Vaccine Hesitancy and Attitude towards Vaccination among Parents of Children between 1-5 Years of Age Attending a Tertiary Care Hospital in Chennai, India

"Even among populations with near universal vaccine coverage, vaccine hesitancy exists."

The state of Tamil Nadu, which has some of the best health indicators in the country, has recently seen a trend of reduction in vaccination coverage. Several factors have been said to influence the vaccine hesitancy that has contributed to that reduction, including socio-cultural context, religious beliefs, misinformation spread through social media, historical influences and mistrust, and beliefs and attitudes about vaccines. Lack of trust in the vaccination policy, health system, vaccine providers, and specific vaccines also plays a role. This study was conducted to respond to the need to understand attitudes towards vaccinations and vaccine hesitancy among parents in Tamil Nadu. The researchers hope that this understanding will help to inform the state's vaccination policy for further improving coverage rates.

During June-July 2018, 100 consecutive parents of children between 1 and 5 years of age attending the paediatrics outpatient department at a tertiary hospital were approached for the study, and all of them consented to participate in an interview. On the whole, their profile reflects a middle class, educated, working class population of a typical Indian urban area. All the children who were part of the study had full coverage of all age-appropriate vaccines.

It was found that, while most parents (94%) thought that the diseases prevented by vaccines are severe, a substantial number (64%) thought that children receive more vaccines than necessary, and about half of them thought that it is better to acquire immunity by natural methods. The responses also revealed that a majority (90%) of the respondents were concerned about adverse effects of vaccines as well as failure of vaccines. Though the majority knew that vaccines protect their children from diseases, the main motivator for vaccinating their children was to gain entry to school.

About 21% reported hesitancy to vaccinate, and 10% reported refusal to at least one vaccine (mostly outside the Universal Immunization Program schedule). Table 4 in the paper shows the responses of the parents to vaccine hesitancy questions. It is noteworthy that there is a tendency of suspicion towards newer vaccines, concerns about adverse events following vaccination, and a feeling that vaccines are not necessary for diseases that are not common.

The overall vaccine hesitancy score was plotted against the parental belief and attitude scores and correlation coefficient calculated. This is shown in Figure 1. The scatter plot shows that as the parental beliefs and attitudes regarding vaccination increase, the vaccine hesitancy decreases.

Previous studies of vaccine acceptance in the same area for the newly introduced measles, mumps, and rubella (MMR) vaccine revealed that trust in the health system and suspicions about new vaccines spreading through social media campaigns had a strong influence on vaccine hesitation. Therefore, the researchers of the present study assert, vaccination programmes and policies should feature strong community engagement strategies to increase awareness about vaccines and to alleviate fears associated with them.

The researchers note that hesitancy to undergo vaccination has also been reported previously in Kerala, which has a high level of literacy and good health indicators. There is, they say, a clear trend of greater vaccine hesitancy in areas with higher socio-economic status and higher education and awareness.

In conclusion, the key finding of this study is that the majority of the vaccine hesitancy is related to newer vaccines, concerns regarding safety of vaccines, and the perception that vaccines are not necessary for illnesses that are uncommon. The researchers suggest that active community engagement before introduction of newer vaccines to allay any anxieties in the minds of the parents is very important. Also, awareness should be created around the fact that certain infections are rare precisely due to effective vaccination coverage. "Such awareness programs will help address vaccine hesitancy and ensure active community engagement in the vaccination program."