These leaders were associated with anti-vaccination

groups, religious groups or health professional groups. A Catholic pro-life group started the rumour that the TT administered to pregnant women only contained a contraceptive hormone that stimulates the body to produce antibodies that results to abortion or allegedly infertility in women (Country L). Causes of vaccine hesitancy linked to the “communication and media environment” were identified by five IMs. Two IMs spoke broadly about “rumours and misconceptions” regarding vaccination circulating in their country and three directly identified negative information conveyed in the mass media (television and internet) as causes Trichostatin A datasheet of vaccine hesitancy. The second important thing is all the internet see more stories. The internet is a useful thing for everybody, even for us, it is much easier to get information, but not always appropriate information. And there are a lot of stories about adverse events following immunization (Country H). Geographic barriers were identified by six IMs as factors in reducing access to vaccination services, but the association

with vaccine hesitancy was not clear. In one country, political conflicts and instability leading to poverty, internal population displacements and insecurity, could partially explain vaccine hesitancy. It is easier to mobilize the vaccination team than the population, who are only coming little by little to the clinic. The problem of distance is the programs responsibility (Country M). Finally, in one country, vaccine hesitancy was seen mainly among illegal settlers or immigrants without an official status. These individuals hesitated to use health services because of fear of being reported to the police, even though the Expanded Programme on Immunization (EPI) offers immunization with permission from the government. The main reason for vaccine hesitancy is living illegally in the country so that theydo not seek or benefit from EPI service at Public Health Clinic in order not to be reported to police (Country D). Three main determinants

Rutecarpine of vaccine hesitancy pertaining to individual and group influences were identified. Risk perceptions were identified by seven IMs as causal factors. This included concerns regarding vaccine safety, lack of perceived benefits of vaccination and lack of understanding of the burden of vaccine-preventable diseases. The new vaccine that we have recently introduced in the country was the DTap, Hepatitis B, Hib-containing pentavalent vaccine and concerns were raised around the safety of this combined vaccine (Country C). There were certain groups that were very concerned about the safety of vaccines, in particular thimerosal-containing vaccines (Country K). People’s level of trust in the health system and health-care providers was identified by four IMs as a causal factor.