Vaccine hesitancy among healthcare workers in Europe: A qualitative study

doi:10.1016/j.vaccine.2016.08.029

Vaccine

Volume 34, Issue 41, 22 September 2016, Pages 5013-5020

https://doi.org/10.1016/j.vaccine.2016.08.029 Get rights and content

Abstract

Healthcare workers (HCWs) are often referred to as the most trusted source of vaccine-related information for their patients. However, the evidence suggests that a number of HCWs are vaccine-hesitant. This study consists of 65 semi-structured interviews with vaccine providers in Croatia, France, Greece, and Romania to investigate concerns HCWs might have about vaccination. The results revealed that vaccine hesitancy is present in all four countries among vaccine providers. The most important concern across all countries was the fear of vaccine side effects. New vaccines were singled out due to perceived lack of testing for vaccine safety and efficacy. Furthermore, while high trust in health authorities was expressed by HCWs, there was also strong mistrust of pharmaceutical companies due to perceived financial interests and lack of communication about side effects. The notion that it is a doctor’s responsibility to respond to hesitant patients was reported in all countries. Concerns were also seen to be country- and context-specific. Strategies to improve confidence in vaccines should be adapted to the specific political, social, cultural and economic context of countries. Furthermore, while most interventions focus on education and improving information about vaccine safety, effectiveness, or the need for vaccines, concerns raised in this study identify other determinants of hesitancy that need addressing. The representativeness of the views of the interviewed HCWs must be interpreted with caution. This a qualitative study with a small sample size that included geographical areas where vaccination uptake was lower or where hesitancy was more prevalent and it reflects individual participants’ beliefs and attitudes toward the topic. As HCWs have the potential of influencing patient vaccination uptake, it is crucial to improve their confidence in vaccination and engage them in activities targeting vaccine hesitancy among their patients.

Introduction

Healthcare workers (HCWs) are considered the most trusted source of vaccine-related information [1]. However, studies are showing that HCWs are losing confidence in vaccination for their children, themselves, or their patients [2], [3], [4], [5]. Public health experts refer to this loss of confidence as “vaccine hesitancy”, which has recently been defined by the SAGE Working Group on Vaccine Hesitancy as “a behaviour, influenced by a number of factors including issues of confidence, complacency, and convenience” [6]. Vaccine hesitant HCWs can have a powerful influence on vaccination decisions, as they might recommend vaccines less frequently to their patients, and/or otherwise undermine confidence and contribute to vaccine hesitancy among the general population [2].

The little available research on HCWs’ attitudes is primarily related to seasonal and/or pandemic influenza vaccines. Most found that HCWs had not taken the influenza vaccine because of lack of time [7], [8], not feeling at risk of influenza [9], [10], because they considered they had no medical indication for the vaccine [4], [5], or due to concerns about safety and efficacy [3], [11].

This research aims to better understand vaccine hesitancy among vaccine providers in Europe, and explore the nature of their concerns, their perceptions of vaccine-related information, and their perceived role in responding to vaccine hesitancy.

Section snippets

Methods

The study was conducted in Croatia, France, Greece and Romania, as these countries responded to ECDC’s call for interest in participating in the project entitled “Comprehensive expert opinion on motivating hesitant population groups to vaccinate”. These countries have very different socio-economic and political backgrounds, allowing a more comprehensive overview of vaccine hesitancy in various contexts. Semi-structured interviews were conducted with healthcare providers who advise on

Results

Sixty-five semi-structured interviews were conducted across Croatia (17/65), France (16/65), Greece (15/65) and Romania (17/65). Most participants were female (66%) and between 25 and 44 years old (58%). The majority were GPs (72%), with gynaecologists (9%), epidemiologists (6%), paediatricians (6%) and internal medicine specialists (6%) also participating (Table 1).

The coding themes identified across all countries included: perceived benefits of vaccination (mentioned 227 times across all

Discussion

The results from the qualitative interviews with HCWs from Croatia, France, Greece and Romania confirm the study’s initial assumption of existence of vaccine hesitancy among HCWs and provide an insight into the reasons behind these doubts. Although the reports from the interviews were overall positive and showed generally high levels of trust and confidence in vaccination, there were also concerns about safety, questions about the need for vaccines, and/or mistrust of pharmaceutical companies

Conflict of interests

None

Funding

This study was commissioned by the European Centre for Disease Prevention and Control (ECDC), under the Framework Service Contract ECDC/2014/013, coordinated by Irina Dinca at ECDC, produced by World Health Communication Associates (WHCA) and sub-contracted to the London School of Hygiene and Tropical Medicine (LSHTM).

The LSHTM research group “The Vaccine Confidence Project” has received funding from the Bill & Melinda Gates Foundation, the Center for Strategic and International Studies, EU

Acknowledgements

We would like to show our gratitude to our colleagues from the four studied countries who provided insight and expertise that greatly assisted the research: Eleni Antoniadou and Agoritsa Baka at the Hellenic Centre for Disease Control, Greece; Adriana Baban at the Babes-Bolyai University, Romania; Patrick Pereti-Watel and Pierre Verger at the Institut national de la santé et de la recherche médicale (INSERM), France and Vesna Visěkruna Vučina at the Croatian National Institute of Public Health,

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Vaccine hesitancy among healthcare workers in Europe: A qualitative study

Abstract

Introduction

Section snippets

Methods

Results

Discussion

Conflict of interests

Funding

Acknowledgements

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