No abstract

Vaccines have reduced child mortality across the world, but low levels of demand for vaccination threatens to undermine progress. Existing frameworks to understand demand tend to prioritise caregivers' decision-making processes. We aimed to build a wider understanding of vaccine demand by applying an adapted socio-ecological model to analyse 158 interviews with caregivers and fathers of young children, and community influencers in Nigeria, Uganda, and Guinea. We found that several factors come together to inform a caregiver's demand for vaccination, including their familial and social relationships, their interactions with government and healthcare institutions, and the wider social and cultural norms in their communities. The study suggests that interventions targeted at families and communities instead of individuals could be effective. The results could be used to ensure that vaccine demand frameworks used by researchers and intervention designers are comprehensive and consider a wider range of influences on the caregiver.

Diphtheria-tetanus-pertussis (DTP) combination vaccines are a cornerstone of infant vaccinations worldwide. DTP vaccine acceptance could be impacted by sub-optimal relationships between parents and healthcare professionals (HCPs). This survey, conducted in France and India between 14/2/2020 and 26/3/2020, aimed to understand perspectives and expectations of parents and HCPs toward DTP vaccination. Participants were parents (parents/guardians of ≤3-year-old children; France: n = 1002, India: n = 1021) and HCPs (general practitioners/pediatricians initiating DTP vaccination; France: n = 300; India: n = 300) who chose to take part. A representative sample of parents was achieved via quotas and random iterative weighting to match key demographics of the target population. In India, only parents from socio-economic classes A/B/C and private HCPs were included. Whilst DTP vaccine acceptance was high among parents in France (85%) and India (98%), French HCPs overestimated parental acceptance (99% thought parents were very/fairly accepting). The proportions of parents reporting that the HCP is someone they trust versus the proportions of HCPs wanting to be seen as trusted were discrepant in France (76% versus 90%) but not India (83% versus 85%). Some surveyed parents indicated that, ideally, they would like some input in vaccine brand decisions alongside HCPs, an opinion shared by some HCPs. In France, short-term experience post-vaccination was more important to parents than HCPs, for whom long-term protection was more important. In India, these aspects were equally important to both. Increased awareness of parents’ priorities and concerns regarding DTP vaccination can support HCPs in their discussions with parents and help build trust, which may impact vaccine acceptance.