الگوهای قبول واقعیت واکسیناسیون

Abstract Immunization is one of the major public health interventions to prevent childhood morbidity and death. The Expanded Programme on Immunization has gathered momentum worldwide since 1974. The range of vaccines in the programme is being expanded in the years to come. All across the globe, a high level of vaccination coverage has been reached and now needs to be sustained. In part, the coverage has been made possible by the broad acceptance of vaccinations, although there are variations resulting in different configurations of fully, partially and non-immunized children. Using the results of studies carried out by the Social Science and Immunization Project in Bangladesh, Ethiopia, India, Malawi, the Netherlands and the Philippines, this article describes and discusses patterns of vaccination acceptance and non-acceptance. It shows how context affects acceptance of vaccinations, and analyses the underlying reasons behind refusal and resistance. The article also develops conceptual tools for the analysis of acceptance and non-acceptance and discusses explanatory theoretical perspectives.

Conclusion As a major global preventive disease control strategy, immunization requires considerable efforts involving new vaccines and delivery mechanisms, vaccine production and procurement, programmatic planning, and securing financial support. For the strategy to be effective in the long run, parents must continue to bring their children in for vaccination. Using results from research carried out in Bangladesh, India, The Philippine, Ethiopia, Malawi and The Netherlands in the framework of the Social Science and Immunization Project, this article has explored how vaccination acceptance and non-acceptance can be understood within the contexts of more promotive and of more prescriptive vaccination regimes. Local vaccination cultures with their own health practices, knowledge and beliefs about immunization, and past experiences with routine or campaign vaccination constitute the interpretational settings. Acceptance dynamics include the trust in biomedical technology and in the health services personnel. The results of ethnographic research show that users’ relations with the health services and users’ perceived quality of their work and personal contact style largely determine whether parents continue to have their children vaccinated. Vaccination non-acceptance situations range from individual non-attendance due to a work overload or difficulties with the accessibility of facilities, to refusal based on previously observed adverse effects. Sometimes the refusal of individual parents has a clear social or political aspect, such as local political strife or a social resistance movement. Under these conditions, in addition to vaccination cultures, an understanding of wide social and political processes is required to comprehend the prevailing gradations of acceptance.