Role of physician’s knowledge in routine immunization coverage

How to cite this article:
Mahapatra T. Role of physician’s knowledge in routine immunization coverage. Ann Trop Med Public Health 2013;6:564-6


How to cite this URL:
Mahapatra T. Role of physician’s knowledge in routine immunization coverage. Ann Trop Med Public Health [serial online] 2013 [cited 2020 Aug 11];6:564-6. Available from:

The process of making an individual immune or resistant to an infectious agent is defined as immunization by World Health Organization (WHO). [1] Timely immunization prevents spread of infection in general population by protecting people who receive them as well as susceptible, unimmunized persons around them through a phenomenon termed herd immunity. [2] In addition, it also increases life expectancy by reducing deaths and disabilities from vaccine-preventable diseases. [2]

Immunization is one of the most successful and cost-effective public health interventions since its very early days and the scenario is even more conclusive in the 21 st century. As per the WHO estimates, vaccines have saved more lives than any other interventions and every year near about 2-3 million deaths are averted world-wide through immunization. [1] Key public health milestones achieved by universal childhood immunization program since its inception (based on the success story of small pox vaccination) by WHO and the United Nations Children’s Fund in early 1980s are near eradication of polio-myelitis, reduction of measles deaths by 71% over 10 years (2000-2011) and possible elimination of maternal and neonatal tetanus. [3]

Despite the evidence of the benefits of immunization, it is depressing to know that globally an estimated 22 million infants did not receive routine immunizations in 2011 and nearly 50% of these infants were from India, Indonesia and Nigeria. [1] By the end of 2011, estimated national immunization coverage rates in India for (Bacillus Calmette-Guérin vaccine against tuberculosis) was 87% and for vaccines like measles, the third doses of (combination vaccine against diphtheria, pertussis and tetanus) and (oral polio vaccine) were below 75%. [4]

The major barriers of routine immunization that have been identified across prior studies are parental ignorance (in case of childhood immunizations) and inadequate supervision by health care providers. [5],[6] Although physicians play an important role in the immunization-related decision-making process for most of the individuals, they are also considered to be a common source of valid information regarding immunization for the population. Thus, the knowledge of the practitioners regarding immunization is considered to be a key factor in the pathway toward achieving universal immunization. The present study also reported lack of knowledge about routine immunization among medical officers of Karnataka and emphasized the need of a comprehensive training program on routine immunization and supportive supervision at regular intervals for achieving an effective immunization session. The perceptions of the health care providers about vaccines were also found to have a meaningful impact on immunization. Parents of under and un-immunized children in this study complained that the providers had different recommendations for shots and often delayed immunizations if their children had a minor illness. [6] Literature suggests that the motivational approach of healthcare providers like physicians, nurses and other health care professionals has a positive impact on childhood immunization and available scientific evidences also emphasize the need to build trustworthy relationships with parents. Gaining trust from parents will help in greater acceptance of and confidence in vaccines. [6]

Studies have also demonstrated that parents’ satisfaction with the quantity and quality of information received from health care providers about possible benefits and risks of vaccine is a strong predictor of success for an immunization program. [5],[7] Miscommunication arising due to confusing and inappropriately judgmental comments from health care providers have been highlighted as one of the reasons for poor immunization status of the children attending a tertiary care hospital in Delhi. [7] Available evidences in contemporary literature indicate that parents’ adherence to the routine immunization can be improved if they perceive that physicians are also inclined to share and clarify their vaccine related concerns. [8] Effective and encouraging parent-provider communications during and after routine immunization addressing possible health benefits of the vaccines, adverse-effects, their management and schedule for next visit are essential for improving parents’ compliance to immunization and thus the coverage of routine immunization programs. Parents must be counseled by healthcare providers regarding importance of childhood immunization, vaccine safety and risks of non-immunization. Physicians must also assure the parents that minor illnesses like cough, diarrhea and fever are not contradiction to routine immunization of their children.

Although several barriers of routine immunization have been mentioned in earlier studies, efforts to address these issues were unsatisfactory. Therefore, identifying these barriers specific to a particular setting will guide in developing the targeted policies to overcome such obstacles. Moreover, physicians must also take active role in recommending routine immunization to the vaccine-hesitant parents and care should be taken so that parents are willing to bring their children to them to receive the immunizations. In adition, in order to improve immunization rates, all health care providers must be educated about recommended childhood immunization schedule and places/infra-structure created to deliver these vaccines to children. A multi-pronged, collaborative information, education and communication program about routine immunization should be organized by public health researchers for improving the existing knowledge of the health care providers.



1. Immunization coverage, Fact sheet, WHO, 2013. Available from: [Last cited on 2013 Jul 31].
2. Andre FE, Booy R, Bock HL, Clemens J, Datta SK, John TJ, et al. Vaccination greatly reduces disease, disability, death and inequity worldwide. Bull World Health Organ 2008;86:140-6.
3. Immunization, UNICEF. Available from: [Last cited on 2013 Aug 01].
4. Immunization Summary, A statistical reference containing data through 2011 (The 2013 ed), UNICEF and WHO, 2013. Available from: [Last cited on 2013 Aug 01].
5. Gust DA, Kennedy A, Shui I, Smith PJ, Nowak G, Pickering LK. Parent attitudes toward immunizations and healthcare providers the role of information. Am J Prev Med 2005;29:105-12.
6. Niederhauser VP, Markowitz M. Barriers to immunizations: Multiethnic parents of under- and unimmunized children speak. J Am Acad Nurse Pract 2007;19:15-23.
7. Kumar D, Aggarwal A, Gomber S. Immunization status of children admitted to a tertiary-care hospital of north India: Reasons for partial immunization or non-immunization. J Health Popul Nutr 2010;28:300-4.
8. Opel DJ, Robinson JD, Heritage J, Korfiatis C, Taylor JA, Mangione-Smith R. Characterizing providers′ immunization communication practices during health supervision visits with vaccine-hesitant parents: A pilot study. Vaccine 2012;30:1269-75.

Source of Support: None, Conflict of Interest: None

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