How do parents and pediatricians arrive at the decision to immunize their children in the private sector? Insights from a qualitative study on rotavirus vaccination across select Indian cities

Key debates on improving vaccination coverage tend to focus on factors that affect uptake in the public health system while ignoring the private sector that plays an important role in providing health services in any low or middle-income country setting. Using in-depth interviews, we explored factors that influenced the decision of parents as well as pediatricians working in the private sector across 8 Indian cities on whether their children should be vaccinated with a particular vaccine Pediatricians and their relationship with parents was an important factor that influenced the decision on whether parents vaccinated their children with a particular vaccine or not. The decision to recommend a vaccine is taken on the principle that it is better to be safe than sorry than on any objective assessment of whether a child requires a particular vaccine or not. Family members and social factors also played a major role in the decision-making. According to some parents, vaccinating their child added an aspirational value to their growth. This is especially true of the newer vaccines that are considered optional in India. The cost of a vaccine did not come up as an inhibiting factor in the decision to vaccinate a child. Access to appropriate evidence was limited for both pediatricians and parents and evidence per se played a minimal role in the final decision to vaccinate a child or not. Far more important were the influences of factors such as relationship with the pediatrician, the role of decisions related to vaccination taken by people in the immediate social network.