Impact Ethics

Immunization Coverage for Inuit Women

Implementation of an Immunization Program with Pertussis Vaccine During Pregnancy (2017-2019)

Identifying barriers, factors that predict success, and interventions to improve coverage among Inuit women.

Principal Investigator: Donna Pierrynowski MacDougall

Co-Investigators: Françoise Baylis, May ElSherif, Scott Halperin, Gwen Healey, Joanne Langley, Cathy MacDonald, Bruce Smith, Audrey Steenbeek, Jacqueline van Wijlen, Sarah Wilson

Community-based research, Nunavut & Nuatsiavut

Funded by the Canadian Institutes of Health Research

Abstract

Whooping cough (also known as pertussis) is a respiratory disease that affects millions of people every year. Babies are more likely than older children and adults to catch whooping cough. Those who catch whooping cough become very sick and may even die. While many people receive a pertussis vaccine (called Tdap) to protect them from whooping cough, babies younger than 6 months of age are too young to get all the doses needed to protect them. One way of protecting these babies is to give their mothers the vaccine during pregnancy (before the babies are born). While many mothers are afraid of getting vaccinated during pregnancy, Tdap is proven to be both safe and effective. In Canada, pregnant women are offered a Tdap vaccine when there is an outbreak in the area in which they live. This is currently the case in Nunavut, home to many of Canada’s Inuit. Inuit babies may be at greater risk of catching pertussis as they often have more respiratory infections and poorer health than non-Inuit children.

We know that the uptake of some vaccines in Inuit women and children has been strong, but we don’t know whether this will be the same for a maternal Tdap program. Currently, there is a pertussis outbreak in Nunavut but not in the nearby region of Nunatsiavut. This provides us with an ideal opportunity for research. This two-year study aims to explore perceptions of Tdap vaccines and preferred sources of vaccine-related information among Inuit pregnant women, antibody response during pregnancy, potential pockets of poor vaccine uptake, and possible ways of improving vaccine coverage during pregnancy. This will be achieved through a mixed methods research approach that includes focus groups, interviews, surveys, and serology testing performed in partnership with Inuit communities and other key stakeholders using gender- and cultural-based frameworks to guide the process.

Objectives

The main goal of this project is to work in partnership with Inuit communities, and other key stakeholders to explore issues related to and the potential role of maternal immunization. Guided by the framework of Inuit Qaujimajatuqangit (IQ; Inuit Knowledge), this work will be integrative, collaborative, and participatory in order to identify “neighborhoods” of under-and un-immunized Inuit populations, and the socio-cultural barriers associated with lower immunization access and uptake, and strengths upon which to build immunization programs, with a particular focus on pregnant Inuit women. To address vaccine access and uptake, and in keeping with the CIHR Institute of Infection and Immunity’s “improved immunization coverage initiative,” the main objectives of this research are:

  1. To understand knowledge, attitudes, beliefs, values, and behaviors relating to maternal immunization of women in Nunavut and Nunatsiavut.
  2. To understand the determinants of vaccine coverage in pregnant women in Nunavut and Nunatsiavut.
  3. To evaluate the effectiveness of a Tdap and influenza (comparator) maternal immunization program.
  4. To identify any “neighborhoods” of under-immunization and if they are related to geographic, social, cultural, ethical, traditional, logistical or other (to be determined) factors.
  5. To identify intervention strategies to address immunization gaps in maternal

Last updated September 2017.