A Qualitative Assessment of Influenza Vaccine Uptake Among Children and its Impact on the Childhood Immunization Program in Kenya

Background: Influenza is a significant contributor to acute respiratory infections (ARI), and children <5 years are at increased risk of severe influenza disease. In Kenya the influenza vaccine is not included in the Kenya Expanded Programme of Immunization (KEPI). To inform roll-out of a national influenza vaccination program, we implemented an influenza vaccine demonstration project in Nakuru and Mombasa counties in Kenya from 2019 to 2021, comparing performance of year-round and campaign vaccination strategies.Methods: We set out to establish reasons for uptake and refusal of the vaccine among caregivers of children aged 6-23 months and the impact of influenza vaccination on the wider immunization program. Using semi-structured questionnaires, we conducted eight focus group discussions among community members and twelve key informant interviews among healthcare workers at selected health facilities. Interviews were audio-recorded and transcribed and data were analysed by coding emergent themes per the WHO vaccine hesitancy matrix.Results: The vaccine was generally well accepted among community members and healthcare workers. Despite the use of various channels of communication such as posters and community health volunteers, vaccine hesitancy was driven by inadequate sensitization, misconceptions about reasons for introducing the vaccine and perceptions of low disease severity among community members. Contextual factors such as COVID-19 affected uptake, healthcare workers were a trusted source of information about vaccines, and concerns were raised among parents about the number of vaccines recommended for children. Healthcare workers reported identifying more children with missed vaccine opportunities during the project period.Conclusion: The influenza vaccine was well received by both healthcare workers and community members. Vaccine uptake was affected by issues such as misconceptions about the vaccine - worsened by the COVID-19 pandemic, perceptions of low disease severity and vaccine overload. The demonstration project strengthened the immunization program by facilitating detection of defaulters.