Resistance to vaccination: The attitudes and practices of primary healthcare workers confronting the H1N1 pandemic

doi:10.1016/j.vaccine.2010.09.104

Vaccine

Volume 28, Issue 51, 29 November 2010, Pages 8120-8124

https://doi.org/10.1016/j.vaccine.2010.09.104 Get rights and content

Abstract

During the H1N1 pandemic, most healthcare workers in Turkey were not willing to take up the vaccine. This qualitative study aims to explore the factors that lead to vaccination resistance among a group of primary healthcare workers in Istanbul. Data were collected through focus group discussions. Thematic content analysis was conducted. All participants considered themselves at risk for infection, yet most of them were not vaccinated. Only persons with a “poor” immune system were considered by the respondents at risk for severe disease and death. Health personnel mostly did not realize their potential role in the transmission of influenza to patients. The decision of vaccination was dependent on the information source. The personnel who depended mainly on the media either did not accept vaccination or was undecided. They believed that the vaccine went through an accelerated authorization procedure. Yet the ones who accepted vaccination relied mostly on evidence-based sources and accessed information from the guidelines of the Ministry of Health, Professional Medical Associations and the World Health Organization. Social networks were also influential factors in the decision-making process. It is important to empower healthcare workers through supporting the skills of acquiring and using evidence-based information. This is particularly important for physicians who also serve as opinion leaders.

Introduction

In April 2006, the Turkish Ministry of Health (MoH), through collaborating with a broad range of experts, published the National Pandemic Influenza Action Plan [1]. Vaccination was defined as one of the main control strategies in this plan. Since vaccine supply would be limited during a pandemic, groups that had to be vaccinated were set through a prioritization process. Personnel required for the maintenance of compulsory services were defined as the first group to receive the vaccine. The objective of vaccinating this group was to provide an indirect decrease in disease burden as well as to prevent absenteeism, which could lead to interruptions in the services provided. Health staff and laboratory personnel, including doctors and nurses, ambulance drivers and personnel responsible for the distribution of vaccines were included within this group [1].

In Turkey, the index case of H1N1 was detected on May 2009 [2], [3]. Through the mid of July, the number of laboratory confirmed cases had raised to 128, still only one third of the them were indigenous [2], [3]. While there were cases notified, no deaths were reported until the end of October 2009. By November the epidemic started to grow quickly and there were 320 deaths by the first week of December 2009 [3].

In accordance with the National Pandemic Influenza Action Plan, the Turkish MoH had arranged to purchase 20 million doses to vaccinate 10 million people. By the first week of November, H1N1 vaccines were provided for the healthcare personnel. However although the vaccine was provided free of charge, most healthcare workers were reluctant to vaccination. This study aims to explore the factors that lead to resistance to vaccination among a group of primary healthcare workers in a district in Istanbul.

Section snippets

Design

This is a qualitative study, which was carried out in November 2009 just before the peak of the H1N1 outbreak in Turkey. Data were collected from healthcare workers working in the primary healthcare centers (PHCs) of a District Health Directorate in Istanbul.

Setting and participants

The district is a migration receiving area with nearly 600 000 inhabitants. Illiteracy rate is approximately 5%, while 60% have eight years or lower education [4]. The District Health Directorate provides primary healthcare services with a

Characteristics of the participants

A total of 33 healthcare workers participated in the study. Among all, 17 were physicians (general practitioners) while the rest were nurses, midwives and sanitary servants. The mean age of the participants was 32.9 ± 6.3 and 26 were female. Among all, only 9 (27.2%) were vaccinated against the pandemic H1N1. Five physicians (29.4%) and four (25.0%) non-physicians had accepted vaccination.

Perceived threat of H1N1 infection

When this study was initiated, available information regarding the pandemic was limited. Yet since the winter

Discussion

Primary healthcare workers are the essential workforce in the control of disease outbreaks [5], [6]. They need to be vaccinated in order to both prevent the nosocomial spread of the virus and to decrease the absenteeism related to the infection. Yet in order to take up vaccination, healthcare workers need to understand the purpose of vaccination. However, our study determined that the awareness related to the purpose of H1N1 vaccination was inadequate leading to low vaccination rates and the

Conclusion

The Turkish experience shows the need to adopt effective risk communication messages targeting healthcare workers. It is indicated that one of the first steps of improving risk communication is to tailor it to the specific situation and the needs of both the population and the medical community [16]. A special emphasis should be given to physicians since studies indicate that prevention related practices of physicians influence their counseling activities; physicians who are more likely to

References (26)

H.G. Hollmeyer et al.
Influenza vaccination of health care workers in hospitals—a review of studies on attitudes and predictors
Vaccine
(2009)
Z.H. Abramson et al.
Influenza vaccination among primary healthcare workers
Vaccine
(2008)
M. Schwarzinger et al.
Positive attitudes of French general practitioners towards A/H1N1 influenza-pandemic vaccination: a missed opportunity to increase vaccination uptakes in the general public?
Vaccine
(2010)
S. Dittmann
Vaccine safety: risk communication—a global perspective
Vaccine
(2001)
A. Kata
A postmodern Pandora's box: anti-vaccination misinformation on the Internet
Vaccine
(2010)
E.A. Zijtregtop et al.
Which factors are important in adults’ uptake of a (pre)pandemic influenza vaccine?
Vaccine
(2009)
Republic of Turkey Ministry of Health Directorate General of Primary Health Care. Pandemic Influenza Action Plan....
Ciblak MA, Albayrak N, Odabas Y, Basak Altas A, Kanturvardar M, Hasoksuz M, et al. Cases of influenza A(H1N1)v reported...
Turkish Ministry of Health....
TurkStat. Turkish Statistical Institute....

W. Opstelten et al.

Threat of an influenza pandemic: family physicians in the front line

BMC Fam Pract

(2009)

K.A. Shaw et al.

The GP's response to pandemic influenza: a qualitative study

Fam Pract

(2006)

F. Hofmann et al.

Influenza vaccination of healthcare workers: a literature review of attitudes and beliefs

Infection

(2006)

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