Background
Methods
Study setting and population
No. | Codea | Age range (years) | Education level | Children | Duration of stay in Poland (years) | Back-and-forth travels b | Reported vaccination refusals (participant/children) and vaccinations |
---|---|---|---|---|---|---|---|
GROUP 1 | |||||||
1 | 9.1 | 31–40 | Secondary education | Yes | 4 | 1 | Participant fully vaccinated in Ukraine aside from BCG vaccination declined. Children fully vaccinated in Ukraine. |
2 | 2.2 | 31–40 | Secondary education | Yes | 4 | 1 | Participant fully vaccinated in Ukraine aside from BCG vaccination declined. Children fully vaccinated in Ukraine aside from BCG vaccination declined. |
3 | 8.1 | 18–20 | Secondary education | Yes | 2 | 1 | Participant declined some early vaccinations in Ukraine. Child fully vaccinated in Poland. |
4 | 6.1 | 21–30 | University degree | No | 3 | 1 | Participant fully vaccinated in Ukraine. |
5 | 5.1 | 21–30 | University degree | No | 3 | 1 | Participant fully vaccinated in Ukraine. |
6 | 1.2 | 21–30 | Bachelor’s degree | No | 3 | 1 | Participant fully vaccinated in Ukraine. |
7 | 6.2 | 31–40 | University degree | Yes | 4 | 1 | Participant fully vaccinated in Ukraine. Child born in Ukraine, fully vaccinated there/in Poland. |
GROUP 2 | |||||||
8 | 7.1 | 21–30 | Secondary education | No | 2 | 1 | Participant declined measles and hepatitis B vaccinations in Ukraine. |
9 | 2.1 | 18–20 | Secondary education | No | < 1 | 0 | Participant fully vaccinated in Ukraine. |
10 | 3.1 | 31–40 | Secondary education | Yes | 1 | 1 | Participant fully vaccinated in Ukraine. Child born in Ukraine, lives in Poland, fully vaccinated in Ukraine. |
11 | 1.1 | 21–30 | Secondary education | No | 1 | 1 | Participant fully vaccinated in Ukraine. |
12 | 10.1 | 21–30 | Vocational education | No | < 1 | 3 | Participant fully vaccinated in Ukraine. |
13 | 4.1 | 31–40 | Secondary education | Yes | < 1 | 1 | Participant fully vaccinated in Ukraine. Children born in Ukraine, live in Poland, fully vaccinated in Ukraine. |
GROUP 3 | |||||||
14 | 5.2 | 21–30 | Secondary education | No | 2 | 1 | Participant declined some early vaccinations in Ukraine. |
15 | 11.2 | 21–30 | Vocational education | No | < 1 | 0 | Participant did not remember if declined some early vaccinations in Ukraine. |
16 | 9.2 | 31–40 | University degree | No | 4 | 0 | Participant declined some early vaccinations in Ukraine. |
17 | 4.2 | 21–30 | Secondary education | Yes | 20 | 1 | Participant fully vaccinated in Ukraine. Child fully vaccinated in Poland. |
GROUP 4 | |||||||
18 | 8.2 | 21–30 | Secondary education | Yes | 2.5 | 4 | Participant declined some early vaccinations in Ukraine. Child born in Ukraine, still lives there, fully vaccinated. |
19 | 7.2 | > 40 | Bachelor’s degree | Yes | < 1 | 1 | Participant fully vaccinated in Ukraine. Children born in Ukraine, still live there, fully vaccinated. |
20 | 12.2 | 31–40 | Secondary education | Yes | 2 | 2 | Participant fully vaccinated in Ukraine. Child born in Ukraine, still lives there, did not receive some early vaccinations. |
21 | 10.2 | 31–40 | Vocational education | Yes | 2 | 1 | Participant declined some early vaccinations in Ukraine. Children born in Ukraine, still live there, and did not receive early vaccinations. |
22 | 3.2 | 21–30 | Vocational education | Yes | < 1 | 1 | Participant fully vaccinated in Ukraine. Child born in Ukraine, still lives there, fully vaccinated. |
Data collection
Analysis
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Vaccine delivery and PHC access\
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Trust in state structures, quality of healthcare and vaccination policies
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Trust in the vaccination provision
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Trust in the vaccines provided (safety/quality/importance)
Results
Factors affecting vaccine uptake, delivery and PHC access
Vaccine delivery and PHC access
“A GP asked about my child’s vaccination record. She did not understand what was written there, so she asked a senior doctor. They figured out that my child had been vaccinated correctly.” (#4, Group 2)
"For 4 days I was trying to get an appointment in the clinic, they did not have time to examine me. They kept saying “come the next day. We do not know what to do then, where to go.” (#6, G1)
“I called him [a dentist] from Poland to make an appointment, to get in the queue, because it’s cheaper there. I go privately because the state-provided care is not any good.” (#9, G3)
“Either we or someone from the family travels with a child to Ukraine for an annual check-up.” (#5, G1)
Participants advocated more vaccination information being available in Ukrainian language through different means.“Information about vaccines should be provided through the Internet, because everyone is on Facebook. Some advertisements need to be there.” (#1, G2)
“A doctor would be the most trustworthy. He should cover a lot of information: what sort of vaccination is it, where it comes from, what side effects might be developed, etc… A doctor and, for example, a person who has already been vaccinated. Or a person who got sick due to the lack of vaccination.” (#2, G2)
“Information about measles vaccination was easy to find everywhere - at the Town Hall and the Provincial Migration Office. It was hanging on all doors. What is it, why is it important. In Polish, Ukrainian, even in English.” (#1, G1)
Trust in state structures, quality of healthcare and vaccination policies
“They are buying a cheaper substitute for a vaccine, on this basis we do not really know what we get in this vaccine. Is there saline or something else?” (#4, G3)
“Many people do not believe what they are told about vaccines. My friends are afraid that they are carrying out experiments on us. They [the government] are crooks, they steal all the time.” (#9, G3)
“These vaccines are for the companies that produce them to make a lot of money, so people think.” (#5, G3)
“It was blown out on television… showing children who died after vaccination.” (#4, G3)
“There was a programme where they said that there were some cases when a child dies. So people are afraid.” (#5, G3)
“In one TV programme the Minister of Health said it [vaccination] was necessary and showed that he was doing it. He said that you had to vaccinate your children.” (#8, G4)
Trust in the vaccination provision
“I think there are cases that people can die, but it can be, for example, the fault of the doctor – they do not carry out thorough examinations, they do not check the child's condition, although there might be some contraindications [for vaccination]. But in general, vaccines help people and they need to be given.” (#9, G3)
"In Ukraine when we went to the GP clinic with the child - the doctor did not carry out a thorough examination. The child could have been ill, though this seemed unimportant. The doctor said: “Do it today, because we do not know when the next vaccine supply will arrive.” (#9, G1)
“Everyone can be a doctor in Ukraine, because you may pay, then buy and have a diploma. I have more confidence in the doctors in Poland, they are trained, and they study medicine for several years.” (#9, G3)
“Where I live, when you go to the doctor, he does not see a sick person, he wants to get as much money as possible from you.” (#7, G4)
“They [doctors] say: Give us money and we will sell you a better product. If there is a thorough control over doctors, it would not be possible. But there is no control and money goes to them.” (#10, G2)
“You can go to the GP clinic, to the hospital, give a bribe and they will write that all vaccinations have been completed and the child can go to school.” (#10, G3)
“If you pay you can get it [vaccination].” (#9, G1)
Confidence in the vaccines provided (vaccination safety/quality/effectiveness/importance)
“I think vaccines are safer in Poland than in Ukraine.” (#7, G1)
“In the EU the quality of vaccines is better.” (#8, G1)
“Ukrainians don't trust vaccines. They think the vaccines are not safe and don't help.” (#12, G4)
“My friend, an Ukrainian mother of a young child follows the vaccination program here in Poland. But she did not vaccinate her child while they were living in Ukraine. There are lots of mums like her.” (#1, G2)
“My brother received all vaccinations here, in Poland, he has not been vaccinated in Ukraine. He felt well after receiving vaccinations.” (#2, G2)
“My friend took her neonate child to the vaccination unit. Her colleague who was a paediatrician and was working there, warned her not to immunize a child against poliomyelitis due to the poor quality of a vaccine. When my child was born I refused to vaccinate him with that vaccine. I told my GP the story I’d heard before. She did not vaccinate him, however she made a note that he was vaccinated.” (#5, G1)
"They produce everything in Odessa, in Ukraine, but they can give vaccines false labels, like “produced in Germany” or “produced in England.” (#9, G3)
“We have a lot of black market vaccines.”(#6, G1)
“In our village three children aged about 1 year were given vaccines and died. The vaccines were poorly stored, and out of date. After that, everyone stopped vaccinating children.” (#8, G1)
“They keep vaccines in a regular fridge, in which a vaccine and a doctor's sandwich is kept.” (#3, G2)
“The vials are left opened after administration for 2-3 days after which other children are vaccinated with the same vial. A child could be vaccinated on the third day [from the same vial], and could become sick. There have been many reports of this kind of behaviour. Therefore, there are refusals”. (#9, G1)
“A friend came for a vaccination to the doctor, they gave her child a bad vaccine and it was sick. But you could pay and the child would get a better vaccine.” (#9, G1)
“Good-quality vaccines are being sold for money.” (#2, G2)
“I have two children, they live here. They were vaccinated here and they feel good. When my sister was at their age she was vaccinated, and then she was sick even more than before vaccination, my mother told me.” (#1, G2)
Some vaccines were considered less important than others and it was a common argument that there is no uptake of self-founded vaccines in Ukraine due to their costs, low salaries and difficult life conditions.“Vaccinations are better here because there is a regulation.”(#11, G3)
“People in Ukraine do not earn enough, it is better to spend money on life. Everyone thinks what he will eat tomorrow, therefore, he does not think about [self-founded] vaccines at all.” (#7, G4)
“I wouldn't get vaccinated against flu in Ukraine. It's better to take a lemon, I would figure out some natural things, it's safer than risking my health and have experiments made on me”. (#1, G1)
“I was pregnant, I had the flu but I didn't hear about any vaccination from the doctor.” (#8, G1)
“If I had heard about it [HPV vaccine] earlier, I might get my daughters vaccinated.” (#2,G1)
“I haven't heard anyone in Ukraine at school, on television talking about HPV vaccination.” (#4, G2)