top of page
Search

Barriers to Influenza Vaccine Uptake

  • Kim Friesen
  • Jun 18, 2019
  • 6 min read

Updated: Jul 25, 2019






Influenza


Influenza, also known as the flu, is a serious illness causing approximately 12,000 hospitalization and 3,500 deaths annually (PHAC, 2019). Most people who are infected with influenza will recover within two weeks, but some people will develop complications ranging from moderate to severe. Although many people consider influenza serious only for the elderly, all ages and even healthy individuals can develop complications. Health problems that can emerge from influenza include ear infections, pneumonia, myocarditis (inflammation of the heart), encephalitis (inflammation of the brain), and multi-organ failure (CDC, 2019).

In the 2018/2019 influenza season (August 26, 2018 to May 18, 2019) there were 38,248 confirmed cases of influenza in Canada (PHAC, 2019). Taking into consideration that many people do not get tested when they visit their physician with flu-like symptoms, there were likely many more cases that we are unaware of (Tim Chisamore, Epidemiologist, personal conversation). Often young children are hit hard, by early January there were 6 deaths in Canada in children under the age of 10 (CBC News, 2019).


The influenza vaccine can help to prevent influenza or reduce the effects of the illness. Unfortunately, vaccine uptake, especially in the young is minimal. The World Health Organization recommends a 75% target coverage rate for influenza vaccination. Data from the 2017/2018 influenza season shows Canadian vaccine coverage rates in the adult population remained suboptimal at the 38% mark, similar to the last two seasons (PHAC, 2019).

The Social Ecological Model


Most research pertaining to vaccine uptake addresses the intrapersonal determinants. Vaccine safety, previous experience receiving vaccines, and perceived overall risk are often the determinants analyzed when looking at vaccine coverage rates. Changing the research method to the social ecological method (SEM) may uncover additional determinants, that if addressed could improve vaccine uptake and reduce the burden of influenza infection. (Poux, 2017.)

The SEM will allow the user to examine multiple levels of social determinants that may affect an individual’s decision to be vaccinated. The levels of the SEM are described in the diagram below (Poux, 2017).



Studying each level of the SEM individually provides an opportunity to identify specific factors that may be affecting vaccination decisions.


Policy


The policy level is the broadest level of the SEM. Effective Government policies have the ability to improve the health of the public (Poux, 2017). The Ontario Government enacted a policy in 2012 (Toronto Sun) to increase the scope of practice of the pharmacist by including seasonal influenza vaccine administration. During the last flu season, pharmacists administered over 1.2 million influenza vaccines (Post Media News, 2019). Allowing pharmacists to administer the influenza vaccine has resulted in a modest increase in influenza coverage rates. Unfortunately, the government put restrictions on vaccine administration by allowing pharmacists to vaccinate individuals 5 years of age and older (MOHLTC, n.d.). This gap in the policy leaves parents of children 6 months to 5 years of age with only two options to access vaccines for their young children: the primary care provider or public health clinic (“Flu vaccine for kids and during pregnancy | Ontario.ca,” n.d.).


Community


The community level of the SEM refers to the physical environment, social networks and availability of community services. The prevalence of infection in the community and an individual’s perceived risk of infection can motivate some people to get the vaccine. If a community is well immunized the most vulnerable, for example, babies under the age of six months, are protected through community immunity (Kumar, et al., 2011). Although community immunity can encourage some people to get vaccinated, it can also have the opposite effect. Some individuals will take advantage of the protection offered by a well-immunized community without contributing to the communities’ immunity themselves (Betsch, Böhm, Korn, & Holtmann, 2017).



The availability of community services such as public transportation, local public health clinics and local pharmacies offering the vaccine may affect an individual’s decision to get the vaccine (Buchan, et al., 2017). Newcomers to Canada may experience an additional community-level barrier when there are language and cultural obstacles to accessing local health care and immunization services (Farmanara, Sherrard, Dubé, & Gilbert, 2018).


Institutional

The institutional level of the SEM identifies organizations that have the ability to influence behaviour. Places of worship, schools and workplaces are organizations where people spend significant amounts of time. The policies, rules, regulations and beliefs that organizations promote can influence the choices individuals make (Poux, 2017). Workplaces that offer influenza vaccine clinics onsite are providing employees with convenient access to protection and may reduce the level of absenteeism due to influenza infections (“Promoting Vaccination in the Workplace | CDC”, 2019). Additional factors at the institutional level are the influences provided by the health care sector. Health care providers that include the provision of information about influenza and encourage patients to get the vaccine as part of their standard practice, increase vaccine uptake (Kumar, et al., 2011).


Interpersonal Level


Friends, family, culture and social networks are key components of the interpersonal level of the SEM. The attitudes and behaviours of the people within an individual’s social circle often impact the personal health choices a person makes (Poux, 2017). The more people who get the influenza vaccine within a person’s social circle, the more likely the person will also get the vaccine (Kumar, et al., 2011). Parents make the decision on influenza vaccines for their children. Those who decline the vaccine often base the decision on information gathered by reading and listening to family, friends and other parents. Parents who choose to get the vaccine for their children often get information from their child’s health care provider. It is often stated that not all physicians approach parents with recommendations to immunize their children against influenza (Umichmedicine, n.d.).



Intrapersonal Level


The intrapersonal level of the SEM is the level that focuses on the individual. Some of the factors that influence behaviour at this level are the characteristics, perceptions, attitudes, gender, age and level of education of an individual (Poux, 2017). The interpersonal level is often the area researchers focus on when trying to determine what impacts personal immunization choices. Those individuals who perceive their risk of infection and the severity of the disease as low were less likely to get the vaccine. Additionally, vaccine adverse events pose a barrier to vaccination when individuals feel they are at risk from the vaccine (Schmid, Rauber, Betsch, Lidolt, & Denker, 2017). Having previously suffered from influenza often motivates people to get the vaccine, where those who have never been infected, tend not to be vaccinated (Schmid, et. Al. 2017).



The SEM is often used to guide public health practice. Each level of this model extends into the other. The most successful approaches to influencing health decisions address the multiple levels and social ecological factors that impact behaviour. It is unlikely that one intervention could address all levels of the model and the SEM does not provide direction as to which level or process will be the most influential. Because influenza vaccine uptake is a multifaceted problem, the SEM has identified several factors to be addressed by a multi pronged approach.


References


Advanced Solutions International, Inc. (n.d.). Ecological Model. Retrieved June 20, 2019, from

Betsch, C., Böhm, R., Korn, L., & Holtmann, C. (2017). On the benefits of explaining

herd immunity in vaccine advocacy. Nature Human Behaviour, 1(3), 0056. Retrieved June 30, 2019 from https://doi.org/10.1038/s41562-017-0056


Buchan, S. A., Rosella, L. C., Finkelstein, M., Juurlink, D., Isenor, J., Marra, F., . . .

Kwong, J. C. (2017, January 30). Impact of pharmacist administration of

influenza vaccines on uptake in Canada. Retrieved June 13, 2019, from


Canada, P. H. A. of. (PHAC), (2019, May 24). FluWatch report: May 12 to May 18, 2019 (Week 20) [Datasets]. Retrieved June 15, 2019, from aem website:


CDC. (2019, April 26). Flu Symptoms & Complications. Retrieved June 15, 2019, from Centers for Disease Control and Prevention website:


Farmanara, N., Sherrard, L., Dubé, È., & Gilbert, N. L. (2018). Determinants of non-vaccination against seasonal influenza in Canadian adults: Findings from the 2015–2016 Influenza Immunization Coverage Survey. Canadian Journal of Public Health, 109(3), 369–378. Retrieved June 25, 2019 from https://doi.org/10.17269/s41997-018-0018-9


Flu vaccine for kids and during pregnancy | Ontario.ca. (n.d.). Retrieved June 26, 2019, from


Kumar, S., Quinn, S. C., Kim, K. H., Musa, D., Hilyard, K. M., & Freimuth, V. S. (2011).

The Social Ecological Model as a Framework for Determinants of 2009 H1N1 Influenza Vaccine Uptake in the United States. Health Education & Behavior, 39(2), 229- 243.doi:10.1177/1090198111415105, Retrieved June 23, 2019 from


Ministry of Health and Long-Term Care (MOHLTC), Ontario Public Drug Programs1 Frequently Asked Questions for Pharmacists Administration of the Publicly Funded Influenza Vaccine and Claims Submission using the Health Network System. (n.d.). Retrieved June 25, 2019, from


Postmedia News. (2019, April 22). EDITORIAL: Thumbs up to expanded health-care

role for pharmacists. Retrieved June 27, 2019, from


Promoting Vaccination in the Workplace | CDC. (2019, April 16). Retrieved June 26, 2019, from

Schmid, P., Rauber, D., Betsch, C., Lidolt, G., & Denker, M. (2017). Barriers of

Influenza Vaccination Intention and Behavior – A Systematic Review of Influenza

Vaccine Hesitancy, 2005 – 2016. Plos One,

12(1).doi:10.1371/journal.pone.0170550


Umichmedicine. (n.d.). Does an 'echo chamber' of information impede flu vaccination for

children? Retrieved June 20, 2019, from https://www.eurekalert.org/pub_releases/2018-


6 flu deaths among kids reported in Canada | CBC News. Retrieved June 15, 2019, from CBC website: https://www.cbc.ca/news/health/flu-1.4975466


 
 
 

コメント

bottom of page