Vaccine Hesitancy: Acceptance and demand of vaccines in the Americas

Transcription

1

2 Vaccine Hesitancy: Acceptance and demand of vaccines in the Americas Desiree Pastor, MD, MPH Regional Immunization Advisor Immunization Unit Department of Family, Gender and Life Course PAHO/WHO

3 Outline 1. Background on vaccination coverage in the Americas 2. Main factors for acceptance and demand of vaccination 3. Missed Opportunities for Vaccination (MOV) in the Americas 4. Lessons learned and the way forward 3

4 SAGE Working Group s Model of the Determinants of Vaccine Hesitancy

5 Question: So, what is the overall role of vaccine hesitancy, in Latin America and the Caribbean (LAC)? Answer: Undefined The SAGE Working Group on Vaccine Hesitancy literature review: identified many vaccine hesitancy studies from the Americas, but limited published data from LAC. reported that the overall impact of vaccine hesitancy hasn t been quantified and there are no standardized metrics. HOWEVER-there are informal reports of growing anti-vaccine sentiment in countries such as Chile, Peru and others, as well as increasing connectivity to Internet across the Region, leading to the easy spread of rumors.

6

7

8 Acceptance and demand of vaccination (1) 1. High political commitment: human and financial resources that provides free vaccination services. 2. Sensitization of parents through education in health services 3. Manual/electronic registry of every child vaccinated in each health facility 4. Outreach vaccination activities, which engage community support to reach unvaccinated children. 5. Cash-transfer and/or social programs (i.e. food stamps) in some low middle income countries.

9 Acceptance and demand of vaccination (2) 1. Measles/Rubella Vaccination Campaigns and Vaccination Week of the Americas with positive messages about vaccine benefits and achievements. 2. Ongoing and strategic partnership with the Education Sector, to raise awareness among parents before entrance to school 3. Permanent information systems with data flow from the local level to sub national and national level 4. Analysis of inequities on immunization at the municipality level to guide interventions at the local level 5. Health professionals recommend vaccination in the public and private sector for all vaccines. 9

10 Challenges for vaccination coverages Since the creation of the EPI 40 years ago, the Americas has made significant strides in providing its population with an umbrella of protection against VPDs. In Latin America and the Caribbean (LAC), vaccines are generally viewed as a public good and political priority. However: While reported regional coverage (DPT3) is generally 90%, there has been a declining trend in recent years. Challenges with coverage inequalities at the subnational level are also a concern; population pockets are still susceptible to VPDs, place the entire Region at risk.

11 Proportion of municipalities with different DTP3 coverage levels in children aged <1 year Latin America and the Caribbean, 2015 Coverage ranges 95% 80-94% <80% Source: Country reports through the PAHO-WHO/UNICEF Joint Reporting Form (JRF), 2016.

12 80% coverage 95% coverage STRATEGY: Strengthen regular program and implement activities to find all children ASAP. STRATEGY: More effort to find fewer unvaccinated children, and these children present additional difficulties to reach: i.e. rural areas, poverty.

13 PAHO s work to investigate and address the causes of low coverage (1) o Implementation of comprehensive strategies to increase coverage in vulnerable municipalities o Development of guidelines for microplanning and monitoring tools to better identify pockets of susceptible populations o Provision of EPI training, data analysis and program evaluation o Sharing of country best buys to address low coverage Determinants of Low Vaccination Coverage

14 Outline 1. Background on vaccination coverage in the Americas 2. Main factors for acceptance and demand of vaccination 3. Missed Opportunities for Vaccination (MOV) in the Americas 4. Lessons learned and the way forward 14

15 15

16 117 articles/grey literature 72 articles reviewed from 19 countries Regional Literature Review, Health care workers Immunization card not reviewed No advice given to vaccinate- lack of communication False contraindications Main reasons for MOV Parents Immunization card not available Lack of time Fear of AEFI vaccines/multiple vaccination 16 Services Lack of vaccines Poor communication Lack of follow up of children

17 PAHO s work to investigate and address the causes of low coverage (2) o Methodology for the Evaluation of Missed Opportunities for Vaccination (MOV)* Current focus on children <5 years. Includes reasons why a child was not vaccinated, including personal reasons (of the parent) Available results has shown that causes of MOV in LAC have been more related to health worker practices and logistical issues than parental attitudes *Implemented in MEX (pilot), DOR, PAN, Bogota, PER)

18 Step 1: Planning the assessment Step 2: Data collection Step 3: Analyzing & interpreting Step 4: Results Step 5: taking action

19 Analysis of Recent Studies 19

20 Analysis of Recent Studies 20

21 Methodology Type of study Cross-sectional evaluation of MOVs in primary and secondary health care facilities that offer vaccination Target population Children aged <5 years and their caregivers Health workers at the selected facilities with an emphasis on general medicine and certain specialties Sample design This is an operational tool The sample is only representative of children aged <5 years visiting health services in the geographic area surveyed on the day of the study

22

23 MOV Studies Conducted in Selected Countries, Dominican Republic Level 14 subnational Panama 10 subnational City of Bogota Peru 20 subnational Health facilities Interviews conducted Children w/ card # % 92 1, , local ,488 1,

24 Proportion of Children Interviewed, Eligible and with Missed Opportunities. Selected Countries, Children interviewed DOR PER PAN BOG # % # % # % # % 1,500 3,488 1, Children with card % 1,751 71% % % Children up to the date Missed opportunities % 1,377 78% % % % % 75 17% 28 5% 24 * Child aged <5 years with vaccination card, who has not begun or completed the vaccination schedule for his or her age; who has no real contraindications for receiving one or more vaccine doses; and who, given the date of administration of a previous dose or doses, is eligible to be vaccinated by the health personnel during the visit to the health facility on the day of the study

25 Primary Reason for Bringing the Child to the Health Center, MOV Studies Selected Countries, % 100 Dominican R. Panama Bogota city Peru Medical consultation Vaccination Acompanying family Healthy child visit Other 25

26 Reasons for No Vaccination, MOV Studies in Selected Countries, % Dominican R. Panama Bogota city Peru Health workers Caregivers Services 26

27 Reasons for No Vaccination: Health Workers MOV Studies in Selected Countries, Asked for the vaccination card The professional said that the child is already vaccinated False contraindication Dominican Republic Peru Panama Bogota 34% 11% 85% 62% % 42% 94% 88% 56% 86% 84% 27

28 Reasons for No Vaccination: Caregiver I didn t bring the child for vaccination Dominican Republic Peru Panama Bogota 82% 49% 85% 51% I forgot/i didn t have time 6% 11% 5% 6% Reasons for No Vaccination: Health Services There are no vaccines (stock outs) Today is not a vaccination 28 day Dominican Republic Peru Panama Bogota 80% 71% 85% 51% 6% 16% 5% 6%

29 Quality of Service, perceived by caregiver MOV Studies in Selected Countries, % Dominican R Panama Bogota city Peru 0 29 Vaccine received Next appointment scheduled Potential reactions explained Satisfied with the care received

30 Outline 1. Background on vaccination coverage in the Americas 2. Main factors for acceptance and demand of vaccination 3. Missed Opportunities for Vaccination (MOV) in the Americas 4. Lessons learned and the way forward 30

31 Lessons Learned: Political Support, Adaptation, Implementation and Analysis 1. The EPI should lead and inform all the stakeholders involved in a MOV study 2. The survey must be adapted to take into account differences in culture, local language and EPI schedule 3. Need to establish algorithms/syntaxes for determining MOV 4. Need to pilot the tools prior to the implementation 5. Train interviewers and explain to them the importance of the data collected 6. Supervision is key 7. Professionals in different disciplines should be part of the analysis

32 Lessons Learned: Dissemination of MoV Results 1. Participation of subnational level EPI officers Dominican Republic Panama Peru 1. Participation of other partners (i.e. Peru: civil society) 2. Countries have identified the results as real problems at the local level 3. More financial assistance is required for interventions and measurement post intervention.

33 The Way Forward 1) Synthetic analysis of the completed assessments 2) Dissemination of Missed Opportunities for Vaccination Best Buys" Manual: a) Systematic review of strategies to reduce MoV b) Monitoring system for MoV c) Guidelines to reduce MoV for the local levels d) Validate the manual with EPI focal points, EPI managers and others field experts 3) Future assessments in other countries: a) Caribbean Region (British Virgin Islands) b) Costa Rica c) Ecuador

34 34 Thank you

35 Thanks! Gracias! 35 Title of the Presentation