A paper in Vaccine X presents the result of a study exploring adult vaccination attitudes and practices by physicians in the United Arab Emirates (UAE) around the time that the COVID-19 vaccines were introduced. The authors suggest that across the Arab region, attitudes towards vaccines “vary”; however, “high rates of vaccine hesitancy” have been identified.
The study was a cross-sectional, descriptive study that used convenience and snowball sampling for data from physicians. The two stages of the study were between June and October 2020 and between November 2022 and March 2023. The authors conclude that, although physicians have “overly positive” attitude, their practices reflect a “more superficial appreciation of vaccines and lack of initiative”.
“Physicians need to adopt a pro-vaccine stance, armed with the proper tools and the right mentality and beliefs.”
An underutilised achievement
“Being one of public health’s greatest achievements, vaccination remains underutilised in all corners of the globe. Behind this lies no simple reason, but some combination of a lack of availability, non-negligible level of distrust, lax immunisation laws, and structural limitations.”
The authors acknowledge that, prior to the introduction of the COVID-19 vaccines, WHO had already classified ‘vaccine hesitancy’ as a top ten global health threat. While we might be (reasonably) concerned about the effects this will have on children and infants, the paper claims that “the situation gets even more dismal” for older populations; a $7.1 billion economic burden has been attributed to unvaccinated adults contracting Vaccine Preventable Diseases (VPDs) in the US.
In response to the “various causes of hesitancy” a “huge effort” has been, and is being, made, much of which is executed through education. The study authors state that physicians play a “key role in patient education”, yet previous research has found “poor knowledge” and “unclear and outdated guidelines” for the UAE. The population of the UAE is characterised as “young” and growing, which will “shift priorities in healthcare services” and cause an increase in healthcare costs. Therefore, the study seeks to “explore and elucidate gaps” in the UAE physicians’ adult vaccination attitudes and practices before and after the introduction of the COVID-19 vaccines.
What does the study find?
The authors collected 1000 responses over the two iterations, with results showing an “overwhelmingly positive attitude and trust towards vaccines, their efficacy, and importance”.
“However, digging deeper, it becomes clear that physicians are facing a number of issues with their patients, specifically with regards to proving, communicating, and assuring them of the vaccines’ safety and effectiveness.”
Over half of the physicians reported a “positive” change of attitudes during the pandemic. 90% support national campaigns to “promote and encourage” vaccination, results that are reflective of global literature. However, this gives an incomplete impression of attitudes compared to practices. Indeed, in the study, “contradictory attitudes and practices emerged”, with vaccine recommendation rates varying between up to 60% and 30% for some vaccines.
Several respondents cited a “lack of awareness” of the recommendations or “lack of responsibility” for promoting various vaccines. Notably, influenza was perceived as a “harmless disease” by “nearly a tenth of the participants”, again echoing other studies in different regions.
Putting perception into practice
The study finds “clear gaps” in preventative and vaccination gaps, as well as patient education.
“Family medicine doctors showed the highest utilisation of preventative practices explored, yet even they had low rates of vaccination practices with nearly half of them not regularly evaluating the need for adult vaccination.”
Another result of the survey is that the participating physicians “did not view adult vaccination as a general physician duty”, instead attributing it to family physicians and internists. Furthermore, they reported “difficulties” evaluating immunisation status and recommending vaccines with “high refusal rates”.
“The lack of time for vaccine education was clear, with the majority dedicating 1-2 min, if any, to healthy young adults for vaccine discussions.”
What can be done?
Although the surveyed physicians had “outright overwhelmingly positive attitudes”, there was a “level of vaccine hesitancy” in their safety, effectiveness, or necessity concerns and a “general level of complacency and lack of ownership”.
“For physicians to be able to communicate vaccines’ safety and effectiveness clearly, they need to be confident about the safety and effectiveness themselves.”
Thus, the authors encourage the promotion and cultivation of a “culture of adult vaccination”, particularly as patients who are susceptible to VPDs, including paediatrics-dominant illnesses like measles or rubella, can experience “much more severe outcomes”. Furthermore, when physicians may be inclined to promote vaccines, they can encounter “severe vaccine hesitancy” from patients.
“Further work can also look at the effectiveness of dialogue-based resources in supporting the physicians improve their vaccination practices given their wide-spread usage in other countries; such resources will also need translation into other more commonly used languages locally such as Arabic, Urdu, and Hindi.”
The conclusion refers to a “complacent culture” that has “plagued” adult vaccination systems and is reflected in “superficial” practices by physicians. How can this be driven and supported? Adult vaccination is a topic of great interest at the Congress in Washington this April, so if you’d like to join the discussion do get your tickets here or subscribe for more insights.
