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Insights into vaccine hesitancy from systems thinking, Rwanda.
Decouttere, Catherine; Banzimana, Stany; Davidsen, Pål; Van Riet, Carla; Vandermeulen, Corinne; Mason, Elizabeth; Jalali, Mohammad S; Vandaele, Nico.
  • Decouttere C; Research Center for Access-to-Medicines, Naamsestraat 69, 3000 Leuven, Belgium.
  • Banzimana S; East African Community Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management, University of Rwanda, Kigali, Rwanda.
  • Davidsen P; System Dynamics Group, University of Bergen, Bergen, Norway.
  • Van Riet C; Research Center for Access-to-Medicines, Naamsestraat 69, 3000 Leuven, Belgium.
  • Vandermeulen C; Leuven University Vaccinology Center, KU Leuven, Leuven, Belgium.
  • Mason E; Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Cambridge, United States of America.
  • Jalali MS; Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Cambridge, United States of America.
  • Vandaele N; Research Center for Access-to-Medicines, Naamsestraat 69, 3000 Leuven, Belgium.
Bull World Health Organ ; 99(11): 783-794D, 2021 Nov 01.
Article in English | MEDLINE | ID: covidwho-1551419
ABSTRACT

OBJECTIVE:

To investigate vaccine hesitancy leading to underimmunization and a measles outbreak in Rwanda and to develop a conceptual, community-level model of behavioural factors.

METHODS:

Local immunization systems in two Rwandan communities (one recently experienced a measles outbreak) were explored using systems thinking, human-centred design and behavioural frameworks. Data were collected between 2018 and 2020 from discussions with 11 vaccination service providers (i.e. hospital and health centre staff); interviews with 161 children's caregivers at health centres; and nine validation interviews with health centre staff. Factors influencing vaccine hesitancy were categorized using the 3Cs framework confidence, complacency and convenience. A conceptual model of vaccine hesitancy mechanisms with feedback loops was developed.

FINDINGS:

A comparison of service providers' and caregivers' perspectives in both rural and peri-urban settings showed that similar factors strengthened vaccine uptake (i) high trust in vaccines and service providers based on personal relationships with health centre staff; (ii) the connecting role of community health workers; and (iii) a strong sense of community. Factors identified as increasing vaccine hesitancy (e.g. service accessibility and inadequate follow-up) differed between service providers and caregivers and between settings. The conceptual model could be used to explain drivers of the recent measles outbreak and to guide interventions designed to increase vaccine uptake.

CONCLUSION:

The application of behavioural frameworks and systems thinking revealed vaccine hesitancy mechanisms in Rwandan communities that demonstrate the interrelationship between immunization services and caregivers' vaccination behaviour. Confidence-building social structures and context-dependent challenges that affect vaccine uptake were also identified.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Vaccines / Patient Acceptance of Health Care Type of study: Cohort study / Observational study / Prognostic study / Qualitative research Topics: Vaccines Limits: Child / Humans Country/Region as subject: Africa Language: English Journal: Bull World Health Organ Year: 2021 Document Type: Article Affiliation country: BLT.20.285258

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Vaccines / Patient Acceptance of Health Care Type of study: Cohort study / Observational study / Prognostic study / Qualitative research Topics: Vaccines Limits: Child / Humans Country/Region as subject: Africa Language: English Journal: Bull World Health Organ Year: 2021 Document Type: Article Affiliation country: BLT.20.285258