While vaccination has proven itself a critical aspect in reducing the global burden of infectious diseases, vaccine hesitancy and confidence remain as some of the greatest threats in global health. In the Asia-Pacific region alone, numerous issues and controversies affected vaccine confidence and uptake. In around 2017, in the Philippines, the Dengvaxia controversy led to wide-scale public outrage; its aftermath led to the plummeting of vaccine confidence and the reduced uptake of routine vaccinations advised by the national immunisation programme (1). Similarly, there were safety scares of the human papillomavirus (HPV) vaccine in Japan, which began in 2013; this led Japan to be ranked as one of the countries with the lowest vaccine confidence in the world (1). Even cultural factors can influence vaccine confidence, as observed in Indonesia between 2015 to 2019; wherein Muslim leaders raised skepticism on the safety of the measles, mumps, and rubella (MMR) vaccine; with claims stating that the vaccine was haram as it contains ingredients derived from pigs, which is not acceptable for the Muslim population (1). Another critical barrier in vaccine confidence is misinformation, which has been noted in South Korea and Malaysia, to elaborate the internet is considered the primary source of vaccine-related information in Malaysia, and in South Korea, online communities that advocate against childhood immunisation have mobilized (1).
All in all, there is an interplay of factors that affect vaccine confidence and uptake, some of which may vary in different levels ranging from the individual, society, health care providers, to the government. Furthermore, with the advent of social media, vaccination discourse is now brought into another dimension, especially now that fake news and misinformation are involved. As the access to information increases, so does the skepticism of the general population, meaning the source of information also needs to be considered with great importance (2). In relation, health literacy is also an essential factor as it influences the usage of healthcare services, as a lack of knowledge not only by the public but also for the healthcare providers can also be considered as gaps that affect vaccine coverage (3). Meanwhile, at a systems level, there are the issues of equitable vaccine delivery and accessibility to healthcare services; this brings into consideration factors such as human resources, need for funding, vaccine supply, equitable delivery, and political support (4).
Despite the numerous barriers mentioned, various solutions can be done in addressing these gaps. Some recommendations include education programmes for healthcare providers, counselling services on vaccination, support from public officials, campaigns on the benefits and risks of vaccines, implementing legal guidelines for misinformation, organised patient medical records, and equitable vaccination that is free to the public (3). Furthermore, targeted engagement can be done in addressing the determinants of vaccine hesitancy. Such factors include the patient-clinician relationship wherein fostering a positive and trusting relationship is essential in patients’ compliance with the provider’s recommendations (5). This means that information-seeking behaviours and trust in healthcare providers differ from alternative sources of info (e.g., one’s social circle such as friends and relatives) for health-related advice is associated with increased chances for vaccine uptake (1,2).
Taking a look at the factors that affect vaccination uptake, it has been noted that risk perception is a key factor that influences individual attitudes of vaccination in influenza and tetanus vaccines (3). Thus, this emphasises the role of healthcare providers in educating the public on vaccines on the importance of vaccination. Educational interventions targeted to healthcare providers and practical recommendations can prove a formidable strategy in increasing vaccine uptake (6). In relation, there is a vast amount of provider-specific educational tools designed by reputable national organisations; however, these resources are not fully maximised. This then brings the idea that providers’ knowledge of immunisation combined with sound governance and management of relevant regulatory bodies (promotion of mass vaccination, reimbursement of vaccines by the appropriate payers, and evaluation of existing vaccine-related educational resources) can be instrumental in achieving increased vaccine coverage and uptake (3,6).
Public health policies and educational institutions also have a role in addressing the public concerns of vaccination. Schools can be a source of health-related information. In lieu to those who do not have access to healthcare services, as the collaboration between healthcare providers, public health institutions, and the education sector can nurture collective norms and values that promote health-seeking behaviour, despite misinformation and sensationalised news on vaccines in mass media (5). In fact, for HPV vaccinations, school-based vaccination delivery methods are proven effective at reaching girls within the WHO recommended age range (9-13 years old) (7). Being able to conduct vaccinations, whether it be on the school or a health facility, increases the prospects that individuals will be able to receive their vaccinations on schedule. Furthermore, collaborations among schools and healthcare facilities can also promote the delivery of vaccination services for out-of-school children (7).
Overall, vaccine communication on a large scale also has its merits and challenges, whether from the providers themselves, the private sector, or other relevant stakeholders. While the internet and mass media have brought negative connotations regarding vaccine information, social media can be a platform for healthcare companies to engage with their consumers and tailor their services accordingly to the needs of their consumers (5). As mentioned, tailored training in vaccine communication strategies for healthcare providers, together with targeted counselling approaches, can be beneficial so that healthcare providers become public health educators and ambassadors who provide the public with factual information on vaccine-related matters (2). With this being said, there are indeed many challenges that influence vaccine uptake in the general population; however, various solutions can address the root causes of these problems. Education is one thing, but interprofessional collaboration is essential in brainstorming effective public health strategies that promote vaccination coverage and reduce the overall burden of vaccine-preventable diseases.
1. de Figueiredo A, Simas C, Karafillakis E, Paterson P, Larson HJ. Mapping global trends in vaccine confidence and investigating barriers to vaccine uptake: a large-scale retrospective temporal modelling study. Lancet. 2020 Sep 26;396(10255):898–908.
2. Costantino C, Caracci F, Brandi M, Bono SE, Ferro A, Sannasardo CE, et al. Determinants of vaccine hesitancy and effectiveness of vaccination counseling interventions among a sample of the general population in Palermo, Italy. Hum Vaccin Immunother. 16(10):2415–21.
3. Alici DE, Sayiner A, Unal S. Barriers to adult immunisation and solutions: Personalized approaches. Hum Vaccin Immunother. 2016 Sep 26;13(1):213–5.
4. Cernuschi T, Gaglione S, Bozzani F. Challenges to sustainable immunisation systems in Gavi transitioning countries. Vaccine. 2018 Oct 29;36(45):6858–66.
5. Nour R. A Systematic Review of Methods to Improve Attitudes Towards Childhood Vaccinations. Cureus [Internet]. [cited 2021 Apr 9];11(7). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6721905/
6. Leung SOA, Akinwunmi B, Elias KM, Feldman S. Educating healthcare providers to increase Human Papillomavirus (HPV) vaccination rates: A Qualitative Systematic Review. Vaccine X [Internet]. 2019 Aug 5 [cited 2021 Apr 9];3. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6708991/
7. Ladner J, Besson M-H, Hampshire R, Tapert L, Chirenje M, Saba J. Assessment of eight HPV vaccination programs implemented in lowest income countries. BMC Public Health. 2012 May 23;12(1):370.
Kevin Miko M. Buac
University of Santo Tomas – Faculty of Medicine and Surgery