Acceptance and feasibility of school-based seasonal influenza vaccination in Singapore: A qualitative study

• Published in: Vaccine Vol. 38; no. 7; pp. 1834 - 1841
• Main Authors: Offeddu, Vittoria, Low, Mabel Sheau Fong, Surendran, Shilpa, Kembhavi, Gayatri, Tam, Clarence C
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 11.02.2020; Elsevier Limited
• Subjects: Acceptability; Age; Child; Child care; Child, Preschool; Children; Children & youth; Cost control; Disease transmission; Education; Feasibility Studies; Health services; Humans; Immunization; Immunization Programs; Infectious diseases; Influenza; Influenza vaccine; Influenza Vaccines - administration & dosage; Influenza, Human - prevention & control; Interviews; Logistics; Parents; Parents & parenting; Qualitative research; School Health Services; School-based vaccination; Schools; Singapore; Teaching; Vaccination; Vaccines; Singapore; PP; Par; MoH; PriPD; GP; PY; IDI; PubPD; Influenza; SIVP; IDS; HPB; Influenza vaccine; School-based vaccination
• ISSN: 0264-410X; 1873-2518
• DOI: 10.1016/j.vaccine.2019.12.020

•School-based influenza vaccination is most feasible in older children in Singapore.•A free or subsidised vaccination programme would achieve the highest coverage.•Public education campaigns may help increase acceptance of school-based vaccination.•Better evidence is required to justify school-based influenza vaccination locally. Influenza is a major cause of disease in children. School-based seasonal influenza vaccination can be a cost-effective tool to improve vaccine uptake among children, and can bring substantial health and economic benefits to the broader community. The acceptance and feasibility of school-based influenza vaccination are likely to be highly context-specific, but limited data exist from tropical settings with year-round influenza transmission. We conducted a qualitative study to assess acceptability and feasibility of a school-based seasonal influenza vaccination programme in Singapore. We conducted qualitative in-depth interviews with key stakeholders, including healthcare professionals, representatives of relevant ministries, preschool principals and parents to understand their perspectives on a proposed school-based seasonal influenza vaccination programme. Interviews were transcribed verbatim and analysed using thematic analysis. We conducted 40 interviews. Although preschool-aged children are currently the recommended age group for vaccination, stakeholders suggested introducing the programme in primary and/or secondary schools, where existing vaccination infrastructure would facilitate delivery. However, more comprehensive evidence on the local influenza burden and transmission patterns among children is required to develop an evidence-based, locally relevant rationale for a school-based vaccination programme and effectively engage policy-makers, school staff, and parents. Extensive, age-appropriate public education and awareness campaigns would increase the acceptability of the programme among stakeholders. Stakeholders indicated that an opt-out programme with free or subsidised vaccination would be the most likely to achieve high vaccine coverage and make access to vaccination more equitable. Overall, participants were supportive of a free or subsidised school-based influenza vaccination programme in primary and/or secondary schools, although children in this age group are not currently a recommended group for vaccination. However, a better informed, evidence-based rationale to estimate the programme’s impact in Singapore is currently lacking. Extensive, age-appropriate public education and awareness campaigns will help ensure full support across key stakeholder groups.