Comparisons of Vaccine Hesitancy across Five Low- and Middle-Income Countries.

Abram L Wagner,Edwin J Asturias,Joseph L Mathew,Zhuoying Huang,Xiaodong Sun,Matthew L Boulton,Ingrid L Contreras-Roldan,Nina B Masters,Gretchen J Domek,Berhanu Gebremeskel,Jia Ren

doi:10.3390/vaccines7040155

Abstract

Vaccine hesitancy is a continuum of behaviors ranging from delay in receipt to vaccination refusal. Prior studies have typically focused on high-income countries, where vaccine hesitancy is particularly prevalent in more affluent groups, but the relationship between socioeconomic status and vaccine hesitancy in Low- and Middle-Income Countries (LMICs) is less clear. The aim of this study was to describe vaccine hesitancy in five LMICs. Mothers of children in Sirajganj, Bangladesh (n = 60), Shanghai, China (n = 788), Addis Ababa, Ethiopia (n = 341), Guatemala City and Quetzaltenango, Guatemala (n = 767), and Chandigarh, India (n = 309), completed a survey between 2016 and 2018 using the WHO’s 10-item Vaccine Hesitancy Scale. The scores of different constructs were compared across countries and by the mother’s education level using linear regression models with generalized estimating equations. Compared to mothers in China, mothers in Bangladesh perceived less vaccination benefit (β: 0.56, P = 0.0001), however, mothers in Ethiopia (β: −0.54, P < 0.0001) and Guatemala (β: −0.74, P = 0.0004) perceived greater benefit. Education level was not significantly linked with vaccine hesitancy. Local circumstances are important to consider when developing programs to promote vaccines. We did not find consistent associations between education and vaccine hesitancy. More research is needed to understand socio-cultural influences on vaccine decision-making.

Highlights

Worldwide, the number of deaths due to vaccine-preventable diseases (VPDs) has decreased precipitously in the past few decades
Guatemala [14], Ethiopia [15], and China [16], along with unpublished data from India and Bangladesh, this study aims to describe vaccine hesitancy in five Low- and Middle-Income Countries (LMICs) using the WHO SAGE Vaccine Hesitancy
Of the surveyed population with only a middle school education or less, though the population surveyed in China was far more educated, with 70% having at least some tertiary education

Summary

Introduction

The number of deaths due to vaccine-preventable diseases (VPDs) has decreased precipitously in the past few decades. The number of deaths from vaccine-preventable diseases declined from 4.1 million in 1990 (9% of all deaths) to 2.7 million in. Between 2000 and 2016, there was an average annual decline of 3.7% in under-5 mortality throughout the world, with 38.4 deaths per 1000 live births in 2016 [2]. The under-5 mortality rate in low- and middle-income countries (LMICs) is much higher than in high income countries. The under-5 mortality rate is 11.8/1000 in China, 26.7/1000 in Guatemala, 34.0/1000 in Bangladesh, 39.2/1000 in India, and 43.4/1000 in Ethiopia compared to 5.4/1000 for high income countries [2]. Routine immunization programs in LMICs is one important way to reduce incidence of VPDs and lower childhood mortality

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