Barriers and reluctance to paediatric vaccination (EPI) and vaccination against Covid-19: results of a survey in Niger
Background. Vaccination adherence among populations is a complex process involving, on the one hand, the expected benefit of a vaccine, and on the other, the perceived risk. To develop an evidence-based communication strategy aimed at improving vaccination coverage in Niger, we conducted a mixed socio-anthropological study of the perceptions among the population on the benefit and the risk of the childhood (Expanded Program on Immunization, EPI) and the Covid-19 vaccines. While the vaccine coverage for some of the EPI vaccines is above 80%, only 33% of the children are fully vaccinated, according to the national vaccination schedule. The first objective of our study was to understand the perceptions that might explain this drop off.
The second objective was to identify the drivers of the low adherence to the Covid-19 vaccination, 22% of the illegible population being vaccinated.
Materials and methods. In March 2023, we interviewed 509 people for the quantitative study and 40 people through focus groups and individual interviews for the qualitative one, in Niamey (80% of the interviewees) and two villages.
Results. 96.9% of the interviewees think that childhood vaccines are “a good thing,” even though 30.6% know that they might have negative side effects. While 87.8% think that it is “easy” or “very easy” to get children vaccinated, 21.4% point out as “annoying” the lack of amiability by the health care workers and 16.9% the waiting time. The qualitative study showed that these two complaints drive some women not to complete the vaccination schedule. We might also hypothesize that, given the perceived lack of amiability, some women don’t get enough information on the side effects and their management. Surprisingly, 73.3% of the interviewees think that vaccines against the disease are a good thing, and 83% of those who have heard messages promoting the vaccination approve them. This apparent contradiction with the low vaccine uptake is explained by a very low perception of the Covid-19 risks. More than half of the population surveyed believe that the disease is not present in the country, a very large majority believe that only ill people can transmit the disease, while only 12.8% think they know anybody who has ever been sick with Covid-19. According to our results, the circulating rumors on the vaccines don’t play a significant role in the low adherence to Covid-19 uptake, nor in the insufficient completeness of the EPI vaccination schedule.
Conclusion. The communication efforts on EPI vaccination should focus on the explanation of the side effects and their management, as well as improving the organization of the vaccination sessions. The communication on Covid-19 vaccination should focus on the reality of the disease in the country and the groups at risk for severe forms.
Freins et réticences à la vaccination pédiatrique (PEV) et contre la Covid-19?: résultats d’une enquête au Niger
Introduction. Nous avons mené au Niger une enquête socio-anthropologique alliant les méthodes quantitative et qualitative de collecte de données sur les représentations de la population sur la vaccination, afin de fournir les bases à une stratégie de communication pour promouvoir les vaccins du Programme élargi de vaccination (PEV) et contre la Covid-19.
Matériel et méthode. Pour l’étude quantitative, nous avons interviewé 509 personnes, choisies selon la méthode des quotas, à 80 % dans la capitale pour des raisons sécuritaires et logistiques. Le volet qualitatif a porté sur 10 personnes en entretiens individuels approfondis et 30 en groupes focus (GF).
Résultats. Nos résultats montrent une adhésion quasi unanime à la vaccination pédiatrique. La crainte des effets secondaires, mentionnés par 30,6 % des enquêtés, un manque d’amabilité du personnel de santé et le temps d’attente, mentionnés respectivement par 21,4 % et 16,9 %, apparaissent comme des facteurs contribuant à expliquer un abandon après les premières doses et le non-respect du calendrier vaccinal. La faible adhésion à la vaccination contre la Covid-19 s’explique par la conjonction de plusieurs idées erronées sur la pandémie. D’abord, la majorité des enquêtés pense que la maladie n’est pas présente dans le pays, 43,8 % seulement estimant qu’elle l’est. Ensuite, la quasi-totalité croit que seules des personnes malades transmettent le virus responsable de la Covid-19 ; 12,8 % estiment connaître quelqu’un qui a eu la maladie et 5,1 % en connaissent dans leur entourage. L’ensemble de ces représentations se traduit par une perception très faible du risque de contracter la maladie. Les rumeurs négatives qui circulent sur les vaccins pédiatriques et contre la Covid-19 ne semblent pas jouer de rôle significatif.
Conclusion. Les efforts de communication sur les vaccins du PEV doivent porter sur l’explication des effets secondaires et leur gestion, ainsi que sur l’amélioration de l’accueil des parents. Concernant la vaccination contre la Covid-19, la communication doit se concentrer sur la réalité de la maladie dans le pays et les groupes à risque de formes graves.