HESITANCY TO VACCINATE AMONG DOCTORS AND PATIENTS
“Hesitancy in terms of immunizations: Basic elements and Bulgaria’s position at the global map” was the
topic of doctor Savina Stoitsova expert in infectious and parasitic diseases. Research is part of the
surveys under project with № KP-06-OPR03/15 dated 19.12.2018, “Children’s immunizations: challenge
for the modern Bulgarian society (Research of issues in communication between paediatricians and
parents for putting down adequate measures in order to improve immunization coverage in Bulgaria”.
Vaccines and immunization programs are among the major successes of public health, Stoitsova noted.
“Indeed, vaccines are among the greatest successes and hesitancy has been present since the
occurrence of vaccines themselves.”
Doctor Stoitsova noted that in 2019 the WHO ranked hesitancy towards immunizations in the list of the
10 greatest threats to mankind globally.
According to the report by the WHO on immunization coverage in Bulgaria it is noted that the MMR
vaccine (vaccine against measles, parotitis and rubella) had 95 % coverage in 2011 which is at the
lower coverage limit recommended for good collective immunity. In the years to come even greater
decline was noted whereas in 2018 the coverage was 93 %. Consequently, the COVID-19 pandemics in
2020 brought even more worrisome results – the coverage during this period was 88 %, and in 2021 –
89 %.
What happens if the immunization coverage is low? Doctor Stoitsova reminded us of two cases in
Bulgaria that obviously state the damages from hesitancy in terms of vaccines.
In the period of 2009-2011 we observed measles outburst whereas the registered cases were 24 364. In 2017 there was a new measles outburst that was smaller (165 cases).
Stoitsova showed Bulgaria’s ranking in terms of the immunization coverage on the European map –
Bulgaria ranks last at present (as of 16.06.23).
At the same time, our country ranks among the first ones when it comes to mortality rates due to
COVID-19 per 100 000 persons of the population, i.e. Bulgaria has very serious problem with this
disease and nevertheless immunization coverage is very low compared to the other EU member-states.
The refusal to vaccinate is not synonymous to hesitancy that covers the spectrum between acceptance
and total refusal to vaccinate”, doctor Savina Stoitsova highlighted.
Hesitancy could be there where one accepts them and there where one denies them, she reminded.
MEASUREMENT OF THE TRUST LEVEL IN VACCINES AMONG GENERAL PRACTITIONERS IN BULGARIA
“Measurement of trust level in vaccines between general practitioners in Bulgaria” was the topic presented by the other lecturer at the event – doctor Vanya Rangelova, doctor of medicine, chief assistant, department “Epidemiology and medicine of emergencies”, Medical university – Plovdiv. Within the context of smooth immunization coverage lowering with some of the mandatory vaccines in Bulgaria before the COVID-19 pandemics, followed by very low immunization coverage with vaccines against COVID-19, as well as in relation to data about high hesitation towards vaccines among the population of the country, it is important to follow attitude towards vaccines not only in society in general, but among the doctors, doctor Rangelova clarified.
Opinion poll was elaborated with four main panels such as information about the participant, attitudes of the general practitioners towards vaccines of the mandatory immunization calendar, experience with vaccine-preventable diseases and communication practices and issues when working with patients.
358 are those who took part in the research. Most of them are from Sofia, whereas most of them have an individual practice. The research shows that most of the doctors have positive attitudes towards immunizations.
98 % fully agree or agree that vaccines are important to children. 98% believe that vaccines are effective and 95 % that vaccines are safe. Most general practitioners approve of the immunization calendar of Bulgaria, 97% of them, correspondingly.
Another important topic included in the research is trust in various sources of information about vaccines among Bulgarian general practitioners. 94% express trust in the information provided by the Bulgarian authorities and international expert organizations. 93% of the inquired trust the information provided by other general practitioners.
In general, doctors’ trust in the sources of information concerning vaccines in Bulgaria is high, doctor Rangelova explained.
HESITANCY AMONG PARENTS AND COMMUNICATION STYLES
“Hesitancy among parents and communication styles” was the topic presented by Veronika Dimitrova from the department “Sociology”, Sofia University. Most of the doctors have answered that they do not have enough time to spend in clarifications to the parents.
60 % of the doctors agree with the statement that they insist on getting a vaccine and over 80% inform the parents in terms of vaccines’ effectiveness. Dimitrova explained that on the grounds of the research factor analysis was performed based on results whereas 4 statements are outstanding.
Factor 1: Patient-centred model that highlights communication. This factor covers 48,6 % of the general practitioners whereas their communication model is to explain the parents the side effects of vaccines, they clarify for them the benefit of vaccines and insist on administering vaccines.
Factor 2: Doctor-centred model that highlights rejection by the practice. 27,4 % are covered by this model in which they do not accept in their practices parents who do not want to have their children vaccinated.
Factor 3: Patient-centred model that highlights awareness and responsibilization of parents. 67, 8% of the general practitioners are included in this model. They are trying to demonstrate understanding of parents’ hesitations and inform them that it is their choice to have a vaccine administered.
Factor 4: Vaccination as an administrative burden and tension in relationship. 30,2% of the general practitioners are included in this model. According to them, the parents who are hesitant and postpone vaccines mess with their work.
Doctor Viktor Iliev defined communication between doctors and patients as short circuit. One party says “doctors behave in rude and unmannered way” and the other party “patients treat us aggressively.
Nevertheless, the psychotherapist reminded us that there is something essential we do not notice. “Being a professional in one sector does not make you a person that can communicate. The patient when going to the doctor is in regression. It is because the patient is there because of some suffering, some pain. The situation is similar – as if a child going to a parent. The parent is responsible for child’s behaviour. Oftentimes the parent gets blamed for not teaching the child the right habits.” The doctor is well aware that he is also responsible for some reactions on behalf of patients, Milotinova declared.
“It is psychotherpay’s turn. If one knows him/herself, he/she exercises this process for his/her feelings – he/she would know other people’s feelings as well.“ The specialist in psychotherapy closed the event calling to the audience. It is everyone’s personal responsibility to take care after him- or herself. We cannot expect someone else to do it for ourselves.”
