Safety and Efficacy of Vaccinations in Patients from High-Risk Groups: New Challenges in the Era of Vaccine Hesitancy

"At a time when the level of vaccine skepticism is high and the epidemiological situation of many diseases is unstable, patients who are more susceptible to infection are particularly endangered."

Vaccine hesitancy results in the slowing of realisation of vaccination schedules even when the availability of appropriate vaccines is guaranteed. This issue is an international one; for instance, the number of patients refusing vaccinations in Poland increased more than ten-fold between 2010 and 2018 from 3,437 to 40,342. This phenomenon is a direct threat to population immunity, which requires vaccine coverage rate at the level of at least 90%. In that context, this literature review looks at communication issues around vaccination of high-risk groups in the paediatric population in Poland.

Having looked at some of the causes of vaccine hesitancy, such as widespread and unlimited access to various, often unreliable, sources of information, the article details infectious disease threats in Poland. Then, various high-risk groups are considered: vaccinations in the risk group of premature ("pre-term born") infants, children with allergic diseases, and children after bone marrow stem cell transplantation. In each group of patients with an increased risk of developing infectious diseases, vaccination recommendations include vaccination against measles, mumps, and rubella (MMR) and against varicella (VZV). As reported here, the safety of vaccinations is a priority task when creating vaccination schedules, as well as during their implementation. The medical qualification for vaccination of patients who have previously had an adverse event after vaccine administration is a particular challenge.

Author Hanna Czajka stresses that general practitioners need to have knowledge of current recommendations, contraindications to vaccination, and adverse post-vaccination reactions in order to properly implement vaccination schedules and to build confidence in vaccination among parents. Research carried out in Poland in 2017 indicates that the most common reason for refusing vaccinations was the fear of adverse events caused by vaccines. Therefore, Czajka recommends better education of parents and the provision of full, reliable information by healthcare professionals. She suggests that it is advisable to extend education programmes at the level of studies of all faculties whose graduates may have an impact on individual parents' decisions concerning vaccinations. "High level of knowledge of health care professionals and their personal positive attitude towards vaccinations are important for improving the vaccination coverage rates."

In conclusion, Czajka observes that parents of children with chronic diseases usually have greater concerns regarding vaccinations compared with the general population. Physicians should be able to explain to these parents that their child is more susceptible to infection. Knowledge about the scale of epidemiological threats and the effects of diseases that can be prevented by vaccination may promote the emergence of pro-health social behaviours. Such a conversation requires time, sufficient level of knowledge, and communication skills. Popularisation of knowledge about the clinical trials assessing safety and efficacy of vaccines is one of the ways of trust-building and active vaccine hesitancy prevention.