International Journal of Public Health

, Volume 62, Issue 1, pp 103–115 | Cite as

Sociocultural determinants of anticipated acceptance of pandemic influenza vaccine in Pune, India: a community survey using mixed-methods

  • Neisha SundaramEmail author
  • Christian Schaetti
  • Leticia Grize
  • Vidula Purohit
  • Saju Joseph
  • Christian Schindler
  • Abhay Kudale
  • Mitchell G. Weiss
Original Article



To investigate community priority and determinants of pandemic influenza vaccine acceptance in Pune, India. Community willingness to accept vaccines is often neglected in pandemic preparedness. Despite an acknowledged need, few such studies have been done in lower income countries.


A cross-sectional, mixed-methods study used semi-structured explanatory model interviews to assess anticipated acceptance of nasal and injectable vaccines at different prices among 436 urban and rural residents. Logistic regression models identified sociocultural determinants of vaccine acceptance.


Over 93 % anticipated acceptance at no-cost; 87.8 % for INR 150 nasal vaccine; 74.1 % for INR 500 and 61.7 % for INR 1000 injectable vaccines. Some respondents preferred low-cost over free vaccines. Illness-related concerns about social isolation, contaminants identified as perceived causes, private-hospital or traditional-healer help seeking, and income were positively associated with anticipated acceptance. Humoral imbalances as perceived cause, home remedies for help-seeking and age were negatively associated.


High acceptability of pandemic influenza vaccines indicates good prospects for mass vaccination. It appeared that confidence was higher in the vaccines than in the health systems delivering them. Vaccination programmes should consider sociocultural determinants influencing vaccine acceptance.


Cultural characteristics Influenza Pandemic Public participation Social characteristics Vaccination 



We thank community respondents for their participation and study interviewers for their diligence and commitment.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical statement

The Institutional Ethics Committee of the Maharashtra Association of Anthropological Sciences, Ethics Commission of Basel and WHO Research Ethics Review Committee provided ethical approval for this study. No incentives were given to participants and written informed consent was obtained prior to interview.


This study was supported by the World Health Organization, Switzerland, which is thankfully acknowledged.

Supplementary material

38_2016_903_MOESM1_ESM.pdf (667 kb)
Supplementary material 1 (PDF 667 kb)


  1. Barrett R (2005) Self-mortification and the stigma of leprosy in northern India. Med Anthropol Q 19:216–230CrossRefPubMedGoogle Scholar
  2. Barrett R, Brown PJ (2008) Stigma in the time of influenza: social and institutional responses to pandemic emergencies. J Infect Dis 197(Suppl 1):S34–S37CrossRefPubMedGoogle Scholar
  3. Bish A, Yardley L, Nicoll A, Michie S (2011) Factors associated with uptake of vaccination against pandemic influenza: a systematic review. Vaccine 29:6472–6484CrossRefPubMedGoogle Scholar
  4. Cobos Munoz D, Monzon LL, Bosch-Capblanch X (2015) Exposing concerns about vaccination in low- and middle-income countries: a systematic review. Int J Public Health 60:767–780CrossRefPubMedGoogle Scholar
  5. Dhere R, Yeolekar L, Kulkarni P, Menon R, Vaidya V, Ganguly M, Tyagi P, Barde P, Jadhav S (2011) A pandemic influenza vaccine in India: from strain to sale within 12 months. Vaccine 29(Suppl 1):A16–A21CrossRefPubMedGoogle Scholar
  6. Directorate General of Health Services (2009) Draft action plan: Pandemic preparedness and response for managing novel influenza a H1N1 (or that arising any other novel strain of influenza). Ministry of Health and Family Welfare, Government of India. Accessed 10 May 2015
  7. Directorate General of Health Services (2010) Situational updates—influenza A H1N1 (29 Aug 2010). Ministry of Health & Family Welfare, Government of India. Accessed 20 Feb 2014
  8. Farmer P, Kleinman A (1989) AIDS as human suffering. Daedalus 118:135–160Google Scholar
  9. Girard MP, Tam JS, Assossou OM, Kieny MP (2010) The 2009 A (H1N1) influenza virus pandemic: a review. Vaccine 28:4895–4902CrossRefPubMedGoogle Scholar
  10. Isalkar, Umesh (17 July 2015) Swine flu vaccine for pregnant women in Maharashtra. The Times of India. Accessed 8 Oct 2015
  11. John TJ (2015) Swine flu surprises. Econ Political Wkl 50:24–26Google Scholar
  12. Koul PA, Bali NK (2015) Influenza vaccination in India: challenges for universal adoption. Vaccine. doi: 10.1016/j.vaccine.2015.07.021 Google Scholar
  13. Larson HJ, Schulz WS, Tucker JD, Smith DM (2015) Measuring vaccine confidence: introducing a global vaccine confidence index. PLoS Curr, 7Google Scholar
  14. Lau JT, Yeung NC, Choi KC, Cheng MY, Tsui HY, Griffiths S (2009) Acceptability of A/H1N1 vaccination during pandemic phase of influenza A/H1N1 in Hong Kong: population based cross sectional survey. BMJ 339:b4164CrossRefPubMedPubMedCentralGoogle Scholar
  15. Maurer J, Harris KM, Parker A, Lurie N (2009) Does receipt of seasonal influenza vaccine predict intention to receive novel H1N1 vaccine: evidence from a nationally representative survey of U.S. adults. Vaccine 27:5732–5734CrossRefPubMedPubMedCentralGoogle Scholar
  16. Ministry of Health & Family Welfare (2015a) Swine Flu-H1N1 (Seasonal Influenza): Action taken by Government of India. Government of India. Accessed 8 Oct 2015
  17. Ministry of Health & Family Welfare (2015b) Swine flu-H1N1 (Seasonal Influenza): do’s and dont’s. Government of India. Accessed 8 Oct 2015
  18. Myers LB, Goodwin R (2011) Determinants of adults’ intention to vaccinate against pandemic swine flu. BMC Public Health 11:15CrossRefPubMedPubMedCentralGoogle Scholar
  19. National Informatics Center (2012) Health care for common diseases: influenza A (H1N1). Government of India. Accessed 24 Apr 2015
  20. Poland GA (2010) The 2009-2010 influenza pandemic: effects on pandemic and seasonal vaccine uptake and lessons learned for seasonal vaccination campaigns. Vaccine 28(Suppl 4):D3–D13CrossRefPubMedGoogle Scholar
  21. Press Trust of India (2015) Swine flu death toll reaches 2123. The Indian express. Accessed 24 Apr 2015
  22. Seale H, Heywood AE, McLaws ML, Ward KF, Lowbridge CP, Van D, MacIntyre CR (2010) Why do I need it? I am not at risk! Public perceptions towards the pandemic (H1N1) 2009 vaccine. BMC Infect Dis 10:99CrossRefPubMedPubMedCentralGoogle Scholar
  23. Shampanier K, Mazar N, Ariely D (2007) Zero as a special price: the true value of free products. Mark Sci 26:742–757CrossRefGoogle Scholar
  24. Sundaram N, Schaetti C, Purohit V, Kudale A, Weiss MG (2014) Cultural epidemiology of pandemic influenza in urban and rural Pune, India: a cross-sectional, mixed-methods study. BMJ Open 4:e006350CrossRefPubMedPubMedCentralGoogle Scholar
  25. Sundaram N, Purohit V, Schaetti C, Kudale A, Joseph S, Weiss MG (2015) Community awareness, use and preference for pandemic influenza vaccines in Pune, India. Hum Vaccin Immunother 11:2376–2388CrossRefPubMedPubMedCentralGoogle Scholar
  26. Suresh PS, Thejaswini V, Rajan T (2011) Factors associated with 2009 pandemic influenza A (H1N1) vaccination acceptance among university students from India during the post-pandemic phase. BMC Infect Dis 11:205CrossRefPubMedPubMedCentralGoogle Scholar
  27. Suresh PS, Rajan T, Thejaswini V, Rajeshkannan R (2012) Psychosocial determinants of 2009 pandemic influenza A (H1N1) vaccine acceptability among Indian health-care workers during the post-pandemic phase. J Infect 65:90–93CrossRefPubMedGoogle Scholar
  28. TNN (2010) Alternative medicine may help in preventing swine flu: MOHFW. The Times of India. Accessed 24 Apr 2015
  29. Wagner-Egger P, Bangerter A, Gilles I, Green E, Rigaud D, Krings F, Staerkle C, Clemence A (2011) Lay perceptions of collectives at the outbreak of the H1N1 epidemic: heroes, villains and victims. Public Underst Sci 20:461–476CrossRefPubMedGoogle Scholar
  30. Weiss MG (1997) Explanatory model interview catalogue (EMIC): framework for comparative study of illness. Transcult Psychiatry 34:235–263CrossRefGoogle Scholar
  31. Weiss MG (2001) Cultural epidemiology: an introduction and overview. Anthropol Med 8:5–29CrossRefGoogle Scholar
  32. Wong LP, Sam IC (2010) Factors influencing the uptake of 2009 H1N1 influenza vaccine in a multiethnic Asian population. Vaccine 28:4499–4505CrossRefPubMedGoogle Scholar
  33. World Health Organization (2008) Meeting with international partners on influenza vaccine technology transfer to developing country vaccine manufacturers: 29 to 30 October 2007. WHO/IVB/08.09 Accessed 25 Apr 2015
  34. World Health Organization (2012) Vaccines against influenza WHO position paper—November 2012. Wkly Epidemiol Rec 87:461–476Google Scholar
  35. World Health Organization (2013) Global vaccine action plan 2011–2020. WHO Press. Accessed 15 Jul 2015
  36. World Health Organization (2015) Influenza update: update number 232. Accessed 25 Apr 2015

Copyright information

© Swiss School of Public Health (SSPH+) 2016

Authors and Affiliations

  • Neisha Sundaram
    • 1
    • 2
    • 3
    Email author
  • Christian Schaetti
    • 1
    • 2
  • Leticia Grize
    • 1
    • 2
  • Vidula Purohit
    • 4
    • 5
  • Saju Joseph
    • 4
    • 5
  • Christian Schindler
    • 1
    • 2
  • Abhay Kudale
    • 4
    • 5
  • Mitchell G. Weiss
    • 1
    • 2
  1. 1.Department of Epidemiology and Public HealthSwiss Tropical and Public Health InstituteBaselSwitzerland
  2. 2.University of BaselBaselSwitzerland
  3. 3.Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore
  4. 4.Centre for Health Research and DevelopmentThe Maharashtra Association of Anthropological SciencesPuneIndia
  5. 5.Department of Anthropology and Interdisciplinary School of Health SciencesSavitribai Phule Pune UniversityPuneIndia

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