title: Community awareness, use and preference for pandemic influenza vaccines in Pune, India.
abstract: Vaccination is a cornerstone of influenza prevention, but limited vaccine uptake was a problem worldwide during the 2009-2010 pandemic. Community acceptance of a vaccine is a critical determinant of its effectiveness, but studies have been confined to high-income countries. We conducted a cross-sectional, mixed-method study in urban and rural Pune, India in 2012-2013. Semi-structured explanatory model interviews were administered to community residents (n = 436) to study awareness, experience and preference between available vaccines for pandemic influenza. Focus group discussions and in-depth interviews complemented the survey. Awareness of pandemic influenza vaccines was low (25%). Some respondents did not consider vaccines relevant for adults, but nearly all (94.7%), when asked, believed that a vaccine would prevent swine flu. Reported vaccine uptake however was 8.3%. Main themes identified as reasons for uptake were having heard of a death from swine flu, health care provider recommendation or affiliation with the health system, influence of peers and information from media. Reasons for non-use were low perceived personal risk, problems with access and cost, inadequate information and a perceived lack of a government mandate endorsing influenza vaccines. A majority indicated a preference for injectable over nasal vaccines, especially in remote rural areas. Hesitancy from a lack of confidence in pandemic influenza vaccines appears to have been less of an issue than access, complacency and other sociocultural considerations. Recent influenza outbreaks in 2015 highlight a need to reconsider policy for routine influenza vaccination while paying attention to sociocultural factors and community preferences for effective vaccine action.
authors.affiliation: a Department of Epidemiology and Public Health ; Swiss Tropical and Public Health Institute ; Basel , Switzerland.|b University of Basel ; Basel , Switzerland.|c Saw Swee Hock School of Public Health; National University of Singapore; National University Health System ; Singapore , Singapore.
authors.forename: Neisha
authors.initials: N
authors.lastname: Sundaram
authors.affiliation: d Centre for Health Research and Development; The Maharashtra Association of Anthropological Sciences ; Pune , Maharashtra , India.|e Savitribai Phule Pune University ; Pune , Maharashtra , India.
authors.forename: Vidula
authors.initials: V
authors.lastname: Purohit
authors.affiliation: a Department of Epidemiology and Public Health ; Swiss Tropical and Public Health Institute ; Basel , Switzerland.|b University of Basel ; Basel , Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Schaetti
authors.affiliation: d Centre for Health Research and Development; The Maharashtra Association of Anthropological Sciences ; Pune , Maharashtra , India.|e Savitribai Phule Pune University ; Pune , Maharashtra , India.
authors.forename: Abhay
authors.initials: A
authors.lastname: Kudale
authors.affiliation: d Centre for Health Research and Development; The Maharashtra Association of Anthropological Sciences ; Pune , Maharashtra , India.|e Savitribai Phule Pune University ; Pune , Maharashtra , India.
authors.forename: Saju
authors.initials: S
authors.lastname: Joseph
authors.affiliation: a Department of Epidemiology and Public Health ; Swiss Tropical and Public Health Institute ; Basel , Switzerland.|b University of Basel ; Basel , Switzerland.
authors.forename: Mitchell G
authors.initials: MG
authors.lastname: Weiss
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007194:India; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012424:Rural Population; D014505:Urban Population; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines
keywords: India; community study; influenza; mixed-methods; pandemic; vaccine hesitancy; vaccine uptake