‘Vaccine hesitancy translating into geographical clustering of epidemics’

What is vaccine hesitancy and why are there uncertainties?

Vaccine hesitancy refers to a delay in acceptance or refusal of vaccination despite the availability of vaccination services. It has existed since the first vaccine was administered 200 years ago. Vaccine hesitancy is complex and context-specific, varying across time, place and vaccines. A reasonably high acceptance and coverage rates are necessary for an immunisation programme to be successful. There are still uncertainties and concerns about the safety and efficacy of vaccines, which promote vaccine hesitancy and undermine public confidence in immunisation. A vaccines advisory group to the WHO identified complacency, inconvenience in accessing vaccines and lack of confidence as key reasons underlying hesitancy.

What necessitated this review report?

Vaccines are one of the best preventive measures that public health care has to offer. Evidence from across the world both in high-income countries (HIC) and low/middle-income countries (LMIC) show that vaccine hesitancy is a significant phenomenon which is translating into geographical clustering of epidemics. A reasonably high acceptance and coverage rates are necessary for an immunisation programme to be successful. Along with authors Preeti Galagali, director, Bengaluru Adolescent Care and Counselling Centre and Vikram Kumar, professor of pediatrics, Subbaiah Institute of Medical Sciences, Shivamogga, we have highlighted the factors affecting vaccine hesitancy and its role in limiting vaccine uptake apart from the inability to achieve collective immunity and possible solutions. The report was planned to create awareness among healthcare professionals and researchers about various published scientific updates on vaccine hesitancy and some of the methods used to tackle it

Has there been an acceptance of Covid-19 vaccination? What is the reason for disparities across countries?

Repeated risk communication is crucial to facilitate informed decision-making. It is important to let families and friends know the importance of greater societal benefits of population-level immunity and the protection it offers to those who are vulnerable. Regarding Covid-19 vaccine acceptance, we assessed several studies including one across 15 survey samples covering 10 low-middle-income countries, Russia and the US that included 44,260 persons. The study showed a considerably higher willingness to take the Covid-19 vaccine in low/middle-income countries as compared to Russia and the US. Another review exploring vaccine hesitancy in high-income countries across four continents indicated that Asia had the highest proportion of studies with vaccine hesitancy of 30 per cent or more. In 2021, the WHO set the target for 70 per cent global vaccination coverage by mid-2022. As of June this year, only 58 of WHO’s 194 member states reached the 70 per cent target and in low-income countries, just 37 per cent of healthcare workers received a complete course of primary vaccination.

What has been your experience in BJMC Pune?

One of our postgraduate students Dr Rosaline conducted a small study to assess the Covid-19 vaccine acceptance among 250 lactating postnatal mothers and found the rate to be very low, only 8 per cent, in view of the potential safety concern and long-term negative effects on the breastfeeding child. After addressing their concerns about the same, nearly 78 per cent of lactating mothers accepted the vaccination. This small study (yet to be published) highlights the need to create awareness among lactating mothers about the positive effects and safety of Covid-19 vaccinations through appropriate counselling and assurance.

What are the interventions and strategies that can address vaccine hesitancy?

We need to be transparent in counselling about vaccine efficacy safety. Answer all the doubts of the vaccine taker or child’s caregiver so that vaccine hesitancy can be prevented. Recipients of newer fast-tracked vaccines for emergency use need to be monitored closely for any adverse events that are analysed for causality. Reporting of any AEFI (adverse event following immunisation) and causality assessment is mandatory in both private and public sectors which will go a long way in curbing vaccine hesitancy.