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Article

Comparisons of Vaccine Hesitancy across Five Low- and Middle-Income Countries

by
Abram L. Wagner
1,*,
Nina B. Masters
1,
Gretchen J. Domek
2,3,
Joseph L. Mathew
4,
Xiaodong Sun
5,
Edwin J. Asturias
2,3,6,
Jia Ren
5,
Zhuoying Huang
5,
Ingrid L. Contreras-Roldan
7,
Berhanu Gebremeskel
1 and
Matthew L. Boulton
1,8
1
Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
2
Department of Pediatrics, University of Colorado Anschutz Medical Campus, B065, 13123 E 16th Ave, Aurora, CO 80045, USA
3
Center for Global Health, Colorado School of Public Health, A090, 13199 E Montview Blvd, Suite 310, Aurora, CO 80045, USA
4
Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
5
Department of Immunization Program, Shanghai Municipal Centers for Disease Control & Prevention, NO. 1380, West Zhongshan Road, Shanghai 200336, China
6
Department of Epidemiology, Colorado School of Public Health, B119, 13001 E 17th Place, Aurora, CO 80045, USA
7
Center for Health Studies, Universidad del Valle de Guatemala, 18 Av. 11-95, Zona 15, Vista Hermosa III, Guatemala City 01015, Guatemala
8
Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
*
Author to whom correspondence should be addressed.
Vaccines 2019, 7(4), 155; https://doi.org/10.3390/vaccines7040155
Submission received: 13 September 2019 / Revised: 3 October 2019 / Accepted: 14 October 2019 / Published: 18 October 2019
(This article belongs to the Section Vaccines and Public Health)
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Abstract

Vaccine hesitancy is a continuum of behaviors ranging from delay in receipt to vaccination refusal. Prior studies have typically focused on high-income countries, where vaccine hesitancy is particularly prevalent in more affluent groups, but the relationship between socioeconomic status and vaccine hesitancy in Low- and Middle-Income Countries (LMICs) is less clear. The aim of this study was to describe vaccine hesitancy in five LMICs. Mothers of children in Sirajganj, Bangladesh (n = 60), Shanghai, China (n = 788), Addis Ababa, Ethiopia (n = 341), Guatemala City and Quetzaltenango, Guatemala (n = 767), and Chandigarh, India (n = 309), completed a survey between 2016 and 2018 using the WHO’s 10-item Vaccine Hesitancy Scale. The scores of different constructs were compared across countries and by the mother’s education level using linear regression models with generalized estimating equations. Compared to mothers in China, mothers in Bangladesh perceived less vaccination benefit (β: 0.56, P = 0.0001), however, mothers in Ethiopia (β: −0.54, P < 0.0001) and Guatemala (β: −0.74, P = 0.0004) perceived greater benefit. Education level was not significantly linked with vaccine hesitancy. Local circumstances are important to consider when developing programs to promote vaccines. We did not find consistent associations between education and vaccine hesitancy. More research is needed to understand socio-cultural influences on vaccine decision-making.
Keywords: vaccines; vaccine hesitancy; low- and middle-income countries; China; Bangladesh; Ethiopia; Guatemala; India vaccines; vaccine hesitancy; low- and middle-income countries; China; Bangladesh; Ethiopia; Guatemala; India

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MDPI and ACS Style

Wagner, A.L.; Masters, N.B.; Domek, G.J.; Mathew, J.L.; Sun, X.; Asturias, E.J.; Ren, J.; Huang, Z.; Contreras-Roldan, I.L.; Gebremeskel, B.; et al. Comparisons of Vaccine Hesitancy across Five Low- and Middle-Income Countries. Vaccines 2019, 7, 155. https://doi.org/10.3390/vaccines7040155

AMA Style

Wagner AL, Masters NB, Domek GJ, Mathew JL, Sun X, Asturias EJ, Ren J, Huang Z, Contreras-Roldan IL, Gebremeskel B, et al. Comparisons of Vaccine Hesitancy across Five Low- and Middle-Income Countries. Vaccines. 2019; 7(4):155. https://doi.org/10.3390/vaccines7040155

Chicago/Turabian Style

Wagner, Abram L., Nina B. Masters, Gretchen J. Domek, Joseph L. Mathew, Xiaodong Sun, Edwin J. Asturias, Jia Ren, Zhuoying Huang, Ingrid L. Contreras-Roldan, Berhanu Gebremeskel, and et al. 2019. "Comparisons of Vaccine Hesitancy across Five Low- and Middle-Income Countries" Vaccines 7, no. 4: 155. https://doi.org/10.3390/vaccines7040155

APA Style

Wagner, A. L., Masters, N. B., Domek, G. J., Mathew, J. L., Sun, X., Asturias, E. J., Ren, J., Huang, Z., Contreras-Roldan, I. L., Gebremeskel, B., & Boulton, M. L. (2019). Comparisons of Vaccine Hesitancy across Five Low- and Middle-Income Countries. Vaccines, 7(4), 155. https://doi.org/10.3390/vaccines7040155

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