Making vaccine technologies work for the poor

This policy briefing examines the factors that facilitate or impede the utilisation of vaccination technologies among the poor. The brief reports that while there have been advances in vaccination initiatives in many parts of the world, in some parts of Africa, the rates of routine vaccinations are either stagnant or falling. The brief takes the position that in order to halt the falling immunisation rates and to develop health promotion strategies that are culturally appropriate, policymakers and practitioners must look closely at local cultural understandings of vaccines.

The brief makes several points including the following:

• There are many cases where people refuse certain vaccines. This may be based on perceived risks, uncertainties or safety concerns. Usually, such concerns are based on people’s experiential knowledge and interpretations of vaccination having negative effects either on their own, or others’, children. However, not all vaccination defaulters are due to mothers’ unwillingness to complete vaccination schedules. Such factors as heavy workloads especially for poorer families, sudden illness, family events, intra-household disputes or necessary travel can arise and prevent families from accessing the necessary vaccinations.
• It is also important to examine issues of supply and demand and their interaction in local settings. For instance, mothers who make the effort to attend vaccination assembly points but find no service or no vaccines, may feel discouraged and therefore not return in the future.
• Cost may be another factor that keeps the poorest families from accessing vaccinations.
• A further area that needs close attention is the context in which vaccinations are provided, and people’s experiences of the vaccination process. This can vary greatly according to social background, poverty and other factors, and have a significant effect on people’s attitudes towards vaccination. If nurses and other health workers shout at mothers who have failed to complete the necessary immunisations and embarrass them in front of other mothers, this can put them off future attendance.

[adapted from authors]