Examining determinants of vaccine acceptance for maternal immunization in a low-resource setting in Zambia: a qualitative assessment from the perspective of women and providers

BACKGROUND: Recently there has been a shift in the global health arena towards maternal immunization as the missing link to protect mother, fetus, and infant. However, as research is being conducted across the maternal immunization portfolio to address underlying immunological mechanisms, effectiveness, stability, and safety, there is minimal data regarding acceptance from the perspective of women and providers, specifically in low-resource settings. Serving as a factor that informs a global and national recommendation for vaccine use, closing this knowledge gap will be necessary to reach policy decisions, develop strategies to introduce maternal vaccines into National Immunization Programs, and secure uptake of such policies on the part of intended beneficiaries. METHODS: Qualitative data was collected across three health facilities (urban, peri-urban, rural) via focus group discussions (women), key informant interviews (family/community members), and clinical vignettes (women). Thematic analysis was guided by the World Health Organization’s Model of Determinants of Vaccine Hesitancy using the seven stages of the Framework Method. RESULTS: Results demonstrated that while women showed confidence in the safety and efficacy of vaccines, hesitancy towards maternal vaccination was fostered by misinformation, religious beliefs, use of traditional medicine, social norms, family involvement, and concerns about risk benefit profiles. In contrast, providers expressed service delivery barriers such as long wait times, husband involvement in decision-making, and religion as main reasons why women were hesitant to be vaccinated during pregnancy. Providers believed that these barriers could easily be overcome with proper outreach, education, and modifications to service delivery. Additionally, providers displayed confidence in their own understanding of the vaccine ecosystem and the level of knowledge women possessed about vaccines. CONCLUSION: To ensure the full potential of maternal vaccines, policies, national strategies, and implementation approaches will need to consider knowledge, attitudes, and beliefs expressed by women and providers, as well as the cultural dynamics of the setting in which vaccines are being administered. Furthermore, research is required to understand the relative strength of explanatory factors in deciding to be vaccinated during pregnancy, as well as exploration of how these factors change over time and contribute to policy and program implementation approaches.2022-09-30T00:00:00