Nurses' Perceptions Of MMR Vaccine Hesitancy In An Area With Low Vaccination Coverage

"Interventions to combat vaccine hesitancy can...only be effective if issues of trust and open communication are addressed."

Child Health Clinics (CHCs) in Rinkeby and Tensta in the Northern part of Stockholm, Sweden have reported low measles, mumps, and rubella (MMR) vaccine coverage since the late 1990s, when Andrew Wakefield published an article in the Lancet, later retracted, on a presumptuous link between autism and the MMR vaccine. The aim of this project was to explore the perceptions, views, and experiences of CHC nurses related to vaccine hesitancy among parents in Rinkeby and Tensta.

Eleven in-depth interviews were conducted in Swedish with female nurses who were directly responsible for vaccination programmes. Four themes emerged:

• The nurses reported that in their experience most parents who declined to have their children vaccinated with the MMR vaccine were of Somali origin. The nurses reported that the Somali community has a large social circle, and religion did not appear to be a driver of vaccine hesitancy. All of the nurses believed that the women in the community were telling each other to avoid vaccines.
• The nurses reported that this group is specifically hesitant towards the MMR vaccine, which they believe is closely linked to autism. The nurses reported they had heard most of the stories related to autism being spread by the women in the community.
• The nurses said some of the Somali parents confused MMR with the other vaccines within the vaccination programme and that they have started refusing the third dose of diphtheria, tetanus, pertussis, polio, and Hib (Haemophilus influenzae bacteria type b) vaccine due to fears of autism.
• During the course of the interviews, it emerged that some of the parents do not accept any vaccines. Although they were reported to be few, these parents believed that the diseases are not so dangerous. The majority of these parents were actually well informed about how vaccines work, but still not willing to vaccinate.

These results highlight the importance of the family and peer group in spreading the autism myth and how grandmothers, in particular, can impact Somali parents' confidence in the vaccine. Hesitant parents in this community tend to mistrust the nurses providing the vaccines, judging by the expressed fear that the nurses would trick them into accepting a vaccine that might harm their children.

In this context, the researchers recommend tailoring vaccination programmes to the local context so as to address the Somali community's particular concerns.