Vaccine Hesitancy for Childhood Vaccinations in Slum Areas of Siliguri, India

This study was conducted to examine the proportion and factors contributing to vaccine hesitancy around childhood vaccinations in slum areas of Siliguri city, West Bengal, India. Considering that the childhood vaccination coverage of urban areas was reported to be 76.2% in West Bengal (2012-13 data), exploring this aspect of vaccination may guide policymakers in undertaking appropriate measures to improve vaccine acceptance and coverage and to reach desired national targets.

A cross-sectional study was carried out among the mothers/primary caregivers of 194 children aged 0-59 months residing in the slums of Siliguri in 2016. Data were collected at the household level using a version of the vaccine hesitancy survey questionnaire originally developed by the World Health Organization (WHO) Strategic Advisory Group of Experts (SAGE) working group on vaccine hesitancy. Associations were analysed using logistic regression.

Although most of the caregivers in the study were convinced of the role of vaccines in protecting children and reported they like to have their children vaccinated with all vaccines, a deeper exploration shows that only 17% had actually gone for all recommended doses on time.

The study found that the majority 161 (83%) of the families were vaccine-hesitant; only 33 (17%) were not hesitant. Nuclear families and mothers of lower educational status had a significantly higher odds of vaccine hesitancy. Reluctance to vaccinate (26.1%) and to be unaware/having no reliable information (20.5%) were the major reasons cited for vaccine hesitancy. As reported here, the inherent migratory and temporary nature of the slum population makes delay and hesitancy even more prominent. This can be deduced from the fact that about 8.7% of caregivers reported being away from home as the reason for hesitancy. The social behaviour of mothers frequently traveling between husband's home and father's home during the postnatal period is a major obstacle. It is likely that mothers staying at father's home will miss reminders from the health workers, who only register deliveries of daughters-in-law in the family to avoid duplication of birth registration.

There was a significant difference in opinion among vaccine-hesitant mothers/caregivers and those who were not vaccine-hesitant regarding statements that childhood vaccines are important for a child's health, that getting vaccinated is a good way to protect children from disease, and that new vaccines carry more risks than older vaccines.

In conclusion, most of the families of the children were vaccine hesitant in the area. Among the approaches proposed to address the issue are: ensuring uniformity in schedules in different health facilities in slum areas, providing appropriate antenatal information and counseling regarding childhood vaccinations, and improving mothers' education. "Intricate issues of lack of trust, motivation to vaccinate need to be addressed by widespread awareness in slums where health access, in general, is poor."