Community Participation in Two Vaccination Trials in Slums of Kolkata, India: A Multi-level Analysis

Mohammad Ali,Byomkesh Manna,R Leon Ochiai,Deok Ryun Kim,Suman Kanungo,Jacqueline Deen,Dipika Sur,Sujit K Bhattacharya,John D Clemens,Anna Lena Lopez

doi:10.3329/jhpn.v28i5.6153

Abstract

This study aims at understanding the individual and community-level characteristics that influenced participation in two consecutive vaccine trials (typhoid and cholera) in urban slums of Kolkata, India. The study area was divided into 80 geographic clusters (communities), with 59,533 subjects aged > or = 2 years for analysis. A multi-level model was employed in which the individuals were seen nested within the cluster. Rates of participation in both the trials were nearly the same; those who participated in the initial trial were likely to participate in the subsequent cholera vaccine trial. Communities with predominantly Hindu population, lower percentage of households with an educated household head, or lower percentage of households owning a motorbike had higher participation than their counterparts. At individual scale, higher participation was observed among younger subjects, females, and individuals from households with a household head who had no or minimal education. Geographic patterns were also observed in participation in the trials. The results illustrated that participation in the trial was mostly influenced by various individual and community-level factors, which need to be addressed for a successful vaccination campaign.

Highlights

Immunization is one of the most cost-effective strategies to prevent millions of infectious disease episodes and deaths around the world
Those who participated in the typhoid vaccine trial were more likely to participate in the subsequent cholera vaccine trial [odds ratio: 5.02; 95% confidence interval (CI) 4.83-5.22] compared to those who did not participate in the typhoid vaccine trial
Since the response variable was measured in logit scale, the estimates for the constants were 0.63, 0.58, and 0.10 for typhoid vaccine, cholera vaccine, and both the trials respectively; when untransformed it implies that the probability of participation in the typhoid vaccine, cholera vaccine, and in both the trials for all individuals across all clusters was 65%, 64%, and 52% respectively

Summary

Introduction

Immunization is one of the most cost-effective strategies to prevent millions of infectious disease episodes and deaths around the world. The success of large phase III and IV trials and massvaccination campaigns in developing-country populations requires information dissemination, discussions with community leaders, and encouragement of community participation. Despite these efforts, not all members of a population may wish to participate in the vaccine trial or the campaign. In some developing-country societies, false perceptions and irrational fears about vaccines may appear when conducting field trials and mass-vaccination campaigns. Such a situation occurred in India during the 1970s when vaccines were associated with fears of family-planning agenda [2,3]. In these types of situation, a vaccine trial or a campaign may become vulnerable to misperceptions and fears, which can greatly influence community participation

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