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A comparison of local determinants of vaccine hesitancy in Botswana and the Dominican Republic, two middle-income countries

Session: Poster Abstract Session: Adult and Pediatric Vaccines
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Vaccine acceptance is a critical component of sustainable immunization programs.  Despite significant research into determinants of vaccine acceptance in developed countries, less is known about those in middle-income countries such as societal norms, trust in the healthcare system and government, and sources of vaccine information including the media.  This study explores knowledge and attitudes regarding vaccines and vaccine-preventable diseases (VPD) among caregivers and immunization providers in Botswana and the Dominican Republic (DR), two middle-income countries with expanding immunization programs, to understand local determinants of vaccine hesitancy.  

Methods: We conducted focus groups with 33 providers and 22 caregivers in Gaborone, Botswana and 37 providers and 59 caregivers in the DR.  Focus groups were conducted in the participants’ native language, digitally recorded and transcribed.  Transcripts were translated into English, coded in qualitative data analysis software (NVivo 10), and analyzed for common themes. 

Results: Botswana’s vaccination rates are >99.5% (based on DTP3).  Respondents reported high vaccine acceptance due to societal norms, trust in the healthcare system and knowledge about vaccines. In the DR, vaccination rates are 85% (based on DTP3).  Respondents reported knowledge about vaccines and VPD was the major promoter of vaccine acceptance.  Participants did not express the same level of trust in the government and healthcare system as was expressed in Botswana, and did not view vaccination as a societal norm. In both countries, the majority of vaccine communication is from healthcare workers and, for providers, is from medical literature.  Negative information from popular media is regarded with skepticism. 

Conclusion: Knowledge of vaccines and VPD were key promoters of vaccine acceptance in both Botswana and the DR.  Participants from Botswana were also significantly influenced by societal norms and a high level of trust in the healthcare system and government, which may affect vaccination rates.  In settings such as the DR, where societal norms and trust of the healthcare system are not primary drivers of vaccine acceptance, public health efforts should consider local promoters of vaccine acceptance.

Lori Kestenbaum, MD1, Andrew Steenhoff, MBBCh, DCH1,2, Maura Murphy3, Marc Callender, MD4, Ingrid Japa, MD5, Bakanuki Nfila2, Charlotte Moser6, Paul Offit, MD1,6, Ndibo Monyatsi7 and Kristen Feemster, MD, MPH, MSHP1,6, (1)Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, (2)Botswana-UPenn Partnership, Gaborone, Botswana, (3)Global Health Program, The Children's Hospital of Philadelphia, Philadelphia, PA, (4)Pediatric practice, Annapolis, MD, (5)Pediatric practice, San Pedro de Macorís, Dominican Republic, (6)Vaccine Education Center, The Children's Hospital of Philadelphia, Philadelphia, PA, (7)Botswana Ministry of Health, Gaborone, Botswana

Disclosures:

L. Kestenbaum, None

A. Steenhoff, None

M. Murphy, None

M. Callender, None

I. Japa, None

B. Nfila, None

C. Moser, None

P. Offit, None

N. Monyatsi, None

K. Feemster, None

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