Calling the Shots: Impacts of Maternal Knowledge and Attitudes on Vaccination Status and Vaccine Hesitancy in India

Abstract

Childhood routine vaccinations have been repeatedly recognized as one of the most cost-effective public health interventions against disease, death, and disability worldwide. Many of the benefits provided through vaccinations, however, are only produced with high levels of vaccine uptake. Vaccine hesitancy, or individual delay or refusal of vaccinations despite the availability of vaccines, thus provides a significant challenge to the success of immunization programs. Such behavior is a particularly problematic in low- and middle-income countries (LMICs) because many of those nations have not reached sufficient immunization coverage, and still face heavy burdens of vaccine preventable diseases. In LMICs, significant proportions of the population lack education and knowledge on vaccinations. Social systems, cultural values, and religious beliefs also dominate decision-making, particularly in regards to health serves such as immunizations. As a result, vaccine hesitancy may be a large contributor to existing levels of under- or non-vaccination. Given this dynamic, it is imperative to understand the drivers of vaccine hesitancy behavior in individuals in such settings. This study is particularly interested in the vaccine hesitancy in India because the country has had historically low immunization coverage. This immunization gap suggests a need for research to guide more effective strengthening of India’s Universal Immunization Programme (UIP). This study further focuses on vaccine hesitancy behavior in mothers because they are the primary caregivers of young children. Additionally, this study concentrates on maternal knowledge on vaccinations and attitudes because they are complex drivers of vaccination uptake that have been largely unexplored. Overall, this study aims to characterize the impacts of maternal knowledge on vaccinations and confidence in health workers on vaccination status and vaccine hesitancy in India. The results of this study reveal that maternal knowledge and attitudes are both significant factors that impact the self-reported vaccination status of children in the country. Among mothers that reported incomplete vaccinations, their vaccine hesitancy was largely due to lack of knowledge on vaccination schedules, sessions, and benefits. Further investigation suggests that communication between health workers and mothers on vaccination relevant information should be improved to further expand vaccine uptake. This study also found that vaccine hesitancy can be attributed to a lack of confidence in health workers being available when needed. This suggests that the UIP should continue health infrastructure as improving maternal confidence in the availability and accessibility of health workers may also be critical for expanding vaccine uptake in mothers in India. These findings have many limitations; this study however is a critical first step to understanding the dynamics of vaccine hesitancy in mothers throughout India.