Parents’ hesitancy towards vaccination in Indonesia: A cross-sectional study in Indonesia

Free vaccination against the human papillomavirus (HPV) began in December, 2010, for Japanese girls aged 12–16 years and since April, 2013, the vaccine was included in the national immunisation programme. However, in June, 2013, the Japanese Ministry of Health, Labour, and Welfare suspended proactive recommendations for the HPV vaccine after unconfirmed reports of adverse events following vaccination appeared in the media.1Gilmour S Kanda M Kusumi E Tanimoto T Kami M Shibuya K HPV vaccination programme in Japan.Lancet. 2013; 382: 768Summary Full Text Full Text PDF PubMed Scopus (54) Google Scholar In January, 2014, the Vaccine Adverse Reactions Review Committee investigating these adverse events concluded that there was no evidence to suggest a causal association between the HPV vaccine and the reported adverse events after vaccination, but they still did not reinstate proactive recommendations for its use.2Saitoh A Okabe N Recent progress and concerns regarding the Japanese immunization program: addressing the “vaccine gap”.Vaccine. 2014; 32: 4253-4258Crossref PubMed Scopus (40) Google Scholar We report the resulting effects of such a decision by presenting data from Sapporo, a city of 2 million people in northern Japan.

10.1016/S0140-6736(15)61152-7

HPV vaccination crisis in Japan

ObjectivesAs Asian Americans are disproportionately affected by the hepatitis B virus (HBV), this study explores predictors of HBV screening and vaccination among Chinese and Korean Americans.MethodsThis study uses cross-sectional data from a community-based sample of Chinese Americans (N = 502) and Korean Americans (N = 487) residing in the metropolitan New York City area from 2008–2009. Logistic regression models were stratified by Asian American subgroup and sex to predict HBV screening (among the entire sample) and HBV vaccination (among those not HBV positive).ResultsOverall, screening rates were high (71.3% among Chinese and 70.1% among Koreans). The majority of respondents were aware of HBV; however, knowledge about HBV transmission was low. In logistic regression, a physician recommendation was consistently associated with HBV screening and vaccination outcomes across all groups; having heard of HBV was significantly associated with screening and vaccination among Chinese males and screening among Korean males and females. Screening and vaccination barriers were reported among all groups, and include lack of knowledge and feeling well/having no health issues.ConclusionsTargeted efforts in these at-risk communities are necessary in order to improve HBV knowledge, address misinformation about HBV, and eliminate provider-, patient-, and resource-related barriers to HBV screening and vaccination.

10.5993/AJHB.41.2.12

Hepatitis B Screening and Vaccination Behaviors among a Community-based Sample of Chinese and Korean Americans in New York City

10.1007/s10995-010-0693-5

To determine how risk perceptions, worry, and distrust relate to pregnant women’s intentions to accept the H1N1 vaccine. Cross-sectional survey of 173 pregnant women recruited from two OB/GYN practices at an urban academic medical center. Survey items were adapted from validated measures of risk, worry, and health care distrust. Vaccination intention was analyzed as a dichotomous variable. Analyses were with student’s t tests, chi squared tests, and logistic regression. Study participants were, on average, 25.6 years old with parity = 2.8. 55% of respondents were Black; 32% completed a high school diploma or less; and half were publically or un- insured. 63% of the respondents reported that they “definitely” or “probably” would accept the H1N1 vaccine. Intention to receive the H1N1 vaccine did not vary by sociodemographic factors nor by source of health information. In univariate analysis, intention was related to higher risk perceptions about probability of and susceptibility to H1N1 influenza (57.9 vs. 31.8%, P = .001 and 67.0 vs. 45.3%, P = .005, respectively), worry about getting H1N1 influenza (48.1 vs. 15.6%, P = <.001), and less distrust in the health care system (mean score 1.07 vs. 1.51, P < .001). In multivariable analysis, only worry about getting H1N1 was related to vaccination intention (OR = 3.43, P = .04). Worry about acquiring disease was a stronger predictor of vaccine intention than risk perceptions, distrust, or worry about vaccine safety. With growing numbers of vaccines being offered during pregnancy and immediately postpartum, these results have important implications for future vaccination intervention, education, and messaging efforts in urban settings.

Risk Perceptions, Worry, or Distrust: What Drives Pregnant Women’s Decisions to Accept the H1N1 Vaccine?

This thought‐provoking book makes the point that vaccination is not an exact science and it is both a medical and social science. This raises questions about how to create greater transparency in vaccine policy, address profit incentives and stop marketing vaccines as something that is done only for individual benefit. Reich recommends that vaccine conversations with parents should be adapted to balance efforts to promote population health, while supporting the concepts of consent, bodily integrity and individual choice in health care.

10.1111/1467-9566.12541

Reich, J.A. Calling the Shots: Why Parents Reject Vaccines.

BackgroundThere is growing evidence of vaccine delays or refusals due to a lack of trust in the importance, safety, or effectiveness of vaccines, alongside persisting access issues. Although immunisation coverage is reported administratively across the world, no similarly robust monitoring system exists for vaccine confidence. In this study, vaccine confidence was mapped across 149 countries between 2015 and 2019.MethodsIn this large-scale retrospective data-driven analysis, we examined global trends in vaccine confidence using data from 290 surveys done between September, 2015, and December, 2019, across 149 countries, and including 284 381 individuals. We used a Bayesian multinomial logit Gaussian process model to produce estimates of public perceptions towards the safety, importance, and effectiveness of vaccines. Associations between vaccine uptake and a large range of putative drivers of uptake, including vaccine confidence, socioeconomic status, and sources of trust, were determined using univariate Bayesian logistic regressions. Gibbs sampling was used for Bayesian model inference, with 95% Bayesian highest posterior density intervals used to capture uncertainty.FindingsBetween November, 2015, and December, 2019, we estimate that confidence in the importance, safety, and effectiveness of vaccines fell in Afghanistan, Indonesia, Pakistan, the Philippines, and South Korea. We found significant increases in respondents strongly disagreeing that vaccines are safe between 2015 and 2019 in six countries: Afghanistan, Azerbaijan, Indonesia, Nigeria, Pakistan, and Serbia. We find signs that confidence has improved between 2018 and 2019 in some EU member states, including Finland, France, Ireland, and Italy, with recent losses detected in Poland. Confidence in the importance of vaccines (rather than in their safety or effectiveness) had the strongest univariate association with vaccine uptake compared with other determinants considered. When a link was found between individuals' religious beliefs and uptake, findings indicated that minority religious groups tended to have lower probabilities of uptake.InterpretationTo our knowledge, this is the largest study of global vaccine confidence to date, allowing for cross-country comparisons and changes over time. Our findings highlight the importance of regular monitoring to detect emerging trends to prompt interventions to build and sustain vaccine confidence.FundingEuropean Commission, Wellcome, and Engineering and Physical Sciences Research Council.

10.1016/S0140-6736(20)31558-0

Mapping global trends in vaccine confidence and investigating barriers to vaccine uptake: a large-scale retrospective temporal modelling study

10.1016/j.vaccine.2014.01.081

Vaccine “hesitancy” is an emerging term in the literature and discourse on vaccine decision-making and determinants of vaccine acceptance. It recognizes a continuum between the domains of vaccine acceptance and vaccine refusal and de-polarizes previous characterization of individuals and groups as either anti-vaccine or pro-vaccine.The primary aims of this systematic review are to: 1) identify research on vaccine hesitancy; 2) identify determinants of vaccine hesitancy in different settings including its context-specific causes, its expression and its impact; and 3) inform the development of a model for assessing determinants of vaccine hesitancy in different settings as proposed by the Strategic Advisory Group of Experts Working Group (SAGE WG) for dealing with vaccine hesitancy.A broad search strategy, built to capture multiple dimensions of public trust, confidence and hesitancy around vaccines, was applied across multiple databases. Peer-reviewed studies were selected for inclusion if they focused on childhood vaccines [≤7 years of age], used multivariate analyses, and were published between January 2007 and November 2012.Our results show a variety of factors as being associated with vaccine hesitancy but they do not allow for a complete classification and confirmation of their independent and relative strength of influence. Determinants of vaccine hesitancy are complex and context-specific – varying across time, place and vaccines.

Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007–2012

Background In July 2009, French public health authorities embarked in a mass vaccination campaign against A/H1N1 2009 pandemic-influenza. We explored the attitudes and behaviors of the general population toward pandemic vaccination. Methodology/Principal Findings We conducted a cross-sectional online survey among 2,253 French representative adults aged 18 to 64 from November 17 to 25, 2009 (completion rate: 93.8%). The main outcome was the acceptability of A/H1N1 vaccination as defined by previous receipt or intention to get vaccinated (“Yes, certainly”, “Yes, probably”). Overall 17.0% (CI 95%, 15.5% to 18.7%) of respondents accepted A/H1N1 vaccination. Independent factors associated with acceptability included: male sex (p = .0001); older age (p = .002); highest or lowest level of education (p = .016); non-clerical occupation (p = .011); having only one child (p = .008); and having received seasonal flu vaccination in prior 3 years (p<.0001). Acceptability was also significantly higher among pregnant women (37.9%) and other at risk groups with chronic diseases (34.8%) (p = .002). Only 35.5% of respondents perceived A/H1N1 influenza illness as a severe disease and 12.7% had experienced A/H1N1 cases in their close relationships with higher acceptability (p<.0001 and p = .006, respectively). In comparison to 26.0% respondents who did not consult their primary care physician, acceptability was significantly higher among 8.0% respondents who were formally advised to get vaccinated, and lower among 63.7% respondents who were not advised to get vaccinated (respectively: 15.8%, 59.5% and 11.7%- p<.0001). Among respondents who refused vaccination, 71.2% expressed concerns about vaccine safety. Conclusions/Significance Our survey occurred one week before the peak of the pandemic in France. We found that alarming public health messages aiming at increasing the perception of risk severity were counteracted by daily personal experience which did not confirm the threat, while vaccine safety was a major issue. This dissonance may have been amplified by having not involved primary care physicians in the mass vaccination campaign.

10.1371/journal.pone.0010199

Low Acceptability of A/H1N1 Pandemic Vaccination in French Adult Population: Did Public Health Policy Fuel Public Dissonance?

10.2807/1560-7917.ES.2019.24.26.1900371

Italy introduced a national law extending the number of compulsory vaccines from four to 10 in July 2017. The implementation placed a further burden on immunisation centres as they were required to cover the increased demand of vaccination by the parents of unvaccinated children. Vaccine coverage (VC) estimated 6 months and 1 year later, at 24 and 30 months (same birth cohort), had increased for all vaccines. At 24 months of age, measles VC increased from 87.3% in 2016 to 91.8% in 2017 and 94.1% at 30 months of age as at June 2018. In six of 21 regions and autonomous provinces, VC for measles was >95%. Despite the implementation of this law, vaccine hesitancy is still a problem in Italy and the political and social debate on mandatory vaccination is ongoing. Regardless of the policy to be adopted in the future, strategies to maintain high vaccination rates and the related herd immunity should be considered, including adequate communication to the population and the implementation of electronic immunisation registries.

The law on compulsory vaccination in Italy: an update 2 years after the introduction

At the November 2011 meeting of the Strategic Advisory Group of Experts (SAGE) on Immunization, SAGE noted with concern the impact of reluctance to accept immunization on the uptake of vaccines reported from both developed and developing countries. These reports led SAGE to request the establishment of a working group on vaccine hesitancy1

REPORT OF THE SAGE WORKING GROUP ON VACCINE HESITANCY

10.1016/j.ypmed.2012.02.015

Objective1) To determine the influenza vaccination coverage required to establish herd immunity, and 2) to assess whether the percentages of vaccination coverage proposed and those registered in the United States and Europe are sufficient to establish herd immunity.MethodsThe vaccination coverage required to establish herd immunity was determined by taking into account the number of secondary cases per infected case (Ro) and the vaccine effectiveness.ResultsThe required percentage that would have been required to establish herd immunity against previous influenza viruses ranged from 13% to 100% for the 1918–19, 1957–58, 1968–69 and 2009–10 pandemic viruses, and from 30% to 40% for the 2008–09 epidemic virus. The objectives of vaccination coverage proposed in the United States — 80% in healthy persons and 90% in high-risk persons — are sufficient to establish herd immunity, while those proposed in Europe — only 75% in elderly and high-risk persons — are not sufficient. The percentages of vaccination coverage registered in the United States and Europe are not sufficient to establish herd immunity.ConclusionThe influenza vaccination coverage must be increased in the United States and Europe in order to establish herd immunity. It is necessary to develop new influenza prevention messages based on herd immunity.Highlights► Vaccination coverage required to establish herd immunity for previous and new influenza viruses. ► Proposed vaccination coverage objectives are sufficient to establish herd immunity. ► Percentages of vaccination coverage registered are not sufficient to establish herd immunity. ► Influenza vaccination coverage must be increased. ► It is important to vaccinate low-risk persons to protect persons with weak immune systems.

The vaccination coverage required to establish herd immunity against influenza viruses

Vaccination has greatly reduced the burden of infectious diseases

Vaccination greatly reduces disease, disability, death and inequity worldwide

10.1542/peds.2013-0698

OBJECTIVES: To evaluate the economic impact of the 2009 routine US childhood immunization schedule, including diphtheria and tetanus toxoids and acellular pertussis, Haemophilus influenzae type b conjugate, inactivated poliovirus, measles/mumps/rubella, hepatitis B, varicella, 7-valent pneumococcal conjugate, hepatitis A, and rotavirus vaccines; influenza vaccine was not included.METHODS: Decision analysis was conducted using population-based vaccination coverage, published vaccine efficacies, historical data on disease incidence before vaccination, and disease incidence reported during 2005 to 2009. Costs were estimated using the direct cost and societal (direct and indirect costs) perspectives. Program costs included vaccine, administration, vaccine-associated adverse events, and parent travel and work time lost. All costs were inflated to 2009 dollars, and all costs and benefits in the future were discounted at a 3% annual rate. A hypothetical 2009 US birth cohort of 4 261 494 infants over their lifetime was followed up from birth through death. Net present value (net savings) and benefit-cost ratios of routine childhood immunization were calculated.RESULTS: Analyses showed that routine childhood immunization among members of the 2009 US birth cohort will prevent ∼42 000 early deaths and 20 million cases of disease, with net savings of $13.5 billion in direct costs and $68.8 billion in total societal costs, respectively. The direct and societal benefit-cost ratios for routine childhood vaccination with these 9 vaccines were 3.0 and 10.1.CONCLUSIONS: From both direct cost and societal perspectives, vaccinating children as recommended with these vaccines results in substantial cost savings.

Economic Evaluation of the Routine Childhood Immunization Program in the United States, 2009

10.17226/25917

In response to the coronavirus disease 2019 (COVID-19) pandemic and the societal disruption it has brought, national governments and the international community have invested billions of dollars and immense amounts of human resources to develop a safe and effective vaccine in an unprecedented time frame. Vaccination against this novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), offers the possibility of significantly reducing severe morbidity and mortality and transmission when deployed alongside other public health strategies and improved therapies. Health equity is intertwined with the impact of COVID-19 and there are certain populations that are at increased risk of severe illness or death from COVID-19. In the United States and worldwide, the pandemic is having a disproportionate impact on people who are already disadvantaged by virtue of their race and ethnicity, age, health status, residence, occupation, socioeconomic condition, or other contributing factors. Framework for Equitable Allocation of COVID-19 Vaccine offers an overarching framework for vaccine allocation to assist policy makers in the domestic and global health communities. Built on widely accepted foundational principles and recognizing the distinctive characteristics of COVID-19, this report's recommendations address the commitments needed to implement equitable allocation policies for COVID-19 vaccine.

Framework for Equitable Allocation of COVID-19 Vaccine

A review of the first 6 years of the national human papillomavirus (HPV) immunisation programme for adolescent girls in England.

Human papillomavirus (HPV) immunisation programme review: 2008 to 2014

10.1056/NEJMp1010594

Today, the most recent in a long line of antivaccinationists are using modern media to sway public opinion and distract attention from scientific evidence. But there are steps we can take to avert the ill effects of these campaigns.

The Age-Old Struggle against the Antivaccinationists

Individual and national/cultural differences were apparent in response to the 2009–2010 influenza pandemic. Overall pandemic influenza immunization rates were low across all nations, including among healthcare workers. Among the reasons for the low coverage rates may have been a lack of concern about the individual risk of influenza, which may translate into a lack of willingness or urgency to be vaccinated, particularly if there is mistrust of information provided by public health or governmental authorities. Intuitively, a link between willingness to be vaccinated against seasonal influenza and against pandemic influenza exists, given the similarities in decision-making for this infection. As such, the public is likely to share common concerns regarding pandemic and seasonal influenza vaccination, particularly in the areas of vaccine safety and side effects, and personal risk. Given the public's perception of the low level of virulence of the recent pandemic influenza virus, there is concern that the perception of a lack of personal risk of infection and risk of vaccine side effects could adversely affect seasonal vaccine uptake. While governments are more often concerned about public anxiety and panic, as well as absenteeism of healthcare and other essential workers during a pandemic, convincing the public of the threat posed by pandemic or seasonal influenza is often the more difficult, and underappreciated task. Thus, appropriate, timely, and data-driven health information are very important issues in increasing influenza vaccine coverage, perhaps even more so in western societies where trust in government and public health reports may be lower than in other countries. This article explores what has been learned about cross-cultural responses to pandemic influenza, and seeks to apply those lessons to seasonal influenza immunization programs.

10.1016/j.vaccine.2010.08.024

The 2009–2010 influenza pandemic: effects on pandemic and seasonal vaccine uptake and lessons learned for seasonal vaccination campaigns

To investigate factors associated with intention to be vaccinated against COVID-19 we conducted a cross-sectional survey of 1,500 UK adults, recruited from an existing online research panel. Data were collected between 14th and 17th July 2020. We used linear regression analyses to investigate associations between intention to be vaccinated for COVID-19 “when a vaccine becomes available to you” and sociodemographic factors, previous influenza vaccination, general vaccine attitudes and beliefs, attitudes and beliefs about COVID-19, and attitudes and beliefs about a COVID-19 vaccination. 64% of participants reported being very likely to be vaccinated against COVID-19, 27% were unsure, and 9% reported being very unlikely to be vaccinated. Personal and clinical characteristics, previous influenza vaccination, general vaccination beliefs, and beliefs and attitudes about COVID-19 and a COVID-19 vaccination explained 76% of the variance in vaccination intention. Intention to be vaccinated was associated with more positive general COVID-19 vaccination beliefs and attitudes, weaker beliefs that the vaccination would cause side effects or be unsafe, greater perceived information sufficiency to make an informed decision about COVID-19 vaccination, greater perceived risk of COVID-19 to others (but not risk to oneself), older age, and having been vaccinated for influenza last winter (2019/20). Despite uncertainty around the details of a COVID-19 vaccination, most participants reported intending to be vaccinated for COVID-19. Actual uptake may be lower. Vaccination intention reflects general vaccine beliefs and attitudes. Campaigns and messaging about a COVID-19 vaccination could consider emphasizing the risk of COVID-19 to others and necessity for everyone to be vaccinated

10.1080/21645515.2020.1846397

COVID-19 vaccination intention in the UK: results from the COVID-19 vaccination acceptability study (CoVAccS), a nationally representative cross-sectional survey

doi.org/10.1073/pnas.1704507114

Few measures in public health can compare with the impact of vaccines.

Simply put: Vaccination saves lives

10.1377/hlthaff.2015.1086

An analysis of return on investment can help policy makers support, optimize, and advocate for the expansion of immunization programs in the world’s poorest countries. We assessed the return on investment associated with achieving projected coverage levels for vaccinations to prevent diseases related to ten antigens in ninety-four low- and middle-income countries during 2011–20, the Decade of Vaccines. We derived these estimates by using costs of vaccines, supply chains, and service delivery and their associated economic benefits. Based on the costs of illnesses averted, we estimated that projected immunizations will yield a net return about 16 times greater than costs over the decade (uncertainty range: 10–25). Using a full-income approach, which quantifies the value that people place on living longer and healthier lives, we found that net returns amounted to 44 times the costs (uncertainty range: 27–67). Across all antigens, net returns were greater than costs. But to realize the substantial positive return on investment from immunization programs, it is essential that governments and donors provide the requisite investments.

Return On Investment From Childhood Immunization In Low- And Middle-Income Countries, 2011–20

10.1016/S0264-410X(03)00377-3

The value of vaccination: a global perspective

10.1016/B978-0-12-802174-3.00001-1

Looking back at the past 100 years of medical advances in the prevention and treatment of disease, vaccination is the miracle of modern medicine. In the past 50 years, evidence suggests it has saved more lives worldwide than any other medical product or procedure. Vaccination has a long history, dating back to the work of the British physician Edward Jenner in 1796 on variolation to protect against smallpox, and advancing in complexity in recent times to the production of multivalent vaccines to protect against infections such as pneumonia and human papilloma virus (HPV), with many antigenic strains of the pathogen in circulation in human communities

The Impact of Vaccination on the Epidemiology of Infectious Diseases

Most Americans expect a vaccine against COVID-19 to be available by some point in 2021, but only half say they will get vaccinated and many are unsure, according to the AP-NORC survey conducted in May 2020.

Expectations for a COVID-19 Vaccine

The SARS-CoV-2 pandemic has led to a global effort to develop, test, manufacture and distribute effective vaccines at unprecedented speed. There are currently over 200 vaccine candidates in development and the results of initial large-scale trials are expected soon; however, to deliver a successful vaccination programme, many challenges remain. This report discusses the key issues involved in developing, evaluating, manufacturing and distributing a vaccine for COVID-19, the impact of those challenges and future strategies to mitigate their effects.

SARS-CoV-2 Vaccine Development & Implementation; Scenarios, Options, Key Decisions

BACKGROUND: AIDS is still a major cause of death. To combat this disease, researchers are developing a vaccine. Although blacks account for most new infections in the United States, they account for a low percent of experimental vaccine recipients. This study, conducted in a mid-sized U.S. city where vaccine trials are held, seeks to learn why. METHODS: We conducted 11 in-depth ethnographic interviews. Two groups were targeted: blacks who had not participated in HIV vaccine trials and blacks who had. RESULTS: Overall, three major causes of nonparticipation were identified: misinformation, fear/mistrust and stigma. Factors that favored participation included having close friends with HIV and being homosexual. CONCLUSIONS: HIV is considered by many blacks to be a gay, white disease. Steps to increase participation must include efforts to destigmatize the condition and disseminate accurate information. Efforts to address historical causes of mistrust through "education" alone are insufficient. Trust needs to be earned through long-term relationships with black communities.

Why blacks do not take part in HIV vaccine trials.

10.1016/j.vaccine.2008.01.011

We report on 30 in-depth mental models interviews with parents discussing vaccination for their children, both in general terms and in response to communications drawn from sources supporting and opposing vaccines. We found that even parents favourable to vaccination can be confused by the ongoing debate, leading them to question their choices. Many parents lack basic knowledge of how vaccines work, and do not find the standard information provided to them to be particularly helpful in explaining it. Those with the greatest need to know about vaccination seem most vulnerable to confusing information. Opportunities for education may be missed if paediatricians do not appreciate parents’ specific information needs.

Parents’ vaccination comprehension and decisions

10.1007/s10865-012-9397-1

While defaults may encourage some health behaviors, how defaults influence controversial behaviors is not well understood. We examined the effect of two default policies on parents’ consent to have their adolescent sons hypothetically receive HPV vaccine at school. A national sample of 404 parents of adolescent sons participated in an online 3×2 between-subjects factorial experiment. Factors varied the default consent policy (opt-in, opt-out, or neutral) and the number of vaccines sons would receive (HPV vaccine alone or along with two other recommended adolescent vaccines). Among parents wanting to get their sons HPV vaccine in the next year, consent was higher in the opt-in condition (compared to the opt-out condition) or if other recommended adolescent vaccines would be included. Default policies had no effect among parents undecided about HPV vaccination. Parents’ consent for school-located HPV vaccination may be higher when presented as an opt-in decision and other vaccines are included.

Default Policies and Parents’ Consent for School-Located HPV Vaccination

Today EMA has released its first safety update on a COVID-19 vaccine — Comirnaty. It concludes that safety data collected on Comirnaty use in vaccination campaigns is consistent with the known safety profile of the vaccine, and no new side effects were identified.

First COVID-19 vaccine safety update published

10.1007/s10339-020-00974-8

Designing effective communication strategies for correcting vaccines misinformation requires an understanding of how the target group might react to information from different sources. The present study examined whether erroneous inferences about vaccination could be effectively corrected by a perceived credible (i.e. expert or trustworthy) source. Two experiments are reported using a standard continued influence paradigm, each featuring two correction conditions on vaccine misinformation. Participants were presented with a story containing a piece of information that was later retracted by a perceived credible or not so credible source. Experiment 1 showed that providing a correction reduced participants’ use of the original erroneous information, yet the overall reliance on misinformation did not significantly differ between the low- and high-expertise correction groups. Experiment 2 revealed that a correction from a high-trustworthy source decreased participants’ reliance on misinformation when making inferences; nonetheless, it did not positively affect the reported intent to vaccinate one’s child. Overall, source trustworthiness was more relevant than source expertise.

The effects of source expertise and trustworthiness on recollection: the case of vaccine misinformation

Erroneous beliefs are difficult to correct. Worse, popular correction strategies, such as the myth-versus-fact article format, may backfire because they subtly reinforce the myths through repetition and further increase the spread and acceptance of misinformation. Here we identify five key criteria people employ as they evaluate the truth of a statement: They assess general acceptance by others, gauge the amount of supporting evidence, determine its compatibility with their beliefs, assess the general coherence of the statement, and judge the credibility of the source of the information. In assessing these five criteria, people can actively seek additional information (an effortful analytic strategy) or attend to the subjective experience of easy mental processing—what psychologists call fluent processing—and simply draw conclusions on the basis of what feels right (a less effortful intuitive strategy). Throughout this truth-evaluation effort, fluent processing can facilitate acceptance of the statement: When thoughts flow smoothly, people nod along. Unfortunately, many correction strategies inadvertently make the false information more easily acceptable by, for example, repeating it or illustrating it with anecdotes and pictures. This, ironically, increases the likelihood that the false information the communicator wanted to debunk will be believed later. A more promising correction strategy is to focus on making the true information as easy to process as possible. We review recent research and offer recommendations for more effective presentation and correction strategies.

Making the truth stick & the myths fade: Lessons from cognitive psychology

10.1080/10510974.2017.1414068

This study aims to explore differences between health misinformation and true information by comparing word usage, sentiments, and online popularity between pro- and anti-vaccine headlines (PVHs and AVHs). Text mining and sentiment analysis showed that AVHs were more likely to use negative sentiment words and trust-related words. PVHs were more likely to use words related to positive sentiments. Anti-vaccine messages (AVMs) were more popular online than pro-vaccine messages (PVMs). AVMs’ online popularity was not related to its emotion words usage. Among PVMs, those with more positive sentiment words were more likely to be shared, commented on, and reacted to online. Wordclouds and word networks were created to visualize the word usage and clustering. Future directions regarding message design and automatic detection and analysis techniques are provided.

Using Text Mining to Compare Online Pro- and Anti-Vaccine Headlines: Word Usage, Sentiments, and Online Popularity

10.1016/j.vaccine.2018.05.007

Most members of the general public use the internet to research health topics. However, the quality of vaccine-related material available online is mixed and internet search engines often bring web users to low-quality anti-vaccine websites.We present a case study of a pro-vaccine information hub launched in 2011. Vaccines Today provides high-quality information about vaccines and diseases, expert interviews, answers to frequently asked questions, parent/patient stories and videos/infographics. Twitter, Facebook, YouTube and Instagram are used to share this content and to engage with various online audiences.This Commentary outlines what works in online communication about vaccines and offers proposals for improving the impact of online vaccine advocacy. The value of networking to boost visibility and search engine ranking is emphasised. Furthermore, we present the case for the sharing and application of best practice in online communication.

Lessons from an online vaccine communication project

10.1016/j.vaccine.2011.11.112

Websites opposing vaccination are prevalent on the Internet. Web 2.0, defined by interaction and user-generated content, has become ubiquitous. Furthermore, a new postmodern paradigm of healthcare has emerged, where power has shifted from doctors to patients, the legitimacy of science is questioned, and expertise is redefined. Together this has created an environment where anti-vaccine activists are able to effectively spread their messages. Evidence shows that individuals turn to the Internet for vaccination advice, and suggests such sources can impact vaccination decisions – therefore it is likely that anti-vaccine websites can influence whether people vaccinate themselves or their children. This overview examines the types of rhetoric individuals may encounter online in order to better understand why the anti-vaccination movement can be convincing, despite lacking scientific support for their claims. Tactics and tropes commonly used to argue against vaccination are described. This includes actions such as skewing science, shifting hypotheses, censoring dissent, and attacking critics; also discussed are frequently made claims such as not being “anti-vaccine” but “pro-safe vaccines”, that vaccines are toxic or unnatural, and more. Recognizing disingenuous claims made by the anti-vaccination movement is essential in order to critically evaluate the information and misinformation encountered online.

Anti-vaccine activists, Web 2.0, and the postmodern paradigm – An overview of tactics and tropes used online by the anti-vaccination movement

This guidance document provides basic broad principles for a spokesper-son of any health authority on how to respond to vocal vaccine deniers. The suggestions are based on psychological research on persuasion, on research in public health, communication studies and on WHO risk communication guidelines.

How to respond to vocal vaccine deniers in public

10.4745/ccdr.v46i06a10

Adverse events following immunizations (AEFI) are important to identify and manage effectively so as to sustain trust in vaccines and optimize health. The AEFI category related to “anxiety about the immunization” was considered problematic as it did not adequately capture the range of stress responses that can occur. The currently used term for this category, immunization stress-related responses (ISRR), is broader, including the full spectrum of signs and symptoms that can arise in response to stress. ISRR can include vasovagal reactions (fainting), hyperventilation and functional neurological symptoms (e.g. weakness, nonepileptic seizures). It is based on a biopsychosocial framework in which biological (e.g. age, sex), psychological (e.g. preparedness, previous experiences, anxiety) and social factors (e.g. response by others, social media) interact to create an individual’s stress response to the immunization process.New guidance is available on prevention, early detection and management of ISRRs which is summarized in the article.

Managing immunization stress-related response: A contributor to sustaining trust in vaccines

10.1016/j.clinthera.2009.07.022

Background: Immunization is regarded as one of the most significant medical achievements of all time. Recently, increasing attention has been paid to the pain resulting from routine childhood immunizations.Objective: This narrative review summarizes existing knowledge about: (1) the epidemiology of childhood immunization pain; (2) the pain experience of children undergoing immunization; (3) current analgesic practices; (4) barriers to practicing pain management in children; and (5) recommendations for improvements in pain management during immunization.Methods: We conducted a search of MEDLINE, PsycINFO, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials for primary research and review articles published from inception of the databases through October 2008. Key search terms included immunization, pain, child/infant, vaccine, and intervention. Additional studies were identified through searches of the reference lists in the retrieved articles. No language restrictions were imposed regarding the type of article (eg, full article, abstract) or language.Results: Vaccine injections are the most common iatrogenic procedure performed in childhood and a major source of distress for children (of all ages), their parents, and the participating health care professionals, as well as a direct cause of vaccine nonadherence. In addition, lack of adequate pain management during immunization exposes children to unnecessary suffering and the potential for long-term consequences, such as fear of needles. Numerous pain management strategies are available to reduce vaccine injection pain, including: (1) physical interventions and injection techniques; (2) psychological interventions; and (3) phar-macologic and combined interventions. However, adoption of pain-relieving techniques into clinical practice has been suboptimal. The underutilization of pain management strategies can be attributed to a lack of knowledge about pain and effective pain prevention strategies, and the persistence of attitudes about pain that interfere with optimal clinical practices. Current analgesic practices could be improved substantially if all stakeholders involved in immunization (eg, policy makers, practitioners, consumers) participate in efforts to reduce pain. Treating pain during childhood immunization has the potential to reduce distress during the procedure and greatly improve satisfaction with the immunization experience through more positive experiences for children and their families. Other potential benefits include improved adherence to immunization schedules and reduced sequelae of untreated pain.Conclusion: Immunization is a global health priority. Medical care can be improved if pain management becomes a routine aspect of the delivery of vaccine injections.

Inadequate pain management during routine childhood immunizations: The nerve of it

10.1007/s10900-020-00837-5

Human papillomavirus (HPV) has been linked to genital warts and multiple cancers affecting both men and women. Despite college students’ high risk for HPV, their vaccination rates remain suboptimal. The current observational study examined the relationship between social norms and HPV vaccine intentions and potential mechanisms underlying this relationship among undergraduates. Participants (N = 190; 66.8% female) completed a survey assessing HPV vaccine social norms, attitudes, self-efficacy, and intentions. Three mediation analyses were conducted to examine whether self-efficacy and attitudes mediated the relationship between social norms (i.e., parents, friends, doctor) and intentions, controlling for demographic and health care covariates. Social norms were indirectly related to intentions through self-efficacy and attitudes in multiple models (ps < .05). Specifically, perceiving greater support for HPV vaccination from one’s friends, parents, and doctor was related to greater HPV vaccine self-efficacy, which, in turn, was related to increased vaccine intentions. In addition, perceiving greater parental and doctor support for HPV vaccination was related to more favorable attitudes towards the vaccine, which, in turn, were related to increased vaccine intentions. Findings suggest potential targets for future interventions to promote HPV vaccination among young adults.

Self-efficacy and HPV Vaccine Attitudes Mediate the Relationship Between Social Norms and Intentions to Receive the HPV Vaccine Among College Students

10.1016/j.socscimed.2019.01.038

RationaleChildhood vaccination is a safe and effective way of reducing infectious diseases. Yet, public confidence in vaccination is waning, driven in part by the ‘manufacture of doubt’ by anti-vaccination activists and websites. However, there is little research examining the psychological underpinnings of anti-vaccination rhetoric among parents.ObjectivesHere, we examined the structure and moral roots of anti-vaccination attitudes amongst Australian parents active on social media parenting sites.MethodsParticipants (N = 296) completed questionnaires assessing their vaccination attitudes, behavioural intentions, and moral preferences.ResultsUsing Latent Profile Analysis, we identified three profiles (i.e., groups), interpretable as vaccine “accepters”, “fence sitters”, and “rejecters”, each characterised by a distinct pattern of vaccination attitudes and moral preferences. Accepters exhibited positive vaccination attitudes and strong intentions to vaccinate; rejecters exhibited the opposite pattern of responses; whilst fence sitters exhibited an intermediate pattern of responses. Compared to accepters, rejecters and fence sitters exhibited a heightened moral preference for liberty (belief in the rights of the individual) and harm (concern about the wellbeing of others). Compared to acceptors and fence sitters, rejecters exhibited a heightened moral preference for purity (an abhorrence for impurity of body), and a diminished moral preference for authority (deference to those in positions of power).ConclusionGiven the sensitivity of fence sitters and rejecters to liberty-related moral concerns, our research cautions against the use of adversarial approaches—e.g., No Jab, No Pay legislation—that promote vaccination uptake by restricting parental freedoms, as they may backfire amongst parents ambivalent toward vaccination.

Accepters, fence sitters, or rejecters: Moral profiles of vaccination attitudes

10.1038/s41562-017-0256-5

Clusters of unvaccinated children are particularly susceptible to outbreaks of vaccine-preventable disease1,2. Existing messaging interventions demonstrate short-term success, but some may backfire and worsen vaccine hesitancy3. Values-based messages appeal to core morality, which influences the attitudes individuals then have on topics like vaccination4,5,6,7. We must understand how underlying morals, not just attitudes, differ by hesitancy type to develop interventions that work with individual values. Here, we show in two correlational studies that harm and fairness foundations are not significantly associated with vaccine hesitancy, but purity and liberty foundations are. We found that medium-hesitancy parents were twice as likely as low-hesitancy parents to highly emphasize purity (adjusted odds ratio: 2.08; 95% confidence interval: 1.27–3.40). High-hesitancy respondents were twice as likely to strongly emphasize purity (adjusted odds ratio: 2.15; 95% confidence interval: 1.39–3.31) and liberty (adjusted odds ratio: 2.19; 95% confidence interval: 1.50–3.21). Our results demonstrate that endorsement of harm and fairness—ideas often emphasized in traditional vaccine-focused messages—are not predictive of vaccine hesitancy. This, combined with significant associations of purity and liberty with hesitancy, indicates a need for inclusion of broader themes in vaccine discussions. These findings have the potential for application to other health decisions and communications as well. <div class="c-nature-box c-nature-box--side c-nature-box--mobile" data-component="entitlement-box"> <div class="js-access-button"> <a href="https://wayf.springernature.com?redirect_uri&#x3D;https%3A%2F%2Fwww.nature.com%2Farticles%2Fs41562-017-0256-5" class="c-article__button" data-test="ra21" data-track="click" data-track-action="institution access" data-track-label="button"> <svg class="u-icon" width="18" height="18" aria-hidden="true" focusable="false"><use href="#global-icon-institution"></use></svg> <span class="c-article__button-text">Access through your institution</span> </a> </div> <div class="js-buy-button"> <a href="#access-options" class="c-article__button c-article__button--inverted" data-test="ra21" data-track="click" data-track-action="buy or subscribe" data-track-label="button"> <span>Buy or subscribe</span> </a> </div> </div> Access this article via University of Bath Access through your institution Change institution Buy or subscribe

Association of moral values with vaccine hesitancy

10.1371/journal.pone.0209505

Background During epidemic crises, some of the information the public receives on social media is misinformation. Health organizations are required to respond and correct the information to gain the public’s trust and influence it to follow the recommended instructions. Objectives (1) To examine ways for health organizations to correct misinformation concerning the measles vaccination on social networks for two groups: pro-vaccination and hesitant; (2) To examine the types of reactions of two subgroups (pro-vaccination, hesitant) to misinformation correction; and (3) To examine the effect of misinformation correction on these two subgroups regarding reliability, satisfaction, self-efficacy and intentions. Methods A controlled experiment with participants divided randomly into two conditions. In both experiment conditions a dilemma was presented as to sending a child to kindergarten, followed by an identical Facebook post voicing the children mothers’ concerns. In the third stage the correction by the health organization is presented differently in two conditions: Condition 1 –common information correction, and Condition 2 –recommended (theory-based) information correction, mainly communicating information transparently and addressing the public’s concerns. The study included (n = 243) graduate students from the Faculty of Social Welfare and Health Sciences at Haifa University. Results A statistically significant difference was found in the reliability level attributed to information correction by the Health Ministry between the Control condition and Experimental condition (sig<0.001), with the average reliability level of the subjects in Condition 2 (M = 5.68) being considerably higher than the average reliability level of subjects in Condition 1 (4.64). A significant difference was found between Condition 1 and Condition 2 (sig<0.001), with the average satisfaction from the Health Ministry’s response of Condition 2 subjects (M = 5.75) being significantly higher than the average satisfaction level of Condition 1 subjects (4.66). Similarly, when we tested the pro and hesitant groups separately, we found that both preferred the response presented in Condition 2. Conclusion It is very important for the organizations to correct misinformation transparently, and to address the emotional aspects for both the pro-vaccination and the hesitant groups. The pro-vaccination group is not a captive audience, and it too requires a full response that addresses the public's fears and concerns.

Correcting misinformation by health organizations during measles outbreaks: A controlled experiment

Seasonal influenza is responsible for thousands of deaths and billions of dollars of medical costs per year in the United States, but influenza vaccination coverage remains substantially below public health targets. One possible obstacle to greater immunization rates is the false belief that it is possible to contract the flu from the flu vaccine. A nationally representative survey experiment was conducted to assess the extent of this flu vaccine misperception. We find that a substantial portion of the public (43%) believes that the flu vaccine can give you the flu. We also evaluate how an intervention designed to address this concern affects belief in the myth, concerns about flu vaccine safety, and future intent to vaccinate. Corrective information adapted from the Centers for Disease Control and Prevention (CDC) website significantly reduced belief in the myth that the flu vaccine can give you the flu as well as concerns about its safety. However, the correction also significantly reduced intent to vaccinate among respondents with high levels of concern about vaccine side effects – a response that was not observed among those with low levels of concern. This result, which is consistent with previous research on misperceptions about the MMR vaccine, suggests that correcting myths about vaccines may not be an effective approach to promoting immunization.

10.1016/j.vaccine.2014.11.017

Does correcting myths about the flu vaccine work? An experimental evaluation of the effects of corrective information

OBJECTIVES: To test the effectiveness of messages designed to reduce vaccine misperceptions and increase vaccination rates for measles-mumps-rubella (MMR).METHODS: A Web-based nationally representative 2-wave survey experiment was conducted with 1759 parents age 18 years and older residing in the United States who have children in their household age 17 years or younger (conducted June–July 2011). Parents were randomly assigned to receive 1 of 4 interventions: (1) information explaining the lack of evidence that MMR causes autism from the Centers for Disease Control and Prevention; (2) textual information about the dangers of the diseases prevented by MMR from the Vaccine Information Statement; (3) images of children who have diseases prevented by the MMR vaccine; (4) a dramatic narrative about an infant who almost died of measles from a Centers for Disease Control and Prevention fact sheet; or to a control group.RESULTS: None of the interventions increased parental intent to vaccinate a future child. Refuting claims of an MMR/autism link successfully reduced misperceptions that vaccines cause autism but nonetheless decreased intent to vaccinate among parents who had the least favorable vaccine attitudes. In addition, images of sick children increased expressed belief in a vaccine/autism link and a dramatic narrative about an infant in danger increased self-reported belief in serious vaccine side effects.CONCLUSIONS: Current public health communications about vaccines may not be effective. For some parents, they may actually increase misperceptions or reduce vaccination intention. Attempts to increase concerns about communicable diseases or correct false claims about vaccines may be especially likely to be counterproductive. More study of pro-vaccine messaging is needed.

10.1542/peds.2013-2365

Effective Messages in Vaccine Promotion: A Randomized Trial

When faced with vaccine hesitancy, public health authorities are looking for effective strategies to address this issue. In this paper, the findings of 15 published literature reviews or meta-analysis that have examined the effectiveness of different interventions to reduce vaccine hesitancy and/or to enhance vaccine acceptance are presented and discussed. From the literature, there is no strong evidence to recommend any specific intervention to address vaccine hesitancy/refusal. The reviewed studies included interventions with diverse content and approaches that were implemented in different settings and targeted various populations. Few interventions were directly targeted to vaccine hesitant individuals. Given the paucity of information on effective strategies to address vaccine hesitancy, when interventions are implemented, planning a rigorous evaluation of their impact on vaccine hesitancy/vaccine acceptance will be essential.

10.1016/j.vaccine.2015.04.041

Strategies intended to address vaccine hesitancy: Review of published reviews

Objective: Strengthening of antivaccination movements in recent decades has coincided with unprecedented increases in the incidence of some communicable diseases. Many intervention programs work from a deficit model of science communication, presuming that vaccination skeptics lack the ability to access or understand evidence. However, interventions focusing on evidence and the debunking of vaccine-related myths have proven to be either nonproductive or counterproductive. Working from a motivated reasoning perspective, we examine the psychological factors that might motivate people to reject scientific consensus around vaccination. To assist with international generalizability, we examine this question in 24 countries. Methods: We sampled 5,323 participants in 24 countries, and measured their antivaccination attitudes. We also measured their belief in conspiracy theories, reactance (the tendency for people to have a low tolerance for impingements on their freedoms), disgust sensitivity toward blood and needles, and individualistic/hierarchical worldviews (i.e., people's beliefs about how much control society should have over individuals, and whether hierarchies are desirable). Results: In order of magnitude, antivaccination attitudes were highest among those who (a) were high in conspiratorial thinking, (b) were high in reactance, (c) reported high levels of disgust toward blood and needles, and (d) had strong individualistic/hierarchical worldviews. In contrast, demographic variables (including education) accounted for nonsignificant or trivial levels of variance. Conclusions: These data help identify the "attitude roots" that may motivate and sustain vaccine skepticism. In so doing, they help shed light on why repetition of evidence can be nonproductive, and suggest communication solutions to that problem. (PsycINFO Database Record

10.1037/hea0000586

The psychological roots of anti-vaccination attitudes: A 24-nation investigation

10.1136/bmjopen-2016-014668

Objectives Despite continuous efforts to improve influenza vaccination coverage, uptake among high-risk groups remains suboptimal. We aimed to identify policy amenable factors associated with vaccination and to measure their importance in order to assist in the monitoring of vaccination sentiment and the design of communication strategies and interventions to improve vaccination rates.Setting The USA, the UK and France.Participants A total of 2412 participants were surveyed across the three countries.Outcome measures Self-reported influenza vaccination.Methods Between March and April 2014, a stratified random sampling strategy was employed with the aim of obtaining nationally representative samples in the USA, the UK and France through online databases and random-digit dialling. Participants were asked about vaccination practices, perceptions and feelings. Multivariable logistic regression was used to identify factors associated with past influenza vaccination.Results The models were able to explain 64%–80% of the variance in vaccination behaviour. Overall, sociopsychological variables, which are inherently amenable to policy, were better at explaining past vaccination behaviour than demographic, socioeconomic and health variables. Explanatory variables included social influence (physician), influenza and vaccine risk perceptions and traumatic childhood experiences.Conclusions Our results indicate that evidence-based sociopsychological items should be considered for inclusion into national immunisation surveys to gauge the public’s views, identify emerging concerns and thus proactively and opportunely address potential barriers and harness vaccination drivers.

Evaluating the importance of policy amenable factors in explaining influenza vaccination: a cross-sectional multinational study

10.1016/j.vaccine.2015.11.065

Suboptimal vaccine uptake in both childhood and adult immunisation programs limits their full potential impact on global health. A recent progress review of the Global Vaccine Action Plan stated that “countries should urgently identify barriers and bottlenecks and implement targeted approaches to increase and sustain coverage”. However, vaccination coverage may be determined by a complex mix of demographic, structural, social and behavioral factors. To develop a practical taxonomy to organise the myriad possible root causes of a gap in vaccination coverage rates, we performed a narrative review of the literature and tested whether all non-socio-demographic determinants of coverage could be organised into 4 dimensions: Access, Affordability, Awareness and Acceptance. Forty-three studies were reviewed, from which we identified 23 primary determinants of vaccination uptake. We identified a fifth domain, Activation, which captured interventions such as SMS reminders which effectively nudge people towards getting vaccinated. The 5As taxonomy captured all identified determinants of vaccine uptake. This intuitive taxonomy has already facilitated mutual understanding of the primary determinants of suboptimal coverage within inter-sectorial working groups, a first step towards them developing targeted and effective solutions.

The 5As: A practical taxonomy for the determinants of vaccine uptake

Misinformation, the circulation of misleading and false information, deepened the crisis by delaying authoritative response to the pandemic by weeks, if not months. Public declarations of misinformation, such as COVID is a hoax, bleach is a COVID cure, wearing a mask increases your chances of getting COVID, caused a delay that cost many American lives. According to a recent study, had the U.S. imposed social distancing one week earlier than it did in March 2020, at least 36,000 fewer people would have died (Pei 2020).

Lies, Bots, and Coronavirus: Misinformation’s Deadly Impact on Health

Our report, Moving the Needle, looks at the importance of vaccination through childhood, working-age adulthood, and later life, and explores the barriers to uptake at different stages of the life course.

Moving the Needle: Promoting vaccination uptake across the life course

10.1037/a0031590

Objective: Vaccination yields a direct effect by reducing infection, but also has the indirect effect of herd immunity: If many individuals are vaccinated, the immune population will protect unvaccinated individuals (social benefit). However, due to a vaccination's costs and risks, individual incentives to free-ride on others' protection also increase with the number of individuals who are already vaccinated (individual benefit). The objective was to assess the consequences of communicating the social and/or individual benefits of herd immunity on vaccination intentions. We assume that if social benefits are salient, vaccination intentions increase (prosocial behavior), whereas salience of individual benefits might decrease vaccination intentions (free-riding). Methods: In an online-experiment (N = 342) the definition of herd immunity was provided with one sentence summarizing the gist of the message, either making the individual or social benefit salient or both. A control group received no information about herd immunity. As a moderator, we tested the costs of vaccination (effort in obtaining the vaccine). The dependent measure was intention to vaccinate. Results: When a message emphasized individual benefit, vaccination intentions decreased (free-riding). Communication of social benefit reduced free-riding and increased vaccination intentions when costs to vaccinate were low. Conclusions: Communicating the social benefit of vaccination may prevent free-riding and should thus be explicitly communicated if individual decisions are meant to consider public health benefits. Especially when vaccination is not the individually (but instead collectively) optimal solution, vaccinations should be easily accessible in order to reach high coverage.

Inviting free-riders or appealing to prosocial behavior? game-theoretical reflections on communicating herd immunity in vaccine advocacy

Vaccines—often lauded as one of the greatest public health interventions—are losing public confidence. Some vaccine experts have referred to this decline in confidence as a crisis. We discuss some of the characteristics of the changing global environment that are contributing to increased public questioning of vaccines, and outline some of the specific determinants of public trust. Public decision making related to vaccine acceptance is neither driven by scientific nor economic evidence alone, but is also driven by a mix of psychological, sociocultural, and political factors, all of which need to be understood and taken into account by policy and other decision makers. Public trust in vaccines is highly variable and building trust depends on understanding perceptions of vaccines and vaccine risks, historical experiences, religious or political affiliations, and socioeconomic status. Although provision of accurate, scientifically based evidence on the risk–benefit ratios of vaccines is crucial, it is not enough to redress the gap between current levels of public confidence in vaccines and levels of trust needed to ensure adequate and sustained vaccine coverage. We call for more research not just on individual determinants of public trust, but on what mix of factors are most likely to sustain public trust. The vaccine community demands rigorous evidence on vaccine efficacy and safety and technical and operational feasibility when introducing a new vaccine, but has been negligent in demanding equally rigorous research to understand the psychological, social, and political factors that affect public trust in vaccines.

10.1016/S0140-6736(11)60678-8

Addressing the vaccine confidence gap

https://doi.org/10.1007/BF02879925

Background: Some believe that vaccinating young women against human papillomavirus (HPV) will increase their risky behavior. In more formal terms, vaccination lowers risk perception, and people compensate for their lower perceived risk by reducing other preventive behaviors.Purpose: We test several predictions from the risk compensation hypothesis in the context of vaccination behavior.Methods: We obtained a random sample of adults (N=705), interviewing them by phone just as the Lyme disease vaccine first became available to the public and again 18 months later. Analyses controlled for age, sex, education, and race.Results: Vaccinated respondents were less likely to continue engaging in two of five protective behaviors after vaccination. The frequency of these protective behaviors did not dip below that among the unvaccinated respondents.Conclusions: We found some evidence of regression (protective behaviors dropping, after vaccination, to levels reported by the unvaccinated cohort). However, we did not finddisinhibition (exceeding the risk taking of the unvaccinated cohort), the greater threat to public health. Although we will not know for several years what effect HPV vaccination has on other behaviors, if any, data on other vaccinations can offer critically important information in the interim.

Risk compensation and vaccination: Can getting vaccinated cause people to engage in risky behaviors?

A community-level vaccine coverage of 80+% will be required to protect the community from infection, dependent on the vaccine efficacy and duration of protection. • Public expectations urgently need to be managed to prepare for a longer-term transition where non-pharmaceutical interventions remain in place. • Behavioural factors underpinning vaccine uptake are: (1) complacency, (2) trust and confidence in efficacy and safety, (3) convenience, (4) sources of information; and, (5) socio-demographic variation.• COVID-19 vaccine deployment faces an unprecedented degree of uncertainty and complexity, which is difficult to communicate, such as immune response, duration of immunity, repeated vaccination, transmission dynamics, microbiological and clinical characteristics and multiple vaccines.• Priority groups for vaccine deployment need transparent public debate to build support for ethical principles.• Current seasonal flu uptake is low in certain groups, suggesting vaccination challenges, which include: high risk groups under the age of 65 (40 - 50%), support staff in health care organisations (as low as 37%) and London and even variation amongst key workers such as Doctors (40 - 100%). • Deployment and tracking should build on existing immunisation programmes such as primary care by GPs to identify comorbidities, track vaccinations and reminders for additional boosters.• COVID-19 vaccine deployment faces an infodemic with misinformation often filling the knowledge void, characterised by: (1) distrust of science and selective use of expert authority, (2) distrust in pharmaceutical companies and government, (3) straightforward explanations, (4) use of emotion; and, (5) echo chambers. • A narrow focus on misinformation disregards the fact that there are genuine knowledge voids, necessitating public dialogue about vaccine concerns and hesitancy rather than providing passive one-way communication strategies.

COVID-19 vaccine deployment: Behaviour, ethics, misinformation and policy strategies

10.1080/21645515.2020.1717182