Zawar Ali, Saima Abid, Imtiaz Ali Shah, Maqsood Ali, Abu Zar Taizai.
Vaccine confidence in Khyber Pakhtunkhwa in light of recent upsurge in polio cases: a view by Public Health Association- Khyber pakhtunkhwa, Pakistan.
Khyber Med Uni Med J Jan ;11(2):107-8.

Vaccine hesitancy as defined by World Health Organization (WHO) refers to "delay in acceptance or refusal of vaccines despite availability of vaccination services. Vaccine hesitancy is complex and context specific, varying across time, place and vaccines. It is influenced by factors such as complacency, convenience and confidence."1 Vaccine hesitancy is a multidimensional complex phenomenon with many determinants.2,3 It is usually seen amongst specific subgroups of population within a country and have certain context. Vaccine hesitancy is not always related to one specific vaccine. Sometimes it is against immunization in general. It is important to understand who is hesitant towards vaccines or the immunization program and why.4 Many models are available to understand and help elucidate this phenomenon. WHO has adopted "the 3C model" as it is readily understandable and has incorporated the themes in its definition as well i.e. complacency, convenience and confidence.5 Complacency and convenience are important determinants of vaccine hesitancy, in this write up we will keep ourselves limited to discussion on vaccine confidence. Vaccine confidence implies "trust in the vaccine (the product), trust in the vaccinator or other health professional (the provider), and trust in those who make the decisions about vaccine provision (the policy-maker)." It is the trust of the public not only on the vaccine itself but also the healthcare workers and the government that leads to vaccine confidence. In the context of polio eradication in Pakistan, the debate on vaccine confidence gains more importance, especially in Khyber Pakhtunkhwa (KP) province. The province has had more cases per population even by national standards. With more than two-thirds of polio cases from Pakistan, reported from Khyber Pakhtunkhwa.7 The routine EPI coverage in KP is below national standards as well. The lack of vaccine confidence has been evident in our province for a few years. In April 2019, in response to rumours about children having side effects from polio drops, a lynch mob attacked a health facility in Peshawar and the polio campaign had to be abandoned.8 What surprised members of KP Public Health Association (PHA) was the intensity of the reaction than the reaction itself. This was a strong expression of lack of trust not just in the vaccine, but the health apparatus that delivers it and the institutions that make vaccination policy.

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