Royal College of Paediatrics and Child Health, 5-11 Theobalds Road, London WC1X 8SH, United Kingdom.
Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, United States.
Vaccine. 2017 Nov 7;35(47):6438-6443. doi: 10.1016/j.vaccine.2017.09.075. Epub 2017 Oct 12.
Vaccine hesitancy constitutes a major threat to the Global Polio Eradication Initiative (GPEI), and to further expansion of routine immunisation. Understanding hesitancy, leading in some cases to refusal, is vital to the success of GPEI. Re-emergence of circulating wild poliovirus in northern Nigeria in mid-2016, after 24months polio-free, gives urgency to this. But it is equally important to protect and sustain the global gains available through routine immunisation in a time of rising scepticism and potential rejection of specific vaccines or immunisation more generally.
This study is based on a purposive sampling survey of 1653 households in high- and low-performing rural, semiurban and urban areas of three high-risk states of northern Nigeria in 2013-14 (Sokoto, Kano and Bauchi). The survey sought to understand factors at household and community level associated with propensity to refuse polio vaccine. Wealth, female education and knowledge of vaccines were associated with lower propensity to refuse oral polio vaccine (OPV) among rural households. But higher risk of refusal among wealthier, more literate urban household rendered these findings ambiguous. Ethnic and religious identity did not appear to be associated with risk of OPV refusal. Risk of vaccine refusal was highly clustered among households within a small sub-group of sampled settlements. Contrary to expectations, households in these settlements reported higher levels of expectation of government as service provider, but at the same time lesser confidence in the efficacy of their relations with government.
Results suggest that strategies to address the micro-political dimension of vaccination - expanding community-level engagement, strengthening the role of local government in public health, and enhancing public participation of women - should be effective in reducing non-compliance, asan important set of strategies complementary to conventional didactic/educational approaches and working through religious and traditional 'influencers'.
疫苗犹豫对全球根除脊髓灰质炎倡议（GPEI）以及常规免疫的进一步扩大构成了重大威胁。了解犹豫情绪——在某些情况下会导致拒绝接种——对于 GPEI 的成功至关重要。2016 年年中，在尼日利亚北部已经 24 个月没有脊髓灰质炎病例后，循环的野生脊灰病毒再次出现，这使得情况变得紧迫。但同样重要的是，在对特定疫苗或免疫接种普遍持怀疑和潜在拒绝的情况下，保护和维持通过常规免疫获得的全球收益。
本研究基于 2013-14 年在尼日利亚北部三个高风险州（索科托、卡诺和包奇）的高绩效和低绩效农村、半城市和城市地区的 1653 户家庭进行的一项有目的抽样调查。该调查旨在了解与家庭和社区层面拒绝口服脊髓灰质炎疫苗（OPV）倾向相关的因素。在农村家庭中，财富、女性教育和疫苗知识与较低的拒绝口服脊髓灰质炎疫苗的倾向相关。但在较富裕、文化程度较高的城市家庭中，拒绝风险更高，这使得这些发现变得模棱两可。族裔和宗教身份似乎与 OPV 拒绝风险无关。在抽样定居点的一小部分家庭中，疫苗拒绝风险高度聚集。与预期相反，这些定居点的家庭报告说，他们对政府作为服务提供者的期望更高，但同时对他们与政府关系的效力的信心较低。
结果表明，解决接种微观政治层面的策略——扩大社区层面的参与、加强地方政府在公共卫生方面的作用以及增强妇女的公共参与——应该能够有效减少不遵守规定的行为，这是一系列重要的策略，可作为常规说教/教育方法的补充，并通过宗教和传统的“影响者”发挥作用。
