Our study found that low influenza vaccination coverage in Poland was related to patients’ false beliefs and high cost of influenza vaccination.
Influenza vaccination is a safe, effective, and cost-effective method of preventing influenza infections (11
). However, the rate of influenza vaccination use in Poland is still unsatisfactory (7
). Although it was growing systematically till 2004 (data from the years 1992-2002 indicate the growth of over 200 times, up to more than 100 doses per 1000 of population) (12
), in the following years the trend was reversed, despite lack of problems with vaccination supply. In the epidemiological season 2007/08, only 9.5% of the Polish general population received the vaccine (13
). Among persons aged 65 and over, the vaccine coverage increased only from 7% in 2004 to 14% in 2007 (7
). The coverage of 13.9% of elderly people in Poland in the 2007/2008 season is the lowest of the 11 studied countries (13
). A survey conducted in university hospitals found that only 22.3% of physicians, 10.6% of nurses, and 13.4% of medical students regularly took vaccines against influenza (14
). Vaccination coverage among health care workers in Poland in the 2007/2008 season was 6.4%, the lowest among the 11 European countries studied (13
These vaccination rates place Poland far behind other European countries, where vaccination coverage reaches 25% (15
), or the USA, where in 2004/2005 season 42% of adults from high-risk groups received vaccination, as well as 62.7% of people aged over 65 years (17
). The WHO encouraged member countries to reach the vaccination level of 75% among high-risk patient groups by the year 2010, as did the European Parliament. Recently, the Council of European Union has recommended reaching 75% vaccination coverage in older-age groups as early as possible, and preferably by the 2014-2015 winter season (18
). Therefore, the need of popularizing influenza vaccination is of the uttermost importance in the Polish society, particularly in high-risk groups, such as the elderly and chronically ill, and among health care workers.
Participants in this study showed a considerable knowledge of influenza, its symptoms, ways of transmission, and complications. However, several illogicalities and misconceptions are worth pointing out. Over 90% of participants were convinced that influenza can be dangerous for health but only 42% of them believed that that the elderly were a priority population for vaccination. For 11% of participants, chronic conditions seemed to be contraindications to vaccination. Moreover, a large portion of participants could not point out any difference between influenza and other viral respiratory tract infections (common colds). Listing runny nose as a typical influenza symptom and believing that influenza vaccination was effective against all types of viral infections (almost 20% of participants) were also common misconceptions. These misconceptions are important, as in many cases, they may lower the motivation for the vaccination. This is especially important for those who had taken the vaccination before. For them, catching a different type of viral disease may prove the influenza vaccination to be ineffective. According to our study, only 60% of previously vaccinated participants had been revaccinated in the year before the survey. Therefore, there is a need for campaigns designed to increase the influenza vaccination rate in Poland that should clearly inform on the scope of influenza vaccination effectiveness and the differences between influenza and other viral respiratory tract infections.
Recent outbreak of the A(H1N1) 2009 virus (“swine flu”) and the pandemic announced by the WHO experts contributed greatly to this problem (19
). Poland was the only EU country that refused to order pandemic vaccine for its citizens (20
). The Ministry of Health announced an official statement in the Polish Parliament in which it not only underestimated the risk of the swine flu, but also questioned the effectiveness and safety of the pandemic vaccine (21
). The Poles believed that message and it went in parallel with their reluctance toward vaccination: according to the Eurobarometer study, as many as 45% of the Poles believed that the vaccination against swine flu could not protect them from the infection (22
). However, it seems that people extended that message to the regular influenza vaccination as well. Recent reports from infective season 2009/2010 prove that this “negative promotion” of influenza vaccination in the mass media was very effective: the coverage rates dropped to 6.5% of the general population (23
The most frequently mentioned reason for not taking influenza vaccination was good health. However, it is noteworthy that nearly 10% of the participants mentioned financial aspects. Similar observations were made in other studies in Poland. Kroneman et al showed that in Poland in 2004 and 2005, 34% and 36% of participants from high-risk groups, respectively, had misconceptions preventing them from receiving vaccination (ie, they believed they were “resistant to influenza”), while 24% of the participants in both years stated that they would not have a vaccination due to financial difficulties (24
). Kalinowski et al found that 37% of students did not receive vaccination due to belief in their good health and 6% due to the cost of the vaccine (25
Some authors outside of Poland believe that the lack of improvement in influenza vaccination coverage in Poland over the last few years and a constant level of patients’ false beliefs point to a lack of effective national strategy for influenza vaccination promotion (26
). The strategy should embrace free-of-charge provision of influenza vaccination, giving priority to the high-risk groups, especially the elderly (27
). The need to pay for the vaccination out of pocket is a strong discouraging factor. In the USA, it was found that introducing a fee of US $10 for a vaccine would decrease the number of vaccinated people by 1/3 (28
). At the same time, there is evidence that reimbursing costs of influenza vaccination increases vaccination coverage (29
High percentage of people who made a conscious decision not to receive influenza vaccination in this survey and a lack of belief in the effectiveness of vaccination (16.8%) indicate that benefits of influenza vaccination should be demonstrated to the public, particularly to the high-risk groups.
This survey proved that primary health settings were not only the most frequent setting where influenza vaccination takes place, but also the most frequent source of information about the need for vaccination. This does not mean, however, that further action promoting vaccination against influenza should not be conducted at this level. The experience from other countries teaches us that family physicians are those who are most capable of persuading patients to receive influenza vaccination (16
), and interventions taken at this level, including both physicians and patients, contribute to popularization of influenza vaccination (30
). Personalized invitations to vaccination at family physicians’ practices are worth applying in the national program of influenza vaccination, as they were found to be particularly effective (27
). The media, on the other hand, played hardly any role in the promotion of influenza vaccination in Poland (25
). We hope that such situation will soon change.
The obvious limitation of this study is the method used for participants’ enrolment. Although the study was performed in a number of primary health care practices in Lodzkie voivodship and the study sample corresponds well with age and sex distribution of the Polish society (), the convenience sample, with overrepresentation of large-city dwellers, did not guarantee the full representativeness of the study for the Polish population. Moreover, the survey covered the people who visited their primary care physician. Thus, it could be biased toward people with greater interest in one’s health in general and influenza vaccination in particular. We could not perform further analysis of participants’ characteristics except sex and age because almost a quarter of them did not state their occupation or stated “other” in the questionnaire. Other characteristics were not collected.
Since major reasons for low influenza vaccination coverage in Poland include patients’ false beliefs and high cost of vaccination, it is necessary to organize informational campaigns that point out the differences between influenza and other viral respiratory tract infections, as well as to make the vaccination available free of charge, especially for high-risk groups.