Reasons for non-vaccination

Abstract: Vaccines are among the most effective public health interventions used today. Population based vaccination programmes are mainly aimed at protecting against common childhood diseases, but other population groups are also the targets for different recommendations. The objectives of this thesis were to assess coverage and reasons for non-vaccination for three of vaccination programmes recommended by the National Board of Health and Welfare: influenza vaccine for the elderly, measles-mumps-rubella vaccine (MMR) for children and hepatitis B vaccine for health-care workers, and also to assess parental knowledge and attitudes towards hepatitis B vaccine for their children. We found that even a well-established and functioning surveillance system on childhood vaccinations cannot present all data needed to fully evaluate the programme. The current national system overestimates the coverage among 2-year-olds and fails to record delayed vaccinations. Our studies show that relatively easy and inexpensive methods can supply information to complement available data. For vaccination programmes such as influenza for the elderly and hepatitis B for health-care workers there are scarce data available, and the use of focussed studies may be the only option to evaluate the programmes. By conducting face-to-face interviews we found that coverage for influenza vaccination in an identified risk group was only 30%. A point prevalence survey among health-care workers showed that only half of those who had started a vaccination course of hepatitis B vaccine had actually completed it despite the fact that the majority of them experienced a risk of exposure once a week or more often.The results show that improvements can be made and repeated studies could be used to evaluate measures taken. Focused studies provide the only option when studying knowledge, attitudes and practice regarding both existing and future vaccination programmes. These can be time-consuming and new ways of collecting data could be an asset. However, despite a favourable situation with high access to the Internet and a target group of the appropriate age, our studies showed that web-based questionnaires still yield significantly lower response rates than the 'classical' mailed paper questionnaire. When studying reasons for non-vaccination, we found a clear lack of knowledge among target groups. We also found that the most important channel to inform them is via health-care staff. Parents of children who should receive MMR, elderly who should receive influenza vaccine, and health-care workers who should receive hepatitis B vaccine all need a chance to discuss their concerns such as necessity of the vaccine, fear of side-effects, etc., with well-informed health-care staff when deciding whether or not to get vaccinated. Health professionals play an important role in the implementation of the nationally recommended vaccinations. Information and advice from well-educated doctors and nurses is positively associated with vaccination. This role should be strengthened and ways to avoid missed opportunities should be further explored. It is also clear that non-vaccination is mostly a question of people not being made aware or reminded of the benefits of vaccines, and systems to provide automatic reminders should be developed.