Understanding determinants of vaccine hesitancy and acceptance in India: A qualitative study of government officials and civil society stakeholders

Abstract

Introduction Few studies have described the drivers of vaccine hesitancy and acceptance in India from the perspective of those involved in the design and implementation of vaccine campaigns–such as government officials and civil society stakeholders–a prerequisite to developing approaches to address this barrier to high immunization coverage and further child health improvements. Methods We conducted a qualitative study to understand government officials and civil society stakeholders’ perceptions of the drivers of vaccine hesitancy in India. We conducted in-depth phone interviews using a structured guide of open-ended questions with 21 participants from international and national non-governmental organizations, professional associations, and universities, and state and national government–six national-level stakeholders in New Delhi, six state-level stakeholders in Uttar Pradesh, six in Kerala, and three in Gujarat–from July 2020 to October 2020. We analyzed data through a multi-stage process following Grounded Theory. We present findings on individual-level, contextual, and vaccine/vaccination program-specific factors influencing vaccine hesitancy. Results We identified multiple drivers and complex ways they influence vaccine beliefs, attitudes, and behaviors from the perspective of government officials and civil society stakeholders involved in vaccine campaigns. Important individual-level influences were low awareness of the benefits of vaccination, safety concerns, especially related to mild adverse events following immunization, and mistrust in government and health service quality. Contextual-level factors included communications, the media environment, and social media, which serves as a major conduit of misinformation and driver of hesitancy, as well as sociodemographic factors–specific drivers varied widely by income, education, urban/rural setting, and across religious and cultural groups. Among vaccine/vaccination-level issues, vaccine program design and delivery and the role of health care professionals emerged as the strongest determinants of hesitancy. Conclusions Drivers of vaccine hesitancy in India, as elsewhere, vary widely by local context; successful interventions should address individual, contextual, and vaccine-specific factors. While previous studies focused on individual-level factors, our study demonstrates the equal importance of contextual and vaccine-specific influences, especially the communication and media environment, influential leaders, sociodemographic factors, and frontline health workers.

COVID-19 vaccine hesitancy among adults in India: A primary study based on health behavior theories and 5C psychological antecedents model

“…This finding has complemented the existing literature that highlights the socio-economic and demographic inequities in vaccination coverage [ 61 , 62 ]. On the other hand, there is also a large section of people, who were hesitant about the COVID-19 vaccine because of their lack of confidence due to the misinformation’ (37.5%) [ 63 , 64 ], and ‘individual health reasons’ (11.1%) [ 65 , 66 ].…”

Interplay of missed opportunity for vaccination and poor response to the vaccine led to measles outbreak in a slum area of Eastern Mumbai, India

“…Since overcrowding facilitates transmission, the population living in the slums was particularly vulnerable. Vaccine hesitancy, influenced by religious, social, cultural, and personal factors, may have also played a role [ 17 , 18 ]. A recent study by Tamysetty et al in Eastern Mumbai’s slums highlighted concerns about vaccine safety, dependence on family members for vaccination decisions, fear, and lack of faith in immunization in the context of COVID-19 vaccination [ 19 ], some of which may be applicable to hesitancy to measles vaccination as well.…”

Childhood Vaccine Attitude and Refusal among Turkish Parents

“… Negative media information: Exposure to negative information about vaccines through social media or other sources can contribute to vaccine hesitancy [ 20 ]. Fear of adverse events: Some parents may be hesitant to vaccinate their child due to the fear of adverse events following immunization (AEFIs) [ 21 ]. Time constraints: Parents may have difficulty finding time to take their child for vaccinations due to work schedules or other commitments [ 13 ].…”

“…Fear of adverse events: Some parents may be hesitant to vaccinate their child due to the fear of adverse events following immunization (AEFIs) [ 21 ].…”