The impact of access to immunization information on vaccine acceptance in three countries

Lori K. Handy, Stefania Maroudi, Maura Powell, Bakanuki Nfila, Charlotte Moser, Ingrid Japa, Ndibo Monyatsi, Elena Tzortzi, Ismini Kouzeli, Anthony Luberti, Maria Theodoridou, Paul Offit, Andrew Steenhoff, Judy A. Shea, Kristen A. Feemster

PLoS One. 2017; 12(8): e0180759, doi: 10.1371/journal.pone.0180759


Introduction: Vaccine acceptance is a critical component of sustainable immunization programs, yet rates of vaccine hesitancy are rising. Increased access to misinformation through media and antivaccine advocacy is an important contributor to hesitancy in the United States and other high-income nations with robust immunization programs.  Little is known about the content and effect of information sources on attitudes toward vaccination in settings with rapidly changing or unstable immunization programs.

Objective: The objective of this study was to explore knowledge and attitudes regarding vaccines and vaccine-preventable diseases among caregivers and immunization providers in Botswana, the Dominican Republic, and Greece and examine how access to information impacts reported vaccine acceptance.

Methods: We conducted 37 focus groups and 14 semi-structured interviews with 96 providers and 153 caregivers in Botswana, the Dominican Republic, and Greece. Focus groups were conducted in Setswana, English, Spanish, or Greek; digitally recorded; and transcribed.Transcripts were translated into English, coded in qualitative data analysis software (NVivo 10, QSR International, Melbourne, Australia), and analyzed for common themes.

Results: Dominant themes in all three countries included identification of health care providers or medical literature as the primary source of vaccine information, yet participants reported insufficient communication about vaccines was available. Comments about level of trust in the health care system and government contrasted between sites, with the highest level of trust reported in Botswana but lower levels of trust in Greece.

Conclusions: In Botswana, the Dominican Republic, and Greece, participants expressed reliance on health care providers for information and demonstrated a need for more communication about vaccines. Trust in the government and health care system influenced vaccine acceptance differently in each country, demonstrating the need for country-specific data that focus on vaccine acceptance to fully understand which drivers can be leveraged to improve implementation of immunization programs.