We have a very interesting post from Robert Steinglass from JSI on a subject rarely discussed on the forum. Thank you! To address vaccine “hesitancy,” frame the question broadly says Robert Steinglass There has been much legitimate discussion in the past 6 months about a growing problem of vaccine hesitancy in developed countries and its potential to become a problem in developing nations. Some reasons for hesitancy are undoubtedly amenable to improved communications initiatives designed to increase parental understanding about the value of vaccines or the danger of diseases. But in many villages and cities, there are many other reasons that I as a parent might be “hesitant” to have my child vaccinated or that my non-participation might be construed as “hesitancy.” Any discussion of “hesitancy” should be framed broadly enough to include problems with service provision, which are correctable to meet the expectations of the client. What may look like hesitation to public health experts, far from the interaction between health workers and parents, may look entirely different from the perspective of individuals and the community. For example, when I brought my child to the vaccination session: - was the health worker present at the appointed time? - was one or more of the required vaccines or syringes absent? -was I yelled at for not having “retained” a vaccination card which I might never have been given in the first place or that was damaged in the rain on the long walk home or that I perhaps did lose? - was I reprimanded publicly for not having returned exactly four weeks after the previous dose? - was I ridiculed for my child’s threadbare or unclean clothing? - was I informed in my own language what the health worker was trying to say to me? - was I made to feel ignorant for asking the health worker to explain the purpose of the vaccination or why my child needed to return yet again for another dose? - was I told when to return for subsequent doses? - was I requested to make unofficial payments that I could not afford? - was I expected to wait in the hot sun without any explanation, without seats, without water? And if the parent did not bring the child the first time nor return with the child for subsequent doses, do we know whether it was because: - the health worker “hesitated” and ultimately choose not to open a multi-dose vial of measles vaccine for fear of being blamed for excessive vaccine wastage? -the scheduled outreach session had been canceled so many times in the past that the parent could not predict that the health worker would truly arrive, as promised, and so could not risk losing a day’s labor or payment without any health benefit? -the hours of operation of the facility or outreach session were not convenient? In short, in addition to understanding the purpose of vaccination, do parents also perceive the quality of services to be acceptable, so that they will want to return? I hope that “hesitancy” will be framed and examined more broadly than just a new communications challenge to counteract growing anti-vaccination lobby groups. To retain the continued trust and involvement of individuals and the community is an old challenge that requires a systematic focus on improving the quality and predictability of services.
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