Knowledge, Attitudes and Beliefs about Vaccination in Primary Healthcare Workers Involved in the Administration of Systematic Childhood Vaccines, Barcelona, 2016/17

"In a time where other sources of information could potentially outweigh the importance of primary healthcare workers, it is crucial that those involved in the systematic administration of childhood vaccines are equipped with the skills and resources needed to manage the growing issue of VH."

Given that vaccine hesitancy (VH) has been described among European vaccine providers and that healthcare professionals (HCPs) have been identified an impactful source of information on vaccination, it is important to address the loss of confidence in vaccines in this population. Thus, the Public Health Agency of Barcelona (ASPB) launched in 2016 a line of research to monitor VH in HCPs and study its determinants in Barcelona. The main objective of this study was to describe the knowledge, attitudes, and beliefs about vaccines among professionals who are directly involved in the administration of systematic childhood vaccines in the public health system of the city.

This investigation is an observational cross-sectional study consisting of data collected through a structured survey. Of the 342 paediatric health professionals in Barcelona's public primary care centres (PCCs), 277 (81%) participated in the study; 136 were paediatricians, 138 were paediatric nurses, and 3 were not defined.

Seventy-one (25.6%; 95% confidence interval (CI): 20.8-31.1) had doubts about at least one of the vaccines in the current vaccination calendar. Respondents reported the most doubt regarding the human papillomavirus (HPV) and varicella vaccines. Thirteen (4.7%) respondents felt that it would be impossible for an unvaccinated and unimmunised child to contract polio, and 198 (71.5%) responded that it is probable or very probable for an unvaccinated child to contract HPV. All vaccines were reported to be safe, with the exception of the HPV vaccine, which was described as dangerous by one participant and unsafe by 14 (5%).

Of the 277 who participated, 269 (97.1%) believed that the child receiving the vaccine benefits considerably/benefits a lot from vaccination, 267 (96.4%) believed that the community benefits considerably/benefits a lot, 256 (92.4%) believed that health personnel benefit considerably/benefit a lot, 253 (91.3%) believed that the government benefits considerably/benefits a lot, and 244 (88.1%) believed that the pharmaceutical industry benefits considerably/benefits a lot. A total of 262 (94.6%) participants reported that the people in their immediate environment were in favour of vaccination.

Those with vaccine doubts chose the VH response option for every single key vaccine belief, knowledge, and social norm. Of those who had doubts about at least one vaccine in the current vaccination calendar, 60% responded that they believed that the current vaccines in the calendar were influenced by illegitimate governmental interests (p=0.029). Similarly, of those who had vaccine doubts, 69% reported believing that the current vaccination calendar was influenced by illegitimate pharmaceutical interests (p=0.004).

Twenty-five (12.8%) participants who reported having children felt worried that children's immune systems could be weakened from receiving too many vaccines, and 65 (33%) of these same respondents believed that at least one vaccine in the current calendar is administered too early. Ten (3.6%) participants did not believe that thanks to scientific research, vaccines are increasingly better and more effective.

Overall, 81 (29.2%) of the 277 HCPs responded that they felt they did not have sufficient information and training to adequately answer questions VH parents may have. The majority of respondents wished to receive more information about vaccines online 145 (52.3%) and through training sessions 139 (50.2%).

Thus, the conclusion can be drawn that HCPs administering vaccines to children in the public health system in Barcelona are lacking crucial information about vaccine components, contraindications, and critical general vaccine knowledge. The researchers stress that improving vaccine knowledge among these professionals is crucial for guiding VH parents and recommending vaccination. To this effect, new and improved training workshops and information material need to be made available as continued education to these HCPs.

Myths could become part of the belief structure of a society, and the results suggest that the environment has already influenced the surveyed professionals in the same way as it does VH families. Addressing this aspect would require working within the socio-cultural context; there are risks associated with focusing only on vaccine uptake rates and overlooking the underlying attitudes and beliefs associated with VH.