Community awareness, use and preference for pandemic influenza vaccines in Pune, India

Abstract

Vaccination is a cornerstone of influenza prevention, but limited vaccine uptake was a problem worldwide during the 2009–2010 pandemic. Community acceptance of a vaccine is a critical determinant of its effectiveness, but studies have been confined to high-income countries. We conducted a cross-sectional, mixed-method study in urban and rural Pune, India in 2012–2013. Semi-structured explanatory model interviews were administered to community residents (n = 436) to study awareness, experience and preference between available vaccines for pandemic influenza. Focus group discussions and in-depth interviews complemented the survey. Awareness of pandemic influenza vaccines was low (25%). Some respondents did not consider vaccines relevant for adults, but nearly all (94.7%), when asked, believed that a vaccine would prevent swine flu. Reported vaccine uptake however was 8.3%. Main themes identified as reasons for uptake were having heard of a death from swine flu, health care provider recommendation or affiliation with the health system, influence of peers and information from media. Reasons for non-use were low perceived personal risk, problems with access and cost, inadequate information and a perceived lack of a government mandate endorsing influenza vaccines. A majority indicated a preference for injectable over nasal vaccines, especially in remote rural areas. Hesitancy from a lack of confidence in pandemic influenza vaccines appears to have been less of an issue than access, complacency and other sociocultural considerations. Recent influenza outbreaks in 2015 highlight a need to reconsider policy for routine influenza vaccination while paying attention to sociocultural factors and community preferences for effective vaccine action.

Public Health Policy and Experience of the 2009 H1N1 Influenza Pandemic in Pune, India

“…For the general population, however, limited coverage was more a matter of limited access, cost of the inactivated vaccine, low perceived personal risk after July 2010 when the LAIV became available, inadequate information and a perceived lack of a government mandate endorsing influenza vaccine. 42 …”

“…It is notable that coverage problems typically attributed to vaccine hesitancy of communities in Western Europe and North America were less of an issue than hesitancy among health professionals to use and prescribe the available vaccine. 42 Implications of vaccine hesitancy among professionals extend well beyond pandemic disease control to other settings, especially with regard to prescribing practices for high-risk groups, such as pregnant women, for whom seasonal influenza vaccination has become a priority for influenza control. 3…”

Awareness and acceptance of H1N1 vaccination among physicians: Experience of 2017 vaccination campaign

“…This study has also found that only 15.8% received advice from doctors regarding influenza vaccination. [ 10 ] For this, appropriate knowledge regarding H1N1 vaccination and infection among physicians is important.…”

Cultural epidemiology: Conceptual framework and current directions of an interdisciplinary field

“…Topics include studies of vaccine acceptance based on awareness, priority and use with a focus on both health care providers and community residents. This work is based on vaccine acceptance and anticipated acceptance studies of oral cholera vaccine in Zanzibar, Kenya and DR Congo (Schaetti et al 2013;Sundaram et al 2016), and a study of influenza vaccine acceptance during the 2009 influenza pandemic in Pune, India (Sundaram et al 2015). More recently, a study of influenza vaccination of pregnant women to protect them and their newborn infants has been developed for WHO.…”