Vaccinations against respiratory infections in Arabian Gulf countries: Barriers and motivators

Alqahtani, Amani S; Bondagji, Daniah M; Alshehari, Abdullah A; Basyouni, Mada H; Alhawassi, Tariq M; BinDhim, Nasser F; Rashid, Harunor

In our study, we found that the coverage rate of meningococcal vaccine was generally low but was relatively higher among "at risk" individuals compared to those who were "not at risk" (29% vs 17%) and that was expected as the recommendations were generally limited to certain individuals such as travellers to Hajj and Umrah pilgrimages, residents of Makkah and Madinah, and individuals with certain medical conditions. For the pertussis vaccine, the coverage rates in GCC countries varied very widely, from 7% in Saudi Arabia to 75% in Oman. A low uptake rate can be explained by not having a consistent pertussis vaccine recommendation for adults, except for certain groups in some countries such as HCWs and pregnant women. The surprisingly higher uptake reported among participants from Oman needs further research to validate, and if confirmed, to explore reasons for this better coverage. The results of studies from Australia and Canada revealed a coverage rate of pertussis vaccine among adults to be around 10%, despite the recommendation of Tdap for those who are likely to come in contact with children, and for pregnant women [52, 53] . Nevertheless, unfortunately findings from other studies show that public health recommendations alone are not enough to increase the vaccination rate and that several other factors need to be addressed to achieve the target level of immunisation coverage [54, 55] . One of the most important factors is physicians' recommendation in both primary health care and hospital settings, since this is a uniform finding across the studies [56, 57] . In a qualitative sense, the significance of physicians' recommendations comes from two opposing directions. Firstly, it is found to be associated with increased uptake, and secondly, from the other direction, its absence represents the most important barrier [58] . Therefore, motivating the clients for vaccination should be the physicians' priority in order to achieve a satisfactory immunisation target rate. Chan et al [59] demonstrated that a computerised reminder system telling the physicians about any patient having an indication for preventive care such as vaccinations to be an effective technique in increasing the vaccine uptake rate but it remains to be seen if such a strategy would be effective in the context of GCC countries. Another important factor that can improve the uptake rate is focused public educational campaigns [60] , which provides the public with the knowledge of the importance of vaccination and its availability. Also, the public can be given detailed information about the disease against which the vaccine offers protection including discussions on how it can be prevented or at least its severity can be lessened by obtaining the vaccine on time as affirmed by Loubet et al [61] .