But the authors of the study said there is no “magic bullet,” or single intervention strategy that works for all instances of vaccine hesitancy.
The magnitude and setting of the problem varies and must be diagnosed for each instance to develop tailored strategies to improve vaccine acceptance.
Among the pivotal factors in decreasing the fear and concern over vaccination is effective communication. Communication must also address concerns and lead to the promotion of acceptance of vaccination.
Do not be misled by the idea that vaccine hesitancy is not only an issue in high income countries. Vaccine hesitancy is a complex, rapidly changing global problem that varies widely.
The WHO regional immunization managers said that while in some cases particular rural ethnic minorities and remote communities were affected; wealthy urban residents expressed concerns regarding vaccine safety, in other instances. The WHO regional managers also said that concerns were related to subgroups of “religious or philosophical objectors.”
Vaccine hesitancy determinants may go both ways. They can act as barriers and promoters, too. For example, a higher level of education does not necessarily predict vaccine acceptance, the experts observed.
A number of studies have already identified that higher education as a potential barrier to vaccine acceptance in some settings. In other studies, it had been identified that education was a promoter of vaccine acceptance in different areas.
Even fear of needles can be a factor for vaccine refusal, the WHO experts said.
Log on to www.phap.org.ph and www.phapcares.org.ph. E-mail the author at reiner.gloor@gmail.com.
