Understanding the three As (Awareness, Access, and Acceptability) dimensions of vaccine hesitancy in Odisha, India

Abstract

Background: A considerable proportion of the population remain unvaccinated due to multiple reasons including vaccine hesitancy. To study the factors responsible for the incomplete immunization of under-5 children from the perspectives of the communities, a vaccine hesitancy survey was done in two districts of Odisha. In addition, the survey aimed to elucidate the reasons for differential vaccine hesitancy. Methods: This community-based cross-sectional study was conducted in the rural areas of Balangir and Nuapada districts in Odisha. We adapted the vaccine hesitancy survey questionnaire (core closed questions) developed by SAGE working group. We used this questionnaire in a sample of 260 households, selected from 30 clusters. The questions were categorized into three main dimensions, namely, awareness about vaccine efficacy, accessibility to obtain vaccine, and acceptability of the vaccines at the individual and community level. We used bivariate and multivariate regression analysis to determine the predictors for refusal or hesitancy of the vaccine. Results: Long distances and time are the two prime factors of accessibility linked with the refusal or hesitancy of the vaccine. We found that there is a high level of acceptance of vaccines at the level of parents and more than three-fourths took their children for vaccination despite hearing negative information about them. Pentavalent and measles were more commonly refused or hesitated vaccines by the parents compared to BCG or polio. Conclusion: In the current scenario of increasing immunization coverage in India, vaccine hesitancy acts as a missing link in action for the policymakers to achieve cent percent target.

Vaccine Hesitancy as a Challenge or Vaccine Confidence as an Opportunity for Childhood Immunisation in India

“…A questionnaire based on that created by the WHO strategic advisory group of experts on immunisation was also administered to 260 households (Balangir: 180; Nuapada: 80) in Odisha [ 24 ]. Nearly 85% had monthly incomes < 5000 Indian rupees (75 US dollars).…”

“…After exclusion of the articles not related to vaccination or focused on adult/traveller vaccination, nine articles reporting childhood VH determinants in India were retrieved [17][18][19][20][21][22][23][24][25]. Seven of them reported results from surveys or interviews of parents/caregivers in India [18][19][20][21][23][24][25]. One study mixed a cross-sectional survey with interviews of parents and healthcare workers [17].…”

Modelling the impact of a smallpox attack in India and influence of disease control measures

“…Regarding vaccine refusal, we did not account for this parameter in our study, although many recent outbreaks of vaccinepreventable diseases have been linked to under vaccinated communities. 74 However, in India, accessibility due to long distances from healthcare facilities is the main factor linked to under-vaccination, but the level of vaccine acceptance is found to be still high, 75 with only 16% of the vaccine-hesitant people refusing vaccination. 76 Finally, for this study, we tested the sensitivity of results to variations in parameters involved in the public health response, such as contacts traced and cases isolated, time to start the intervention and number of doses delivered each day.…”

Study of determinants of immunization status among under-five children attending OPD in a rural health center of the tertiary health care institute

“…Congruent to our findings, access or distance to services was mentioned as a reason to undervaccination in children in low middle-income countries by Indian and other studies. [ 28 29 30 ]…”

“…[ 24 ] This invites the prompt mobilization of healthcare outreach by healthcare functionary and strong political commitment toward rural infrastructure development. [ 9 28 ]…”