g. HPV or TT). Even if there had been reports of vaccine hesitancy in their country, 11 of the 13 IMs considered that vaccine hesitancy was not common and that it did not have a significant impact

on vaccine uptake in the routine immunization programmes. IMs from two countries BYL719 order indicated that mass immunization campaigns, rather than routine immunization programmes, were affected by vaccine hesitancy. However, two IMs stated that vaccine hesitancy was an important issue in their country. When IMs were asked about the percentage of non-vaccinated and under-vaccinated individuals in their country due to lack of confidence in vaccination, only six provided estimates ranging from GPCR & G Protein inhibitor less than 1% to 20% (Table 2). Four IMs reported issues of complacency in their countries (Table 2). As an example, one IM cited a particular indigenous group which had refused vaccination because vaccination programme

activities coincided with a cultural event. Four IMs stated that complacency was not a problem in their countries because immunization was perceived as a priority by most of the population. Factors concerning convenience and ease of access were perceived to be important by nine of the IMs (Table 2). Convenience was a factor for sub-populations which did not use the health services provided and for hard-to-reach populations. For instance, in one country, more than 25% of the population had no access to health services and access was difficult for immigrants, refugees, nomad populations, those living in remote areas, and for women (mainly because of the socio-norms that require them be accompanied for travel to obtain health care). Fig. 1 summarizes the opinions of IMs regarding the main determinants of vaccine hesitancy in the Working Group matrix. Religious beliefs were often a causal factor in vaccine hesitancy (cited by nine IMs). Several IMs were able to specifically identify religious groups in their country that were known to be opposed to all vaccines, while others discussed “religious reasons” without specifying

a religion or a group. Religious beliefs were usually linked of to refusal of all vaccines, except in one country, where there were specific problems of acceptance of the HPV vaccine among Catholic groups. Other groups in which vaccine hesitancy was encountered included ethnic or indigenous groups, people of higher socioeconomic status, well-educated people and people living in urban areas. One IM indicated that the older generation was more hesitant than the younger generation, and another found that women were more hesitant than men. The actual problem is vaccine refusal due to religious beliefs. This religion is apostolic. They are reluctant to bring their children to the hospital [for immunization] (Country B).