The inclusion of vaccine hesitancy among the 10 leading threats to public health worldwide highlighted the urgent need for interventions that can address the problem. Besides hesitancy, Wakiso and Hoima districts continue to report low immunization rates of coverage with vaccine preventable diseases continuing to be frequent and recurrent. This study set out to find out what is responsible for recurrence of these VPDs and low in Hoima and Wakiso Districts of Uganda and to identify possible interventions, approaches and strategies that can help address these problems.
This mixed methods study included quantitative and qualitative research methods comprising focus group discussions (FGDs) and in-depth interviews for caregivers of children that were eligible for immunization; face-to-face interviews for immunization focal health workers; key informant interviews (KIIs) for immunization focal persons and decision makers within the two districts; and a systematic review on vaccine hesitancy and underimmunization in sub-Saharan Africa. The study population included 643 caregiver interviews, 20 FGDs and 80 KIIs.
The drivers of hesitancy and underimmunization identified comprise geographical, community, caregiver, child and health system factors. These were access difficulties, geographical barriers, inadequate funding, cold chain inadequacies, inadequate social mobilization, vaccine stock outs, high training needs for health workers, and adverse events. Most vaccine hesitancy determinants listed on WHO matrix were applicable, including poor access to vaccines or to vaccination services, diminished trust in some vaccines, and diminished acceptance for some vaccines especially for children and HPV vaccines.
The ministry of health needs to train the Health Workers, enhance outreach services, social mobilization, and build trust in communities. It also needs to work with supervisors to avail more funding for district cold chain teams especially transportation required for mentorship, train and frequently supervise health workers, ensure a steadier supply of vaccines, injections, cold chain consumables, and record books. Additionally, the ministry of health needs to sensitize the community more, plan joint collaborated engagement activities, involve communities in organizing introduction of new vaccines and activities for catch up immunization campaigns to help improve the outputs of the immunization program.