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  1. May 2021
    1. Peccia, J., Zulli, A., Brackney, D. E., Grubaugh, N. D., Kaplan, E. H., Casanovas-Massana, A., Ko, A. I., Malik, A. A., Wang, D., Wang, M., Weinberger, D. M., & Omer, S. B. (2020). SARS-CoV-2 RNA concentrations in primary municipal sewage sludge as a leading indicator of COVID-19 outbreak dynamics. MedRxiv, 2020.05.19.20105999. https://doi.org/10.1101/2020.05.19.20105999

    1. Williamson, E. J., Walker, A. J., Bhaskaran, K., Bacon, S., Bates, C., Morton, C. E., Curtis, H. J., Mehrkar, A., Evans, D., Inglesby, P., Cockburn, J., McDonald, H. I., MacKenna, B., Tomlinson, L., Douglas, I. J., Rentsch, C. T., Mathur, R., Wong, A. Y. S., Grieve, R., … Goldacre, B. (2020). OpenSAFELY: Factors associated with COVID-19 death in 17 million patients. Nature, 1–11. https://doi.org/10.1038/s41586-020-2521-4

    1. Poletti, P., Tirani, M., Cereda, D., Trentini, F., Guzzetta, G., Marziano, V., Buoro, S., Riboli, S., Crottogini, L., Piccarreta, R., Piatti, A., Grasselli, G., Melegaro, A., Gramegna, M., Ajelli, M., & Merler, S. (2020). Infection fatality ratio of SARS-CoV-2 in Italy. ArXiv:2007.04381 [q-Bio]. http://arxiv.org/abs/2007.04381

    1. Aleta, A., Martín-Corral, D., Pastore y Piontti, A., Ajelli, M., Litvinova, M., Chinazzi, M., Dean, N. E., Halloran, M. E., Longini Jr, I. M., Merler, S., Pentland, A., Vespignani, A., Moro, E., & Moreno, Y. (2020). Modelling the impact of testing, contact tracing and household quarantine on second waves of COVID-19. Nature Human Behaviour, 1–8. https://doi.org/10.1038/s41562-020-0931-9

    1. 2017

    2. Vaccination and trust. How concerns arise and the role of communication in mitigating crises. (2017). Copenhagen: WHO Regional Office for Europe. www.euro.who.int /vaccinetrust

    3. When situations occur in which unwanted events are rightly or wrongly connected with vaccination, they may erode confidence in vaccines and the authorities delivering them. This document presents the scientific evidence behind WHO’s recommendations on building and restoring confidence in vaccines and vaccination, both in ongoing work and during crises. The evidence draws on a vast reserve of laboratory research and fieldwork within psychology and communication. It examines how people make decisions about vaccination; why some people are hesitant about vaccination; and the factors that drive a crisis, covering how building trust, listening to and understanding people, building relations, communicating risk and shaping messages to the audiences may mitigate crises. This document provides a knowledge base for stakeholders who develop communication strategies or facilitate workshops on communication and trust-building activities in relation to vaccines and immunization, such as immunization programme units, ministries of health, public relations and health promotion units, vaccine safety communication trainers and immunization advisory bodies
    4. How concerns arise and the role of communication in mitigating crises
    5. Vaccination and trust
    1. 2016-08-17

    2. BackgroundIn high-income countries, substantial differences exist in vaccine uptake relating to socioeconomic status, gender, ethnic group, geographic location and religious belief. This paper updates a 2009 systematic review on effective interventions to decrease vaccine uptake inequalities in light of new technologies applied to vaccination and new vaccine programmes (eg, human papillomavirus in adolescents).MethodsWe searched MEDLINE, Embase, ASSIA, The Campbell Collaboration, CINAHL, The Cochrane Database of Systematic Reviews, Eppi Centre, Eric and PsychINFO for intervention, cohort or ecological studies conducted at primary/community care level in children and young people from birth to 19 years in OECD countries, with vaccine uptake or coverage as outcomes, published between 2008 and 2015.ResultsThe 41 included studies evaluated complex multicomponent interventions (n=16), reminder/recall systems (n=18), outreach programmes (n=3) or computer-based interventions (n=2). Complex, locally designed interventions demonstrated the best evidence for effectiveness in reducing inequalities in deprived, urban, ethnically diverse communities. There is some evidence that postal and telephone reminders are effective, however, evidence remains mixed for text-message reminders, although these may be more effective in adolescents. Interventions that escalated in intensity appeared particularly effective. Computer-based interventions were not effective. Few studies targeted an inequality specifically, although several reported differential effects by the ethnic group.ConclusionsLocally designed, multicomponent interventions should be used in urban, ethnically diverse, deprived populations. Some evidence is emerging for text-message reminders, particularly in adolescents. Further research should be conducted in the UK and Europe with a focus on reducing specific inequalities.
    3. 10.1136/jech-2016-207572
    4. Interventions to reduce inequalities in vaccine uptake in children and adolescents aged <19 years: a systematic review
    1. 2018-04-09

    2. IntroductionBeyond their impact on health, vaccines can lead to large economic benefits. While most economic evaluations of vaccines have focused on the health impact of vaccines at a national scale, it is critical to understand how their impact is distributed along population subgroups.MethodsWe build a financial risk protection model to evaluate the impact of immunisation against measles, severe pneumococcal disease and severe rotavirus for birth cohorts vaccinated over 2016–2030 for three scenarios in 41 Gavi-eligible countries: no immunisation, current immunisation coverage forecasts and the current immunisation coverage enhanced with funding support. We distribute modelled disease cases per socioeconomic group and derive the number of cases of: (1) catastrophic health costs (CHCs) and (2) medical impoverishment.ResultsIn the absence of any vaccine coverage, the number of CHC cases attributable to measles, severe pneumococcal disease and severe rotavirus would be approximately 18.9 million, 6.6 million and 2.2 million, respectively. Expanding vaccine coverage would reduce this number by up to 90%, 30% and 40% in each case. More importantly, we find a higher share of CHC incidence among the poorest quintiles who consequently benefit more from vaccine expansion.ConclusionOur findings contribute to the understanding of how vaccines can have a broad economic impact. In particular, we find that immunisation programmes can reduce the proportion of households facing catastrophic payments from out-of-pocket health expenses, mainly in lower socioeconomic groups. Thus, vaccines could have an important role in poverty reduction.
    3. 10.1136/bmjgh-2017-000613
    4. Poverty reduction and equity benefits of introducing or scaling up measles, rotavirus and pneumococcal vaccines in low-income and middle-income countries: a modelling study
    1. 2019-01-10

    2. In the World Health Organization (WHO) European Region, differences in uptake rates of routine childhood immunisation persist within and among countries, with rates even falling in some areas. There has been a tendency among national programmes, policymakers and the media in recent years to attribute missed vaccinations to faltering demand or refusal among parents. However, evidence shows that the reasons for suboptimal coverage are multifactorial and include the social determinants of health. At the midpoint in the implementation of the European Vaccine Action Plan 2015–2020 (EVAP), national immunisation programmes should be aware that inequity may be a factor affecting their progress towards the EVAP immunisation targets. Social determinants of health, such as individual and household income and education, impact immunisation uptake as well as general health outcomes – even in high-income countries. One way to ensure optimal coverage is to make inequities in immunisation uptake visible by disaggregating immunisation coverage data and linking them with already available data sources of social determinants. This can serve as a starting point to identify and eliminate underlying structural causes of suboptimal uptake. The WHO Regional Office for Europe encourages countries to make the equitable delivery of vaccination a priority.
    3. 10.2807/1560-7917.ES.2019.24.2.1800204
    4. Towards equity in immunisation
    1. 2017-09-07

    2. 10.1136/jech-2017-209113
    3. Background Cervical cancer disproportionately affects women from lower socioeconomic backgrounds. A human papillomavirus (HPV) vaccination programme was introduced in Scotland in 2008 with uptake being lower and inequitable in a catch-up cohort run for the first three years of the programme compared with the routine programme. The socioeconomic differences in vaccine uptake have the potential to further increase the inequality gap in regards to cervical disease.Methods Vaccination status was linked to demographic, cytological and colposcopic data, which are routinely collected by the Scottish HPV surveillance system. Incidence rates and relative risk of cervical intraepithelial neoplasia (CIN) 1, 2 and 3 in unvaccinated and vaccinated women were stratified by birth year and deprivation status using Poisson regression.Results Women who received three doses of HPV vaccine have significantly decreased risk of CIN 1, 2 and 3. Vaccine effectiveness was greater in those women from the most deprived backgrounds against CIN 2 and 3 lesions. Compared with the most deprived, unvaccinated women, the relative risk of CIN 3 in fully vaccinated women in the same deprivation group was 0.29 (95% CI 0.2 to 0.43) compared with 0.62 (95% CI 0.4 to 0.97) in vaccinated women in the least-deprived group.Conclusions The HPV vaccine is associated with significant reductions in both low-grade and high-grade CIN for all deprivation categories. However, the effect on high-grade disease was most profound in the most-deprived women. These data are welcoming and allay the concern that inequalities in cervical cancer may persist or increase following the introduction of the vaccine in Scotland.
    4. The impact of bivalent HPV vaccine on cervical intraepithelial neoplasia by deprivation in Scotland: reducing the gap
    1. 2018-07-09

    2. Jansen, K. U., & Anderson, A. S. (2018). The role of vaccines in fighting antimicrobial resistance (AMR). Human Vaccines & Immunotherapeutics, 14(9), 2142–2149. https://doi.org/10.1080/21645515.2018.1476814

    3. The problem of antimicrobial resistance (AMR) and the associated morbidity and mortality due to antibiotic resistant bacterial pathogens is not new. However, AMR has been increasing at an alarming rate with appearances of diseases caused by bacteria exhibiting resistance to not just one but multiple classes of antibiotics. The World Health Organization (WHO) supported by governments, health ministries and health agencies has formulated global action plans to combat the rise in AMR, supporting a number of proven initiatives such as antimicrobial stewardship, investments in development of new classes of antibiotics, and educational programs designed to eliminate inappropriate antibiotic use. Vaccines as tools to reduce AMR have historically been under-recognized, yet the positive effect in reducing AMR has been well established. For example Haemophilus influenzae type B (Hib) as well as Streptococcus pneumoniae (pneumococcal) conjugate vaccines have impressive track records in not only preventing life threatening diseases caused by these bacteria, but also reducing antibiotic use and AMR. This paper will describe the drivers of antibiotic use and subsequent development of AMR; it will make the case how existing vaccines are already participating in combatting AMR, describe future prospects for the role of new vaccines in development to reduce AMR, and highlight challenges associated with future vaccine development to combat AMR.
    4. 10.1080/21645515.2018.1476814
    5. The role of vaccines in fighting antimicrobial resistance (AMR)
    1. 2007-11-27

    2. 10.2471/BLT.07.040089
    3. In low-income countries, infectious diseases still account for a large proportion of deaths, highlighting health inequities largely caused by economic differences. Vaccination can cut health-care costs and reduce these inequities. Disease control, elimination or eradication can save billions of US dollars for communities and countries. Vaccines have lowered the incidence of hepatocellular carcinoma and will control cervical cancer. Travellers can be protected against “exotic” diseases by appropriate vaccination. Vaccines are considered indispensable against bioterrorism. They can combat resistance to antibiotics in some pathogens. Noncommunicable diseases, such as ischaemic heart disease, could also be reduced by influenza vaccination.Immunization programmes have improved the primary care infrastructure in developing countries, lowered mortality in childhood and empowered women to better plan their families, with consequent health, social and economic benefits.Vaccination helps economic growth everywhere, because of lower morbidity and mortality. The annual return on investment in vaccination has been calculated to be between 12% and 18%. Vaccination leads to increased life expectancy. Long healthy lives are now recognized as a prerequisite for wealth, and wealth promotes health. Vaccines are thus efficient tools to reduce disparities in wealth and inequities in health.
    4. Vaccination greatly reduces disease, disability, death and inequity worldwide
    1. 2018-03-07

    2. 10.1016/j.vaccine.2017.12.012
    3. IntroductionThe WHO Regional Office for Europe developed the Guide to tailoring immunization programmes (TIP), offering countries a process through which to diagnose barriers and motivators to vaccination in susceptible low vaccination coverage and design tailored interventions. A review of TIP implementation was conducted in the European Region.Material and methodsThe review was conducted during June to December 2016 by an external review committee and was based on visits in Bulgaria, Lithuania, Sweden and the United Kingdom that had conducted a TIP project; review of national and regional TIP documents and an online survey of the Member States in the WHO European Region that had not conducted a TIP project. A review committee workshop was held to formulate conclusions and recommendations.ResultsThe review found the most commonly cited strengths of the TIP approach to be the social science research as well as the interdisciplinary approach and community engagement, enhancing the ability of programmes to “listen” and learn, to gain an understanding of community and individual perspectives. National immunization managers in the Region are generally aware that TIP exists and that there is strong demand for the type of research it addresses. Further work is needed to assist countries move towards implementable strategies based on the TIP findings, supported by an emphasis on enhanced local ownership; integrated diagnostic and intervention design; and follow-up meetings, advocacy and incentives for decision-makers to implement and invest in strategies.ConclusionsUnderstanding the perspectives of susceptible and low-coverage populations is crucial to improving immunization programmes. TIP provides a framework that facilitated this in four countries. In the future, the purpose of TIP should go beyond identification of susceptible groups and diagnosis of challenges and ensure a stronger focus on the design of strategies and appropriate and effective interventions to ensure long-term change.
    4. The WHO Tailoring Immunization Programmes (TIP) approach: Review of implementation to date
  2. Apr 2021
    1. 2019-04-11

    2. Lutkenhaus, R. O., Jansz, J., & Bouman, M. P. A. (2019). Mapping the Dutch vaccination debate on Twitter: Identifying communities, narratives, and interactions. Vaccine: X, 1. https://doi.org/10.1016/j.jvacx.2019.100019

    3. In recent years, vaccination rates in the Netherlands have declined slightly, but steadily. The Dutch National Institute for Public Health and the Environment (RIVM) commissioned a Committee for Vaccine Willingness (VWC) to study the societal context of the decline. One of the societal contexts is the Internet, where audiences discuss vaccination and refer to sources of health-related information of varying quality.Working for the VWC, we have explored the Dutch vaccination debate on Twitter in order to: (1) identify online communities in the vaccination debate, (2) identify vaccine-related narratives; and (3) understand how the online communities interact with each other. We identified seven different communities, including (public) health professionals, writers and journalists, anti-establishment, and international vaccination advocates.The debate is spearheaded by the writers & journalists community, while the health- and anti-establishment communities try to influence it. The health community circulates facts, figures and scientific studies, while negative messages about vaccination – either from a homeopathy or conspiracy perspective – are most prevalent in the anti-establishment. The facts and figures shared by the health community hardly reach other communities, whereas the myths introduced by the anti-establishment do spill over to other communities. Our study provides further evidence that negative perceptions about vaccination might be rooted in a wider sentiment of distrust of traditional institutions.We argue that Dutch health organizations should try to address questions, doubts, and worries among the general audience more actively, and present scientific information in a simpler and more attractive way.
    4. 10.1016/j.jvacx.2019.100019
    5. Mapping the Dutch vaccination debate on Twitter: Identifying communities, narratives, and interactions
    1. 2007-03-20

    2. Jegede, A. S. (2007). What Led to the Nigerian Boycott of the Polio Vaccination Campaign? PLOS Medicine, 4(3), e73. https://doi.org/10.1371/journal.pmed.0040073

    3. Vaccination is a crucial tool for preventing and controlling disease, but its use has been plagued by controversies worldwide [1–6]. In this article, I look at the controversy surrounding the immunization program against polio in Nigeria, in which three states in northern Nigeria in 2003 boycotted the polio immunization campaign. I discuss the problems caused by the boycott, its implications, and how it was resolved. Finally, I make recommendations for the future to prevent a similar situation from arising.
    4. 10.1371/journal.pmed.0040073
    5. What Led to the Nigerian Boycott of the Polio Vaccination Campaign?
    1. 2015-05-29

    2. Grant, L., Hausman, B. L., Cashion, M., Lucchesi, N., Patel, K., & Roberts, J. (2015). Vaccination Persuasion Online: A Qualitative Study of Two Provaccine and Two Vaccine-Skeptical Websites. Journal of Medical Internet Research, 17(5), e4153. https://doi.org/10.2196/jmir.4153

    3. Methods Results Discussion Abbreviations Copyright Original PaperLenny Grant, MA, MAT ; Bernice L Hausman, PhD ; Margaret Cashion, BS ; Nicholas Lucchesi, BS ; Kelsey Patel, BS ; Jonathan Roberts, BA Vaccination Research Group, Department of English, Virginia Tech, Blacksburg, VA, United StatesCorresponding Author:Lenny Grant, MA, MATVaccination Research GroupDepartment of EnglishVirginia Tech323 Shanks Hall (MC0112)181 Turner St. NWBlacksburg, VA, 24061United StatesPhone: 1 540 231 6501Fax:1 540 231 5692Email: lenny@vt.eduAbstractBackground: Current concerns about vaccination resistance often cite the Internet as a source of vaccine controversy. Most academic studies of vaccine resistance online use quantitative methods to describe misinformation on vaccine-skeptical websites. Findings from these studies are useful for categorizing the generic features of these websites, but they do not provide insights into why these websites successfully persuade their viewers. To date, there have been few attempts to understand, qualitatively, the persuasive features of provaccine or vaccine-skeptical websites.Objective: The purpose of this research was to examine the persuasive features of provaccine and vaccine-skeptical websites. The qualitative analysis was conducted to generate hypotheses concerning what features of these websites are persuasive to people seeking information about vaccination and vaccine-related practices.Methods: This study employed a fully qualitative case study methodology that used the anthropological method of thick description to detail and carefully review the rhetorical features of 1 provaccine government website, 1 provaccine hospital website, 1 vaccine-skeptical information website focused on general vaccine safety, and 1 vaccine-skeptical website focused on a specific vaccine. The data gathered were organized into 5 domains: website ownership, visual and textual content, user experience, hyperlinking, and social interactivity.Results: The study found that the 2 provaccine websites analyzed functioned as encyclopedias of vaccine information. Both of the websites had relatively small digital ecologies because they only linked to government websites or websites that endorsed vaccination and evidence-based medicine. Neither of these websites offered visitors interactive features or made extensive use of the affordances of Web 2.0. The study also found that the 2 vaccine-skeptical websites had larger digital ecologies because they linked to a variety of vaccine-related websites, including government websites. They leveraged the affordances of Web 2.0 with their interactive features and digital media.Conclusions: By employing a rhetorical framework, this study found that the provaccine websites analyzed concentrate on the accurate transmission of evidence-based scientific research about vaccines and government-endorsed vaccination-related practices, whereas the vaccine-skeptical websites focus on creating communities of people affected by vaccines and vaccine-related practices. From this personal framework, these websites then challenge the information presented in scientific literature and government documents. At the same time, the vaccine-skeptical websites in this study are repositories of vaccine information and vaccination-related resources. Future studies on vaccination and the Internet should take into consideration the rhetorical features of provaccine and vaccine-skeptical websites and further investigate the influence of Web 2.0 community-building features on people seeking information about vaccine-related practices.
    4. 10.2196/jmir.4153
    5. Vaccination Persuasion Online: A Qualitative Study of Two Provaccine and Two Vaccine-Skeptical Websites
    1. 2009-07-12

    2. Dannetun, E., Tegnell, A., Hermansson, G., & Giesecke, J. (2005). Parents’ reported reasons for avoiding MMR vaccination. Scandinavian Journal of Primary Health Care, 23(3), 149–153. https://doi.org/10.1080/02813430510031306

    3. Objective. During the second half of the 1990s and the first years of the 2000s a declining coverage for MMR vaccination in two-year-olds was observed in Sweden. The aim was to assess reasons for postponement or non-vaccination. Design. A telephone survey using a structured questionnaire on parents’ attitudes regarding their choice to postpone or abstain from vaccinating their child. Setting. The County of Östergötland in Sweden. Subjects. A total of 203 parents of children who had no registered date for MMR vaccination at a Child Health Centre. Main outcome measures. Parental reasons for non-vaccination. Results. In all, 26 of the 203 children had received MMR vaccination but this had not been registered. Of those not vaccinated, 40% of the parents had decided to abstain and 60% to postpone vaccination. Fear of side effects was the most common reason for non-vaccination in both groups. The main source of information was the media followed by the Child Health Centre. Parents with a single child more often postponed vaccination and those who abstained were more likely to have had a discussion with a doctor or nurse about MMR vaccine. Conclusion. Postponers and abstainers may have different reasons for their decision. The role of well-trained healthcare staff in giving advice and an opportunity to discuss MMR vaccination with concerned parents is very important.
    4. 10.1080/02813430510031306
    5. Parents’ reported reasons for avoiding MMR vaccination
    1. 2002-06-26

    2. Wolfe, R. M. (2002). Content and Design Attributes of Antivaccination Web Sites. JAMA, 287(24), 3245. https://doi.org/10.1001/jama.287.24.3245

    3. Context Individuals searching the Internet for vaccine information may find antivaccination Web sites. Few published studies have systematically evaluated these sites.Objectives To examine antivaccination Web site attributes and to delineate the specific claims and concerns expressed by antivaccination groups.Design and Setting In late 2000, using a metasearch program that incorporates 10 other search engines, we reviewed and analyzed 772 links to find 12 Web sites that promulgated antivaccination information. Analyzing links from these 12 sites yielded another 10 sites, producing a total of 22 sites for study. Using a standardized form, 2 authors (R.M.W., L.K.S.) systematically evaluated these sites based on specific content and design attributes.Main Outcome Measures Presence or absence of 11 Web site content attributes (antivaccination claims) and 10 Web site design attributes.Results The most commonly found content claims were that vaccines cause idiopathic illness (100% of sites), vaccines erode immunity (95%), adverse vaccine reactions are underreported (95%), and vaccination policy is motivated by profit (91%). The most common design attributes were the presence of links to other antivaccination sites (100%of sites), information for legally avoiding immunizations (64%), and the use of emotionally charged stories of children who had allegedly been killed or harmed by vaccines (55%).Conclusion Antivaccination Web sites express a range of concerns related to vaccine safety and varying levels of distrust in medicine. The sites rely heavily on emotional appeal to convey their message.
    4. 10.1001/jama.287.24.3245
    5. Content and Design Attributes of Antivaccination Web Sites
    1. 2017-06-28

    2. Jolley, D., & Douglas, K. M. (2017). Prevention is better than cure: Addressing anti-vaccine conspiracy theories. Journal of Applied Social Psychology, 47(8), 459–469. https://doi.org/10.1111/jasp.12453

    3. The current research tested if explicit anti‐conspiracy arguments could be an effective method of addressing the potentially harmful effects of anti‐vaccine conspiracy theories. In two studies, participants were presented with anti‐conspiracy arguments either before, or after reading arguments in favor of popular conspiracy theories concerning vaccination. In both studies, anti‐conspiracy arguments increased intentions to vaccinate a fictional child but only when presented prior to conspiracy theories. This effect was mediated by belief in anti‐vaccine conspiracy theories and the perception that vaccines are dangerous. These findings suggest that people can be inoculated against the potentially harmful effects of anti‐vaccine conspiracy theories, but that once they are established, the conspiracy theories may be difficult to correct.
    4. 10.1111/jasp.12453
    5. Prevention is better than cure: Addressing anti‐vaccine conspiracy theories
    1. 2010-03-26

    2. Betsch, C., Renkewitz, F., Betsch, T., & Ulshöfer, C. (2010). The Influence of Vaccine-critical Websites on Perceiving Vaccination Risks. Journal of Health Psychology, 15(3), 446–455. https://doi.org/10.1177/1359105309353647

    3. This large-scale Internet-experiment tests whether vaccine-critical pages raise perceptions of the riskiness of vaccinations and alter vaccination intentions. We manipulated the information environment (vaccine-critical website, control, both) and the focus of search (on vaccination risks, omission risks, no focus). Our analyses reveal that accessing vaccine-critical websites for five to 10 minutes increases the perception of risk of vaccinating and decreases the perception of risk of omitting vaccinations as well as the intentions to vaccinate. In line with the ‘risk-as-feelings’ approach, the affect elicited by the vaccine-critical websites was positively related to changes in risk perception.
    4. 10.1177/1359105309353647
    5. The Influence of Vaccine-critical Websites on Perceiving Vaccination Risks
    1. 2019-10-07

    2. Objective: Vaccine hesitancy has been identified as one of the major contributors to child under-vaccination. Research indicates that some hesitant parents’ mistrust extends to specific conspiracy ideation, but research on vaccine conspiracy beliefs is still scarce. Our objective was to explore factors contributing to parental vaccine conspiracy beliefs and actual vaccine uptake in children.Design: A cross-sectional correlational design with a non-probabilistic sample of 823 volunteer participants surveyed online.Main outcome measures: We focussed on the contributions of the analytically rational and experientially intuitive thinking styles, as well as measures of emotional functioning, namely optimism and emotions towards vaccination, to vaccine conspiracy beliefs and vaccine uptake as outcomes.Results: The obtained results showed that greater vaccine conspiracy beliefs were associated with stronger unpleasant emotions towards vaccination and greater experientially intuitive thinking, as well as lower levels of education. Furthermore, unpleasant emotions towards vaccination and intuitive thinking were associated with vaccine refusal.Conclusion: These findings confirm the primary importance of emotions, along with the propensity towards intuitive thinking, in the context of vaccine conspiracy beliefs and refusal, supporting the notion that parents’ avoidance is guided by their affect. These results have direct implications for addressing vaccine hesitancy within public campaigns and policies.
    3. 10.1080/08870446.2019.1673894
    4. It just doesn’t feel right – the relevance of emotions and intuition for parental vaccine conspiracy beliefs and vaccination uptake
    1. 2013-06-28

    2. Shelby, A., & Ernst, K. (2013). Story and science. Human Vaccines & Immunotherapeutics, 9(8), 1795–1801. https://doi.org/10.4161/hv.24828

    3. 10.4161/hv.24828
    4. With little or no evidence-based information to back up claims of vaccine danger, anti-vaccine activists have relied on the power of storytelling to infect an entire generation of parents with fear of and doubt about vaccines. These parent accounts of perceived vaccine injury, coupled with Andrew Wakefield’s fraudulent research study linking the MMR vaccine to autism, created a substantial amount of vaccine hesitancy in new parents, which manifests in both vaccine refusal and the adoption of delayed vaccine schedules. The tools used by the medical and public health communities to counteract the anti-vaccine movement include statistics, research, and other evidence-based information, often delivered verbally or in the form of the CDC’s Vaccine Information Statements. This approach may not be effective enough on its own to convince vaccine-hesitant parents that vaccines are safe, effective, and crucial to their children’s health. Utilizing some of the storytelling strategies used by the anti-vaccine movement, in addition to evidence-based vaccine information, could potentially offer providers, public health officials, and pro-vaccine parents an opportunity to mount a much stronger defense against anti-vaccine messaging.
    5. Story and scienceHow providers and parents can utilize storytelling to combat anti-vaccine misinformation
    1. 2007-04-20

    2. Jacobson, R. M., Targonski, P. V., & Poland, G. A. (2007). A taxonomy of reasoning flaws in the anti-vaccine movement. Vaccine, 25(16), 3146–3152. https://doi.org/10.1016/j.vaccine.2007.01.046

    3. 10.1016/j.vaccine.2007.01.046
    4. AbstractIn a scholarly analysis of widely held misconceptions, Gilovich provides a classification scheme of common flaws in reasoning seen in contemporary society. He broadly categorizes these flaws as having cognitive determinants or in having motivational and social determinants. In this survey, the authors examine the various claims against routine childhood and adult vaccines as made by the more public and more organized entities of the anti-vaccine movement as well as those made apparent by surveys of parents and other groups of individuals. The claims illustrate the breadth of reasoning flaws while providing a basis for anticipating and correcting them.
    5. A taxonomy of reasoning flaws in the anti-vaccine movement
    1. 2019-04-16

    2. Objective:To evaluate whether the MMR vaccine increases the risk for autism in children, subgroups of children, or time periods after vaccination.Design:Nationwide cohort study.Setting:Denmark.Participants:657 461 children born in Denmark from 1999 through 31 December 2010, with follow-up from 1 year of age and through 31 August 2013.Measurements:Danish population registries were used to link information on MMR vaccination, autism diagnoses, other childhood vaccines, sibling history of autism, and autism risk factors to children in the cohort. Survival analysis of the time to autism diagnosis with Cox proportional hazards regression was used to estimate hazard ratios of autism according to MMR vaccination status, with adjustment for age, birth year, sex, other childhood vaccines, sibling history of autism, and autism risk factors (based on a disease risk score).Results:During 5 025 754 person-years of follow-up, 6517 children were diagnosed with autism (incidence rate, 129.7 per 100 000 person-years). Comparing MMR-vaccinated with MMR-unvaccinated children yielded a fully adjusted autism hazard ratio of 0.93 (95% CI, 0.85 to 1.02). Similarly, no increased risk for autism after MMR vaccination was consistently observed in subgroups of children defined according to sibling history of autism, autism risk factors (based on a disease risk score) or other childhood vaccinations, or during specified time periods after vaccination.Limitation:No individual medical charts were reviewed.Conclusion:The study strongly supports that MMR vaccination does not increase the risk for autism, does not trigger autism in susceptible children, and is not associated with clustering of autism cases after vaccination. It adds to previous studies through significant additional statistical power and by addressing hypotheses of susceptible subgroups and clustering of cases.
    3. /10.7326/M18-2101
    4. Measles, Mumps, Rubella Vaccination and Autism
    1. 2018-10

    2. Broniatowski, D. A., Jamison, A. M., Qi, S., AlKulaib, L., Chen, T., Benton, A., Quinn, S. C., & Dredze, M. (2018). Weaponized Health Communication: Twitter Bots and Russian Trolls Amplify the Vaccine Debate. American Journal of Public Health, 108(10), 1378–1384. https://doi.org/10.2105/AJPH.2018.304567

    3. 10.2105/AJPH.2018.304567
    4. weets across user types. We conducted a content analysis of a Twitter hashtag associated with Russian troll activity.Results. Compared with average users, Russian trolls (χ2(1) = 102.0; P < .001), sophisticated bots (χ2(1) = 28.6; P < .001), and “content polluters” (χ2(1) = 7.0; P < .001) tweeted about vaccination at higher rates. Whereas content polluters posted more antivaccine content (χ2(1) = 11.18; P < .001), Russian trolls amplified both sides. Unidentifiable accounts were more polarized (χ2(1) = 12.1; P < .001) and antivaccine (χ2(1) = 35.9; P < .001). Analysis of the Russian troll hashtag showed that its messages were more political and divisive.Conclusions. Whereas bots that spread malware and unsolicited content disseminated antivaccine messages, Russian trolls promoted discord. Accounts masquerading as legitimate users create false equivalency, eroding public consensus on vaccination.Public Health Implications. Directly confronting vaccine skeptics enables bots to legitimize the vaccine debate. More research is needed to determine how best to combat bot-driven content.
    5. Weaponized Health Communication: Twitter Bots and Russian Trolls Amplify the Vaccine Debate
    1. 2020-04-08

    2. Walter, D., Ophir, Y., & Jamieson, K. H. (2020). Russian Twitter Accounts and the Partisan Polarization of Vaccine Discourse, 2015–2017. American Journal of Public Health, 110(5), 718–724. https://doi.org/10.2105/AJPH.2019.305564

    3. 10.2105/AJPH.2019.305564
    4. Objectives. To understand how Twitter accounts operated by the Russian Internet Research Agency (IRA) discussed vaccines to increase the credibility of their manufactured personas.Methods. We analyzed 2.82 million tweets published by 2689 IRA accounts between 2015 and 2017. Combining unsupervised machine learning and network analysis to identify “thematic personas” (i.e., accounts that consistently share the same topics), we analyzed the ways in which each discussed vaccines.Results. We found differences in volume and valence of vaccine-related tweets among 9 thematic personas. Pro-Trump personas were more likely to express antivaccine sentiment. Anti-Trump personas expressed support for vaccination. Others offered a balanced valence, talked about vaccines neutrally, or did not tweet about vaccines.Conclusions. IRA-operated accounts discussed vaccines in manners consistent with fabricated US identities.Public Health Implications. IRA accounts discussed vaccines online in ways that evoked political identities. This could exacerbate recently emerging partisan gaps relating to vaccine misinformation, as differently valenced messages were targeted at different segments of the US public. These sophisticated targeting efforts, if repeated and increased in reach, could reduce vaccination rates and magnify health disparities.
    5. Russian Twitter Accounts and the Partisan Polarization of Vaccine Discourse, 2015–2017
    1. 2020-09-19

    2. Thousands of people have descended on central London to protest against mass coronavirus vaccinations.
    3. Trafalgar Square protest: Hundreds of anti-vaxxers and coronavirus sceptics gather in central London
    1. 2017-12-27

    2. Smith, N., & Graham, T. (2019). Mapping the anti-vaccination movement on Facebook. Information, Communication & Society, 22(9), 1310–1327. https://doi.org/10.1080/1369118X.2017.1418406

    3. 10.1080/1369118X.2017.1418406
    4. Over the past decade, anti-vaccination rhetoric has become part of the mainstream discourse regarding the public health practice of childhood vaccination. These utilise social media to foster online spaces that strengthen and popularise anti-vaccination discourses. In this paper, we examine the characteristics of and the discourses present within six popular anti-vaccination Facebook pages. We examine these large-scale datasets using a range of methods, including social network analysis, gender prediction using historical census data, and generative statistical models for topic analysis (Latent Dirichlet allocation). We find that present-day discourses centre around moral outrage and structural oppression by institutional government and the media, suggesting a strong logic of ‘conspiracy-style’ beliefs and thinking. Furthermore, anti-vaccination pages on Facebook reflect a highly ‘feminised’ movement ‒ the vast majority of participants are women. Although anti-vaccination networks on Facebook are large and global in scope, the comment activity sub-networks appear to be ‘small world’. This suggests that social media may have a role in spreading anti-vaccination ideas and making the movement durable on a global scale.
    5. Mapping the anti-vaccination movement on Facebook
    1. 2018-07

    2. Motta, M., Callaghan, T., & Sylvester, S. (2018). Knowing less but presuming more: Dunning-Kruger effects and the endorsement of anti-vaccine policy attitudes. Social Science & Medicine, 211, 274–281. https://doi.org/10.1016/j.socscimed.2018.06.032

    3. ObjectivesImmunization is considered one of the most successful and cost-effective public health interventions protecting communities from preventable infectious diseases. The Korean government set up a dedicated workforce for national immunization in 2003, and since then has made strides in improving vaccination coverage across the nation. However, some groups remain relatively vulnerable and require intervention, and it is necessary to address unmet needs to prevent outbreaks of communicable diseases. This study was conducted to characterize persistent challenges to vaccination.MethodsThe study adopted a qualitative method in accordance with the Consolidated Criteria for Reporting Qualitative Research checklist. Three focus group interviews were conducted with 15 professionals in charge of vaccination-related duties. The interviews were conducted according to a semi-structured guideline, and thematic analysis was carried out. Data saturation was confirmed when the researchers agreed that no more new codes could be found.ResultsA total of 4 main topics and 11 subtopics were introduced regarding barriers to vaccination. The main topics were vaccine hesitancy, personal circumstances, lack of information, and misclassification. Among them, vaccine hesitancy was confirmed to be the most significant factor impeding vaccination. It was also found that the factors hindering vaccination had changed over time and disproportionately affected certain groups.ConclusionsThe study identified ongoing unmet needs and barriers to vaccination despite the accomplishments of the National Immunization Program. The results have implications for establishing tailored interventions that target context- and group-specific barriers to improve timely and complete vaccination coverage.
    4. 10.3961/jpmph.18.063
    5. Factors Influencing Vaccination in Korea: Findings From Focus Group Interviews
    1. 2018-08

    2. Motta, M., Callaghan, T., & Sylvester, S. (2018). Knowing less but presuming more: Dunning-Kruger effects and the endorsement of anti-vaccine policy attitudes. Social Science & Medicine, 211, 274–281. https://doi.org/10.1016/j.socscimed.2018.06.032

    3. 10.1016/j.socscimed.2018.06.032
    4. ObjectiveAlthough the benefits of vaccines are widely recognized by medical experts, public opinion about vaccination policies is mixed. We analyze public opinion about vaccination policies to assess whether Dunning-Kruger effects can help to explain anti-vaccination policy attitudes.RationalePeople low in autism awareness – that is, the knowledge of basic facts and dismissal of misinformation about autism – should be the most likely to think that they are better informed than medical experts about the causes of autism (a Dunning-Kruger effect). This “overconfidence” should be associated with decreased support for mandatory vaccination policies and skepticism about the role that medical professionals play in the policymaking process.MethodIn an original survey of U.S. adults (N = 1310), we modeled self-reported overconfidence as a function of responses to a knowledge test about the causes of autism, and the endorsement of misinformation about a link between vaccines and autism. We then modeled anti-vaccination policy support and attitudes toward the role that experts play in the policymaking process as a function of overconfidence and the autism awareness indicators while controlling for potential confounding factors.ResultsMore than a third of respondents in our sample thought that they knew as much or more than doctors (36%) and scientists (34%) about the causes of autism. Our analysis indicates that this overconfidence is highest among those with low levels of knowledge about the causes of autism and those with high levels of misinformation endorsement. Further, our results suggest that this overconfidence is associated with opposition to mandatory vaccination policy. Overconfidence is also associated with increased support for the role that non-experts (e.g., celebrities) play in the policymaking process.ConclusionDunning-Kruger effects can help to explain public opposition to vaccination policies and should be carefully considered in future research on anti-vaccine policy attitudes.