Exposing concerns about vaccination in low- and middle-income countries: a systematic review

Abstract

Objectives Concerns about vaccination lead to under-and no-vaccination. Our objective is to synthesise and expose evidence on individuals' and communities' concerns about vaccination to influence current debates on strategies to improve vaccination coverage in low-and middle-income countries. Methods Systematic literature review till February 2014, following standard methods. Published and grey literature that focused on individuals and community concerns on childhood vaccinations were selected. Results 44 quantitative, qualitative and mixed-methods studies were included. Main reported concerns referred to perceptions of vaccine harms (e.g. attribution of fatal events). Other concerns included programme distrust (mainly due to rumours and conspiracies) and health system unfriendliness. Conclusions Concerns about vaccination are widespread and further worsen the challenges related to programmatic and health system barriers to vaccination. There is a disconnection between qualitative and quantitative research which misses the opportunity to quantify what is reported in the former. Strikingly, there is a wealth of evidence on concerns but much lesser evidence on interventions to address them. We welcome World Health Organization initiative to tackle vaccine hesitancy and call for the synthesis of evidence and production of guidance on strategies to address concerns on vaccination.

Trends in childhood measles vaccination highlight socioeconomic inequalities in Vietnam

“…However, other countries, like Vietnam, toward the end of study period have shown wealthier, higher educated, more urbanized populations to be clusters of vaccine hesitancy, similar to high-income countries. Reasons, for which groups and individuals are vaccine hesitant along with solutions to increase vaccine coverage, are context specific and tend to be clustered, consistent with our findings in Vietnam (Dubé et al 2015; Muñoz et al 2015). …”

“…This recapitulates recent trends in high-income settings to an extent, where increasingly large subsets of society refuse to vaccinate their children for non-medical reasons (Phadke et al 2016). Similarly, a recent systematic review, including studies in 19 low- and middle-income countries, found vaccine hesitancy for individuals and communities to be related to concerns about harmful effects, mistrust, and health system access issues (Muñoz et al 2015). In some low-income countries, rural populations, ethnic minorities, and poor populations have greater vaccine hesitancy, as was the case with Vietnam toward the beginning of the study.…”

Oral Polio Vaccine Refusal Pattern in Kumbotso Local Government Area, Kano State, Northern Nigeria

“…Of this number, 142 (48.3%) were males, while 152 (51.7%) were females. This was similar to findings in other studies conducted, where the most common reason given by parents for refusing vaccination was "too many doses" (Balraj and John, 1986;Cobos et al, 2015).…”

Childhood Vaccine Acceptance and Refusal among Warao Amerindian Caregivers in Venezuela; A Qualitative Approach

“…Concerns about adverse events are also among the main barriers to vaccination in other South American countries [10] as well as in low- and middle-income countries in other parts of the world [7]. In fact, even in Western populations concerns about vaccine safety and serious side effects are among the main reasons for delay or refusal of childhood vaccines [15].…”

“…This includes not only perceptions of vaccinations and diseases, but also perceptions of vulnerability and protection and the role of medicines in producing and maintaining health [6]. Qualitative and quantitative studies addressing concerns about vaccination often fail to provide recommendations for interventions [7]. …”