Vaccine Hesitancy among Medical Practitioners

"[T]here is a need to improve sensitization of doctors in the state on vaccines and their safety profiles with a view to reducing vaccine hesitancy among them."

In the last decade, Nigeria's polio programme, with the support of health development partners, has made significant progress in re-building the confidence of health workers and the general public regarding the safety and efficacy of oral polio vaccine (OPV) and the continued implementation of polio supplemental immunisation activities (PSIAs) in interrupting polio transmission. However, there is anecdotal evidence that the vestiges of misconception and/or poor understanding of Polio Eradication Initiative (PEI) strategies still remain in Northern Nigeria. Vaccine hesitancy or noncompliance is not limited to members of the public but can occur among medical practitioners as well. In this context, this paper explored the perceptions and perspectives of doctors in Kebbi State, Nigeria, on immunisation programmes in the country.

This was a cross-sectional study carried out on September 23 2017, when the WHO Kebbi State Field Office organised a 1-day seminar on cholera and polio for doctors in active practice in the state. With respect to the PEI in Nigeria, Kebbi State is classified as a Tier 2 high-risk state in view of its low immunisation coverage, presence of nomadic and hard-to-reach populations, pockets of noncompliance (vaccine hesitancy), and geographical contiguity with Sokoto State, where circulating vaccine-derived polio virus (cVDPV) had been recently isolated.

Sixty-three of the 80 medical doctors in attendance at the seminar completed self-administered questionnaires, which were analysed using descriptive statistics. Key findings:

• A small proportion of the respondents indicated noninvolvement of their children or relatives in PSIAs; this poses some risks to the attainment of polio-free status, especially in light of the fact that only 43.55% of the doctors reported having under-5 children (their own children) with complete vaccination. Furthermore, 84% of the doctors surveyed had a child or a relative with a child who had missed routine immunisation (RI) previously.
• 66.67% and 67.74% of the doctors believed in the quality of the vaccine and capacity of the health workers to effectively deliver PSIAs, respectively.
• Adequate training of workers (26.23%) and public enlightenment campaigns (23.68%) were proposed as PSIA enhancers. Collaboration with community and religious leaders (29.2%), education and public sensitisation (28.09%), and improved government funding (13.48%) to improve RI were also suggested. Other ideas include incentives and fines (8.99%), adequate training of staff (10.11%), house-to-house vaccination (4.49%), and media/publicity (5.62%).

The researchers suggest that "The hesitancy observed among doctors might be as a result of influence of religion, limited knowledge of vaccine development and their safety profile, and previous antivaccination sentiments....The low RI uptake rate among the respondents' children <5 years may be due to their dissatisfaction with the current approaches to interrupt poliovirus transmission in Nigeria." For example, some doctors propose the use of incentives, which has been applied to PSIAs in Northern Nigeria, especially in communities with high numbers of noncompliance (vaccine refusal). This has achieved significant successes in conjunction with other demand-creation interventions, such as the use of polio survivor groups, Quranic teachers' engagement, health camps, etc. Yet, "The call for incentivization by doctors in this study...is not sustainable for a routine health intervention such as the National Routine Immunization Programme (EPI)."

"Furthermore, the low demand for RI antigens, including polio vaccines, may be due to low risk perception of the respondents, as none of the respondents' children had suffered polio. It may be that the respondents perceive polio and other VPDs [vaccine-preventable diseases] as little threat to their children, who feed well and are likely to be healthy."

In conclusion, the researchers suggest that vaccine hesitancy among medical doctors could be a threat to sustained polio interruption and efforts toward improving RI in Kebbi State. They contend that the state government and development partners should modify current approaches to attaining polio-free certification status, including by sensitising doctors on vaccines uptake and safety.