Elsevier

Vaccine

Volume 29, Issue 38, 2 September 2011, Pages 6472-6484
Vaccine

Review
Factors associated with uptake of vaccination against pandemic influenza: A systematic review

https://doi.org/10.1016/j.vaccine.2011.06.107Get rights and content

Abstract

Background

In June 2009 a global influenza pandemic was declared by the World Health Organisation. A vaccination programme against H1N1 influenza was introduced in many countries from September 2009, but there was low uptake in both the general population and health professionals in many, though not all, countries.

Purpose

To examine the psychological and demographic factors associated with uptake of vaccination during the 2009 pandemic.

Method

A systematic literature review searching Web of Science and PubMed databases up to 24 January 2011.

Results

37 articles met the study inclusion criteria. Using the framework of Protection Motivation Theory the review found that both the degree of threat experienced in the 2009 pandemic influenza outbreak and perceptions of vaccination as an effective coping strategy were associated with stronger intentions and higher uptake of vaccination. Appraisal of threat resulted from both believing oneself to be at risk from developing H1N1 influenza and concern and worry about the disease. Appraisal of coping resulted from concerns about the safety of the vaccine and its side effects. There was evidence of an influence of social pressure in that people who thought that others wanted them to be vaccinated were more likely to do so and people getting their information about vaccination from official health sources being more likely to be vaccinated than those relying on unofficial sources. There was also a strong influence of past behaviour, with those having been vaccinated in the past against seasonal influenza being more likely to be vaccinated against pandemic influenza. Demographic factors associated with higher intentions and uptake of vaccination were: older age, male gender, being from an ethnic minority and, for health professionals, being a doctor.

Discussion

Interventions designed to increase vaccination rates could be developed and implemented in advance of a pandemic. Strategies to improve uptake of vaccination include interventions which highlight the risk posed by pandemic influenza while simultaneously offering tactics to ameliorate this risk (e.g. vaccination). Perceived concerns about vaccination can be tackled by reducing the omission bias (a perception that harm caused by action is worse than harm caused by inaction). In addition, interventions to increase seasonal influenza vaccination in advance of a future pandemic may be an effective strategy.

Section snippets

Background

A new strain of H1N1 influenza (sometimes referred to as swine flu) was identified in Mexico in April 2009 and spread to over 100 countries around the world, causing the World Health Organization (WHO) to declare a global flu pandemic on 11 June 2009. Vaccines based on the new virus (pandemic vaccines) were rapidly developed and introduced progressively between September and December 2009 in more than 75 countries. Many of these countries had default vaccination programmes some of which, based

Methods

Web of Science and PubMed were searched on 23rd and 24th January 2011 with no time period restrictions using the following search terms: Uptake vaccin* pandemic; Intervention vaccin* pandemic; Pre-pandemic vaccin*; Attitudes vaccin* pandemic; Multiple dose vaccin* pandemic; Emotion vaccin* pandemic; Anxiety vaccin* pandemic; Belief vaccin* pandemic; Uptake vaccin* influenza; Uptake vaccin* H1N1; Uptake vaccin* H5N1; Intention vaccin* influenza; Intention vaccin* H1N1; Intention vaccin* H5N1;

Results

The search identified 4051 papers. 37 were retained as meeting the study inclusion criteria (see Fig. 1). Table 1 shows the studies included in the review. Thirty-four studies were about H1N1 vaccination and three were about both H1N1 and seasonal influenza vaccination. Nineteen examined associations with reported intentions to be vaccinated, three examined associations with intentions and behaviour and 15 examined associations with behaviour. Thirty-six studies were quantitative cross

Discussion

It is clear that many of those to whom the vaccine against the H1N1 pandemic influenza was offered were not willing to be vaccinated during the vaccination programmes. Consistent with Protection Motivation Theory, this review has found that both the degree of threat experienced in the 2009 pandemic influenza outbreak and perceptions of vaccination as an effective coping strategy were associated with stronger intentions and higher uptake of vaccination. Appraisal of threat resulted from both

Acknowledgements

Contributors: Dr Alison Bish carried out the review and prepared the article for publishing. Prof Lucy Yardley and Prof Susan Michie contributed to drafts of the article. Prof Angus Nicoll provided expert advice on the vaccination programme and experience across Europe and provided critical comments on the article. All authors have approved the final article. Funding: The UK Department of Health commissioned this research but did not have a role in the decision to publish the work.

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