Questionnaires and Focus Groups Based Quantitative & Qualitative Study of Vaccine Hesitancy and Confidence Among At-risk and Marginalized Populations: Persons With Special Needs, Intellectual Disabilities and Congenital Anomalies

Global vaccines programs prevent infectious diseases, congenital anomalies and cancer [1,2]. Full and partial avoidance of vaccines, or postponing vaccines, may lead to morbidity, disability and mortality. This is particularly significant among children and adults with special needs, intellectual and developmental disabilities, and congenital anomalies, which are at-risk groups, together representing over 15% of the general population [3,4]. Studies have shown that this population is particularly vulnerable when it comes to infectious diseases, hospitalizations, sexually transmitted diseases, abuse and neglect [5,6,7]. Furthermore, this is a marginalized population, with (in average) a lower socioeconomic status and at a lower level of education of themselves and their caregivers [8]. The reasons for hesitance, avoidance or selectivity of vaccines by the caregivers are not comprehensively characterized. Therefore, the investigators outline our thoughts and Insights from our ongoing work, for over two decades, with this population. In the investigators experience, when doctors and nurses ask the patients and their caregivers what are the reasons for less-then-optimal vaccination state, there are several explanations: concurrent illnesses that made them postpone vaccinations, access challenges, being preoccupied with many other health tasks, and paradoxically the fear that the child is too fragile for receiving the vaccine or that the vaccine itself will do harm. Also, some may be wrongly advised about contraindications that are misinterpreted. It is surprising that the infestigators hear from caregivers about the fear from the vaccines, and not about the fear from the diseases. Another important issue is the unfortunate vulnerability of this population to STD's, which the investigators repeatedly hear from caregivers that this is a non-issue for them, which is clearly a dangerous misconception [9].

Therefore, healthcare professionals are missing valuable information about possible risks and intervention opportunities among an at-risk population.

Objectives:

1. The investigators will systematically map the reasons for the delay and/or avoidance, and/or hesitance to vaccinate by conducting a large-scale evaluation of current and planned immunizations among persons of all ages who have special needs, intellectual and developmental disabilities and congenital anomalies (study group). The investigatorswill use a comprehensive questionnaire to collect this information, as well as focused discussion groups for in-depth qualitative investigations. The investigators will compare the data with their sibling's vaccination status and with recruits from the general population (control group).

According to the concept "Do not talk about us without us", The investigators will include persons with special needs and disabilities in the study and make all efforts to hear directly from them in focus groups or individually about their approach to vaccinations, including hesitancies and misconceptions about the procedure.