Barriers for Influenza Vaccination
Determinants of Influenza Vaccination, 2003 2004: Shortages, Fallacies and Disparities. Jones TF, Ingram LA, Craig AS, and Schaffner W. Clinical Infectious Diseases 2004;39:1824-1828.
What are the barriers to protecting people with influenza vaccination?
Researchers conducted a telephone survey in Tennessee from February through May 2004 to assess people's knowledge, attitudes, and beliefs about influenza vaccination and to assess how ease-of-access may affect vaccination rates. The survey was limited to those who spoke English and to those who had land-line telephones. The survey included questions on demographic characteristics, influenza vaccination history and related experiences, and risk factors for influenza disease.
Seventy-five percent of the 4,028 persons interviewed indicated that they had one or more conditions for which the CDC recommends routine influenza vaccination. About half (52%) of the respondents had received influenza vaccination during the previous season.
Of the 2077 respondents ultimately vaccinated, 6% reported encountering difficulties getting the vaccine?13% of those who were unvaccinated had tried to obtain vaccine?primarily because the vaccine was not readily available. First-time vaccinees were no more likely to encounter problems than were repeat vaccinees, and children encountered no more problems than did adults.
This study found that there was racial disparity between those who received vaccine?whites were more likely to have been vaccinated than respondents of other races. In addition, immunization was greater among urban/suburban residents than among rural residents, greater among persons 50 years of age or older than among persons aged younger than 50 years of age, and greater among persons with risk factors for which CDC recommends vaccination than among persons without such risk factors.
Among persons aged 50 years of age and older, those with annual household incomes of less than $30,000 were more likely to get vaccinated than were those with higher incomes, whereas the opposite was true among persons younger than 50 years of age.
Additional barriers to influenza immunization included the observations that unvaccinated persons commonly believed that vaccination was unnecessary (33%), that vaccination would cause illness (21%), or that they failed to think about being vaccinated (21%), and these beliefs were significantly more common among individuals who had a high-risk medical condition than among those who did not.
The survey also identified cases where health providers missed opportunities to immunize against influenza when high risk patients were seen for other reasons.
The relevance/bottom line
In addition to the well-recognized barriers to successful influenza vaccination such as socioeconomic status, access to vaccine, racial disparities and missed vaccination opportunities, this study demonstrates that misperceptions about the need, effectiveness, and safety of influenza vaccination remain an important impediment to immunization, especially among those most in need of vaccination.
This study was limited to those who spoke English and who had landline telephones, selecting against those without telephones, those utilizing cellular telephones and non-English-speaking individuals, especially nursing home residents and Hispanic populations. Nevertheless, this study demonstrates the impact of myths and misunderstanding on vaccine uptake among those who need it.
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