Elsevier

Social Science & Medicine

Volume 49, Issue 12, December 1999, Pages 1705-1716
Social Science & Medicine

Patterns of vaccination acceptance

https://doi.org/10.1016/S0277-9536(99)00239-7Get rights and content

Abstract

Immunization is one of the major public health interventions to prevent childhood morbidity and death. The Expanded Programme on Immunization has gathered momentum worldwide since 1974. The range of vaccines in the programme is being expanded in the years to come. All across the globe, a high level of vaccination coverage has been reached and now needs to be sustained. In part, the coverage has been made possible by the broad acceptance of vaccinations, although there are variations resulting in different configurations of fully, partially and non-immunized children. Using the results of studies carried out by the Social Science and Immunization Project in Bangladesh, Ethiopia, India, Malawi, the Netherlands and the Philippines, this article describes and discusses patterns of vaccination acceptance and non-acceptance. It shows how context affects acceptance of vaccinations, and analyses the underlying reasons behind refusal and resistance. The article also develops conceptual tools for the analysis of acceptance and non-acceptance and discusses explanatory theoretical perspectives.

Section snippets

Variations in contexts

In many countries, vaccinations have become integrated into the regular health services. The same staff are involved in curative and preventive health care, and contacts between health workers and patients usually include a range of activities. Vaccinations are also organized as “vertical” programmes with their own staff and resources. These two variants can be called routine vaccination and campaign vaccination. In a third approach, a specific vaccination campaign may be conducted side by side

Vaccination acceptance and non-acceptance

The vaccination status of cohorts of children in specified areas or groups is expressed as a coverage rate or ratio, with the number of vaccinated children as the numerator and the total number of children as the denominator. The indicative value is questionable, since in many countries births are not registered and consequently the denominator has to be estimated. Moreover, due to vaccination registration problems the accuracy and/or reliability of the numerator can also be doubtful. This was

Explanatory perspectives

An explanatory framework for understanding vaccination acceptance requires linkages to theoretical perspectives. These perspectives also illuminate the representations of vaccination acceptance in the discourses of various immunization programme stakeholders—vaccinologists, policy makers, programme managers, vaccinators. No single explanation pertains to all the different patterns of acceptance. Encouraged by a promotive regime, young mothers might follow the practice they see around them and

Conclusion

As a major global preventive disease control strategy, immunization requires considerable efforts involving new vaccines and delivery mechanisms, vaccine production and procurement, programmatic planning, and securing financial support. For the strategy to be effective in the long run, parents must continue to bring their children in for vaccination.

Using results from research carried out in Bangladesh, India, The Philippine, Ethiopia, Malawi and The Netherlands in the framework of the Social

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