In Turkey, primary care staffs have observed an increased rate of vaccination refusal in recent years. The aim of the present study was to determine the prevalence of vaccination refusal and hesitancy in Turkey, in addition to the demographic features and underlying reasons. The present descriptive cross-sectional study was conducted in İstanbul and Tekirdağ, two big Turkish cities that are exposed to widespread internal migration. To reflect Turkey’s demographic structure, 1004 participants were selected using cluster sampling based on birthplace, age, and level of education, from all individuals who attended family medicine outpatient clinics at Namık Kemal University and Şişli Hamidiye Etfal Training and Research Hospital. A face-to-face questionnaire method was used. Data show that this decline was mainly the result of the increasing rate of vaccine rejection and hesitation, for which the most important reason was found to be distrust of vaccine companies. It can be concluded that individuals who display vaccine refusal and hesitation are mostly born in the developed geographical regions of Turkey and have high income and educational levels. According to these results, we anticipate that vaccination rates may fall in Turkey in the coming years.

Vaccine rejection and hesitation in Turkey

10.1037/hea0000294

ObjectiveRisk beliefs are central to most theories of health behavior, yet many unanswered questions remain about an increasingly studied risk construct, anticipated regret. We sought to better understand anticipated regret’s role in motivating health behaviors.MethodsWe systematically searched electronic databases for studies of anticipated regret and behavioral intentions or health behavior. We used random effects meta-analysis to synthesize effect sizes from 81 studies (n=45,618).ResultsAnticipated regret was associated with both intentions (r+= .50, p<.001) and health behavior (r+= .29, p<.001). Greater anticipated regret from engaging in a behavior (i.e., action regret) predicted weaker intentions and behavior, while greater anticipated regret from not engaging in a behavior (i.e., inaction regret) predicted stronger intentions and behavior. Anticipated action regret had smaller associations with behavioral intentions related to less severe and more distal hazards, but these moderation findings were not present for inaction regret. Anticipated regret generally was a stronger predictor of intentions and behavior than other anticipated negative emotions and risk appraisals.ConclusionsAnticipated inaction regret has a stronger and more stable association with health behavior than previously thought. The field should give greater attention to understanding how anticipated regret differs from similar constructs, its role in health behavior theory, and its potential use in health behavior interventions.

Anticipated Regret and Health Behavior: A Meta-Analysis

Vaccine confidence depends on trust in vaccines as products and trust in the system that produces them. In the US, this system consists of a complex network connecting pharmaceutical companies, government agencies, and the healthcare system. We explore narratives from White and African American adults describing their trust in these institutions, with a focus on influenza vaccine. Our data were collected between 2012 and 2014 as part of a mixed-methods investigation of racial disparities in influenza immunization. We interviewed 119 adults, primarily in Maryland and Washington, DC, in three stages utilizing semi-structured interviews (12), focus groups (9, n=91), and in-depth interviews (16). Analysis was guided by grounded theory. Trust in institutions emerged as a significant theme, with marked differences by race. In 2018, we contextualized these findings within the growing scholarship on trust and vaccines. Most participants distrusted pharmaceutical companies, which were viewed to be motivated by profit. Trust in government varied. Whites described implicit trust of federal institutions but questioned their competency. African Americans were less trusting of the government and were more likely to doubt its motives. Trust in institutions may be fragile, and once damaged, may take considerable time and effort to repair.

 10.1016/j.socscimed.2018.12.020

“You don’t trust a government vaccine”: Narratives of Institutional Trust and Influenza Vaccination among African American and White Adults

BackgroundThe current outbreak of Ebola in eastern DR Congo, beginning in 2018, emerged in a complex and violent political and security environment. Community-level prevention and outbreak control measures appear to be dependent on public trust in relevant authorities and information, but little scholarship has explored these issues. We aimed to investigate the role of trust and misinformation on individual preventive behaviours during an outbreak of Ebola virus disease (EVD).MethodsWe surveyed 961 adults between Sept 1 and Sept 16, 2018. We used a multistage sampling design in Beni and Butembo in North Kivu, DR Congo. Of 412 avenues and cells (the lowest administrative structures; 99 in Beni and 313 in Butembo), we randomly selected 30 in each city. In each avenue or cell, 16 households were selected using the WHO Expanded Programme on Immunization's random walk approach. In each household, one adult (aged ≥18 years) was randomly selected for interview. Standardised questionnaires were administered by experienced interviewers. We used multivariate models to examine the intermediate variables of interest, including institutional trust and belief in selected misinformation, with outcomes of interest related to EVD prevention behaviours.FindingsAmong 961 respondents, 349 (31·9%, 95% CI 27·4–36·9) trusted that local authorities represent their interest. Belief in misinformation was widespread, with 230 (25·5%, 21·7–29·6) respondents believing that the Ebola outbreak was not real. Low institutional trust and belief in misinformation were associated with a decreased likelihood of adopting preventive behaviours, including acceptance of Ebola vaccines (odds ratio 0·22, 95% CI 0·21–0·22, and 1·40, 1·39–1·42) and seeking formal health care (0·06, 0·05–0·06, and 1·16, 1·15–1·17).InterpretationThe findings underscore the practical implications of mistrust and misinformation for outbreak control. These factors are associated with low compliance with messages of social and behavioural change and refusal to seek formal medical care or accept vaccines, which in turn increases the risk of spread of EVD.FundingThe Harvard Humanitarian Initiative Innovation Fund.

10.1016/S1473-3099(19)30063-5

Institutional trust and misinformation in the response to the 2018–19 Ebola outbreak in North Kivu, DR Congo: a population-based survey

Operation Warp Speed and global vaccine research efforts have succeeded in rapidly launching three vaccine candidates for coronavirus disease 2019 (COVID-19) into Phase III clinical trials. A recent letter from Centers for Disease Control and Prevention (CDC) Director Redfield underscored the possibility of “large-scale” distribution of a coronavirus vaccine as early as November 1, 2020. However, recent polling reveals that the majority of Americans remain skeptical of both the safety and efficacy of a potential Covid-19 vaccine. Even more troublesome is the fact that a comprehensive, collaborative vaccine marketing campaign has not been initiated to educate the U.S. public on and encourage widespread Covid-19 vaccination. Accordingly, this article lays out a plan of action, utilizing proven immunization marketing strategies and novel approaches, that could be used to combat vaccine hesitancy toward Covid-19. A vaccine may indeed be our ticket out of this pandemic, but targeted marketing is needed to increase public optimism toward that fact.

0.1080/21645515.2020.1831859

The Missing Link in the Covid-19 Vaccine Race

10.1371/journal.pone.0054149

The demand for vaccination against infectious diseases involves a choice between vaccinating and not vaccinating, in which there is a trade-off between the benefits and costs of each option. The aim of this paper is to investigate these trade-offs and to estimate how the perceived prevalence and severity of both the disease against which the vaccine is given and any vaccine associated adverse events (VAAE) might affect demand. A Discrete Choice Experiment (DCE) was used to elicit stated preferences from a representative sample of 369 UK mothers of children below 5 years of age, for three hypothetical vaccines. Cost was included as an attribute, which enabled estimation of the willingness to pay for different vaccines having differing levels of the probability of occurrence and severity of both the infection and VAAE. The results suggest that the severity of the health effects associated with both the diseases and VAAEs exert an important influence on the demand for vaccination, whereas the probability of these events occurring was not a significant predictor. This has important implications for public health policy, which has tended to focus on the probability of these health effects as the main influence on decision making. Our results also suggest that anticipated regrets about the consequences of making the wrong decision also exert an influence on demand.

The Effect of Perceived Risks on the Demand for Vaccination: Results from a Discrete Choice Experiment

10.1016/j.vaccine.2015.04.036

The SAGE Working Group on Vaccine Hesitancy concluded that vaccine hesitancy refers to delay in acceptance or refusal of vaccination despite availability of vaccination services. Vaccine hesitancy is complex and context specific, varying across time, place and vaccines. It is influenced by factors such as complacency, convenience and confidence. The Working Group retained the term ‘vaccine’ rather than ‘vaccination’ hesitancy, although the latter more correctly implies the broader range of immunization concerns, as vaccine hesitancy is the more commonly used term. While high levels of hesitancy lead to low vaccine demand, low levels of hesitancy do not necessarily mean high vaccine demand. The Vaccine Hesitancy Determinants Matrix displays the factors influencing the behavioral decision to accept, delay or reject some or all vaccines under three categories: contextual, individual and group, and vaccine/vaccination-specific influences.

Vaccine hesitancy: Definition, scope and determinants

10.1016/j.vaccine.2010.04.052

Suboptimal childhood vaccination uptake results in disease outbreaks, and in developed countries is largely attributable to parental choice. To inform evidence-based interventions, we conducted a systematic review of factors underlying parental vaccination decisions. Thirty-one studies were reviewed. Outcomes and methods are disparate, which limits synthesis; however parents are consistently shown to act in line with their attitudes to combination childhood vaccinations. Vaccine-declining parents believe that vaccines are unsafe and ineffective and that the diseases they are given to prevent are mild and uncommon; they mistrust their health professionals, Government and officially-endorsed vaccine research but trust media and non-official information sources and resent perceived pressure to risk their own child's safety for public health benefit. Interventions should focus on detailed decision mechanisms including disease-related anticipated regret and perception of anecdotal information as statistically representative. Self-reported vaccine uptake, retrospective attitude assessment and unrepresentative samples limit the reliability of reviewed data – methodological improvements are required in this area.

Factors underlying parental decisions about combination childhood vaccinations including MMR: A systematic review

10.1016/j.ypmed.2016.05.025

ObjectiveVaccination is an effective preventive measure to reduce influenza transmission, especially important in a pandemic. Despite the messages encouraging vaccination during the last pandemic, uptake remained low (37.6% in clinical risk groups). This study investigated the effect of different types of messages regarding length, content type, and framing on vaccination intention.MethodAn online experiment was conducted in February 2015. A representative sample of 1424 people living in England read a mock newspaper article about a novel influenza pandemic before being randomised to one of four conditions: standard Department of Health (DoH) (long message) and three brief theory-based messages - an abridged version of the standard DoH and two messages additionally targeting pandemic influenza severity and vaccination benefits (framed as risk-reducing or health-enhancing, respectively). Intention to be vaccinated and potential mediators were measured.ResultsThe shortened DoH message increased vaccination intention more than the longer one, by increasing perceived susceptibility, anticipated regret and perceived message personal relevance while lowering perceived costs, despite the longer one being rated as slightly more credible. Intention to be vaccinated was not improved by adding information on severity and benefits, and the health-enhancing message was not more effective than the risk-reducing.ConclusionA briefer message resulted in greater intention to be vaccinated, whereas emphasising the severity of pandemic influenza and the benefits of vaccination did not. Future campaigns should consider using brief theoretically-based messages, targeting knowledge about influenza and precautionary measures, perceived susceptibility to pandemic influenza, and the perceived efficacy and reduced costs of vaccination.

Increasing the intent to receive a pandemic influenza vaccination: Testing the impact of theory-based messages

10.1037/0278-6133.26.2.136

Background: Risk perceptions are central to many health behavior theories. However, the relationship between risk perceptions and behavior, muddied by instances of inappropriate assessment and analysis, often looks weak. Method: A meta-analysis of eligible studies assessing the bivariate association between adult vaccination and perceived likelihood, susceptibility, or severity was conducted. Results: Thirty-four studies met inclusion criteria (N = 15,988). Risk likelihood (pooled r = .26), susceptibility (pooled r = .24), and severity (pooled r = .16) significantly predicted vaccination behavior. The risk perception-behavior relationship was larger for studies that were prospective, had higher quality risk measures, or had unskewed risk or behavior measures. Conclusions: The consistent relationships between risk perceptions and behavior, larger than suggested by prior meta-analyses, suggest that risk perceptions are rightly placed as core concepts in theories of health behavior.

Meta-analysis of the relationship between risk perception and health behavior: the example of vaccination

10.1037/0278-6133.25.1.82

The role of worry, regret, and perceived risk in preventive health decisions was explored in a longitudinal questionnaire study on influenza vaccination among 428 university employees. The study yielded 3 main findings. First, ratings of anticipated worry and regret were stronger predictors of vaccination than perceived risk and mediated the effect of risk on vaccination. Second, the anticipated level of emotions differed systematically from experienced emotions, such that vaccinated individuals anticipated more regret and less worry than they actually experienced. Third, anticipated and experienced emotions had implications for subsequent vaccination decisions. Those who did not vaccinate in the 1st year but had high levels of worry and regret were likely to be vaccinated the following year.

Emotions and preventive health behavior: worry, regret, and influenza vaccination

10.1177/2372732215600716

Even though there are policies in place, and safe and effective vaccines available, almost every country struggles with vaccine hesitancy, that is, a delay in acceptance or refusal of vaccination. Consequently, it is important to understand the determinants of individual vaccination decisions to establish effective strategies to support the success of country-specific public health policies. Vaccine refusal can result from complacency, inconvenience, a lack of confidence, and a rational calculation of pros and cons. Interventions should, therefore, be carefully targeted to focus on the reason for non-vaccination. We suggest that there are several interventions that may be effective for complacent, convenient, and calculating individuals whereas interventions that might be effective for those who lack confidence are scarce. Thus, efforts should be concentrated on motivating the complacent, removing barriers for those for whom vaccination is inconvenient, and adding incentives and additional utility for the calculating. These strategies might be more promising, economic, and effective than convincing those who lack confidence in vaccination.

Using Behavioral Insights to Increase Vaccination Policy Effectiveness

 10.1542/peds.2013-2037

OBJECTIVE:To characterize provider-parent vaccine communication and determine the influence of specific provider communication practices on parent resistance to vaccine recommendations.METHODS:We conducted a cross-sectional observational study in which we videotaped provider-parent vaccine discussions during health supervision visits. Parents of children aged 1 to 19 months old were screened by using the Parent Attitudes about Childhood Vaccines survey. We oversampled vaccine-hesitant parents (VHPs), defined as a score ≥50. We developed a coding scheme of 15 communication practices and applied it to all visits. We used multivariate logistic regression to explore the association between provider communication practices and parent resistance to vaccines, controlling for parental hesitancy status and demographic and visit characteristics.RESULTS:We analyzed 111 vaccine discussions involving 16 providers from 9 practices; 50% included VHPs. Most providers (74%) initiated vaccine recommendations with presumptive (eg, “Well, we have to do some shots”) rather than participatory (eg, “What do you want to do about shots?”) formats. Among parents who voiced resistance to provider initiation (41%), significantly more were VHPs than non-VHPs. Parents had significantly higher odds of resisting vaccine recommendations if the provider used a participatory rather than a presumptive initiation format (adjusted odds ratio: 17.5; 95% confidence interval: 1.2–253.5). When parents resisted, 50% of providers pursued their original recommendations (eg, “He really needs these shots”), and 47% of initially resistant parents subsequently accepted recommendations when they did.CONCLUSIONS:How providers initiate and pursue vaccine recommendations is associated with parental vaccine acceptance.

The Architecture of Provider-Parent Vaccine Discussions at Health Supervision Visits

10.1037/0278-6133.26.2.146

Objective: Accurate measurement of beliefs about risk probability is essential to determine what role these beliefs have in health behavior. This study investigated the ability of several types of risk perception measures and of other constructs from health behavior theories to predict influenza vaccination. Design: Prospective study in which students, faculty, and staff at 3 universities (N = 428) were interviewed in the fall, before influenza vaccine was available, and again early in the next calendar year. Main Outcome Measure: Self-reported influenza vaccination. Results: Two interview questions that asked about feeling at risk and feeling vulnerable predicted subsequent behavior better (r = .44, p = .001) than 2 questions that asked for agreement or disagreement with statements about risk probability (r = .25, p = .001) or 4 questions that asked respondents to estimate the magnitude of the risk probability (r = .30, p = .001). Of the 4 perceived risk magnitude scales, a 7-point verbal scale was the best predictor of behavior. Anticipated regret was the strongest predictor of vaccination (r = .45, p = .001) of all constructs studied, including risk perceptions, worry, and perceived vaccine effectiveness. Conclusion: Risk perceptions predicted subsequent vaccination. However, perceived risk phrased in terms of feelings rather than as a purely cognitive probability judgment predicted better. Because neither feeling at risk nor anticipated regret is represented in the most commonly used theories of health behavior, the data suggest that these theories are missing important constructs. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Risk perceptions: Assessment and relationship to influenza vaccination.

The global spread of COVID-19 has created an urgent need for a safe and effective vaccine. However, even if a safe and medically effective vaccine is developed, hesitancy by citizens to receive it would undercut its effectiveness as a tool for limiting the spread of COVID-19.1,2,3 A potential driver of hesitancy in the United States is the politicization of a potential vaccine, including when one might be approved with respect to the presidential election and which public figures are endorsing its safety and efficacy.4,5 Using a pair of randomized survey experiments, we show that announcing approval of a COVID-19 vaccine one week before the election compared to one week after considerably reduces both beliefs about its safety and efficacy and willingness to receive it. However, endorsement by Dr. Anthony Fauci increases reported beliefs about safety and willingness to receive a vaccine among all partisan subgroups. Further, an endorsement by Dr. Fauci increased uptake and confidence in safety even if a vaccine receives pre-election approval. The results here suggest that perceptions of political influence in COVID-19 vaccine approval could significantly undermine the viability of a vaccine as a strategy to end the pandemic.

10.21203/rs.3.rs-95823/v1

Timing of COVID-19 Vaccine Approval and Endorsement by Public Figures

10.1186/1471-2431-12-154

BackgroundA critical factor shaping parental attitudes to vaccination is the parent’s interactions with health professionals. An effective interaction can address the concerns of vaccine supportive parents and motivate a hesitant parent towards vaccine acceptance. Poor communication can contribute to rejection of vaccinations or dissatisfaction with care. We sought to provide a framework for health professionals when communicating with parents about vaccination.MethodsLiterature review to identify a spectrum of parent attitudes or ‘positions’ on childhood vaccination with estimates of the proportion of each group based on population studies. Development of a framework related to each parental position with determination of key indicators, goals and strategies based on communication science, motivational interviewing and valid consent principles.ResultsFive distinct parental groups were identified: the ‘unquestioning acceptor’ (30–40%), the ‘cautious acceptor’ (25–35%); the ‘hesitant’ (20–30%); the ‘late or selective vaccinator’ (2–27%); and the ‘refuser’ of all vaccines (<2%). The goals of the encounter with each group will vary, depending on the parents’ readiness to vaccinate. In all encounters, health professionals should build rapport, accept questions and concerns, and facilitate valid consent. For the hesitant, late or selective vaccinators, or refusers, strategies should include use of a guiding style and eliciting the parent’s own motivations to vaccinate while, avoiding excessive persuasion and adversarial debates. It may be necessary to book another appointment or offer attendance at a specialised adverse events clinic. Good information resources should also be used.ConclusionsHealth professionals have a central role in maintaining public trust in vaccination, including addressing parents’ concerns. These recommendations are tailored to specific parental positions on vaccination and provide a structured approach to assist professionals. They advocate respectful interactions that aim to guide parents towards quality decisions.

Communicating with parents about vaccination: a framework for health professionals

10.1016/j.vaccine.2016.10.042

While most people vaccinate according to the recommended schedule, this success is challenged by individuals and groups who delay or refuse vaccines. The aim of this article is to review studies on vaccine hesitancy among healthcare providers (HCPs), and the influences of their own vaccine confidence and vaccination behaviour on their vaccination recommendations to others.The search strategy was developed in Medline and then adapted across several multidisciplinary mainstream databases including Embase Classic & Embase, and PschInfo. All foreign language articles were included if the abstract was available in English.A total of 185 articles were included in the literature review. 66% studied the vaccine hesitancy among HCPs, 17% analysed concerns, attitudes and/or behaviour of HCPs towards vaccinating others, and 9% were about evaluating intervention(s). Overall, knowledge about particular vaccines, their efficacy and safety, helped to build HCPs own confidence in vaccines and their willingness to recommend vaccines to others. The importance of societal endorsement and support from colleagues was also reported.In the face of emerging vaccine hesitancy, HCPs still remain the most trusted advisor and influencer of vaccination decisions. The capacity and confidence of HCPs, though, are stretched as they are faced with time constraints, increased workload and limited resources, and often have inadequate information or training support to address parents’ questions. Overall, HCPs need more support to manage the quickly evolving vaccine environment as well as changing public, especially those who are reluctant or refuse vaccination. Some recommended strategies included strengthening trust between HCPs, health authorities and policymakers, through more shared involvement in the establishment of vaccine recommendations.

Vaccine hesitancy and healthcare providers

10.4161/hv.24657

Despite being recognized as one of the most successful public health measures, vaccination is perceived as unsafe and unnecessary by a growing number of individuals. Lack of confidence in vaccines is now considered a threat to the success of vaccination programs. Vaccine hesitancy is believed to be responsible for decreasing vaccine coverage and an increasing risk of vaccine-preventable disease outbreaks and epidemics. This review provides an overview of the phenomenon of vaccine hesitancy. First, we will characterize vaccine hesitancy and suggest the possible causes of the apparent increase in vaccine hesitancy in the developed world. Then we will look at determinants of individual decision-making about vaccination.

Vaccine hesitancy An overview

Individuals care about how they are perceived by others, and take visible actions to signal their type. This paper investigates social signaling in the context of childhood immunization in Sierra Leone. Despite high initial vaccine take-up, many parents do not complete the five immunizations that are required in a child’s first year of life. I introduce a durable signal - in the form of differently colored bracelets - which children receive upon vaccination, and implement a 22-month-long experiment in 120 public clinics. Informed by theory, the experimental design separately identifies social signaling from leading alternative mechanisms. In a first main finding, I show that individuals use signals to learn about others’ actions. Second, I find that the impact of signals varies significantly with the social desirability of the action. In particular, the signal has a weak effect when linked to a vaccine with low perceived benefits and a large, positive effect when linked to a vaccine with high perceived benefits. Of substantive policy importance, signals increase timely and complete vaccination at a cost of approximately 1 USD per child, with effects persisting 12 months after the roll out. Finally, I structurally estimate a dynamic discrete-choice model to quantify the value of social signaling.

Social Signaling and Childhood Immunization: A Field Experiment in Sierra Leone

10.1016/j.vaccine.2011.06.107

BackgroundIn June 2009 a global influenza pandemic was declared by the World Health Organisation. A vaccination programme against H1N1 influenza was introduced in many countries from September 2009, but there was low uptake in both the general population and health professionals in many, though not all, countries.PurposeTo examine the psychological and demographic factors associated with uptake of vaccination during the 2009 pandemic.MethodA systematic literature review searching Web of Science and PubMed databases up to 24 January 2011.Results37 articles met the study inclusion criteria. Using the framework of Protection Motivation Theory the review found that both the degree of threat experienced in the 2009 pandemic influenza outbreak and perceptions of vaccination as an effective coping strategy were associated with stronger intentions and higher uptake of vaccination. Appraisal of threat resulted from both believing oneself to be at risk from developing H1N1 influenza and concern and worry about the disease. Appraisal of coping resulted from concerns about the safety of the vaccine and its side effects. There was evidence of an influence of social pressure in that people who thought that others wanted them to be vaccinated were more likely to do so and people getting their information about vaccination from official health sources being more likely to be vaccinated than those relying on unofficial sources. There was also a strong influence of past behaviour, with those having been vaccinated in the past against seasonal influenza being more likely to be vaccinated against pandemic influenza. Demographic factors associated with higher intentions and uptake of vaccination were: older age, male gender, being from an ethnic minority and, for health professionals, being a doctor.DiscussionInterventions designed to increase vaccination rates could be developed and implemented in advance of a pandemic. Strategies to improve uptake of vaccination include interventions which highlight the risk posed by pandemic influenza while simultaneously offering tactics to ameliorate this risk (e.g. vaccination). Perceived concerns about vaccination can be tackled by reducing the omission bias (a perception that harm caused by action is worse than harm caused by inaction). In addition, interventions to increase seasonal influenza vaccination in advance of a future pandemic may be an effective strategy.

Factors associated with uptake of vaccination against pandemic influenza: A systematic review

10.1542/peds.2012-2452

BACKGROUND AND OBJECTIVE: Parents decide whether their children are vaccinated, but they rarely reach these decisions on their own. Instead parents are influenced by their social networks, broadly defined as the people and sources they go to for information, direction, and advice. This study used social network analysis to formally examine parents’ social networks (people networks and source networks) related to their vaccination decision-making. In addition to providing descriptions of typical networks of parents who conform to the recommended vaccination schedule (conformers) and those who do not (nonconformers), this study also quantified the effect of network variables on parents’ vaccination choices.METHODS: This study took place in King County, Washington. Participation was limited to US-born, first-time parents with children aged ≤18 months. Data were collected via an online survey. Logistic regression was used to analyze the resulting data.RESULTS: One hundred twenty-six conformers and 70 nonconformers completed the survey. Although people networks were reported by 95% of parents in both groups, nonconformers were significantly more likely to report source networks (100% vs 80%, P < .001). Model comparisons of parent, people, and source network characteristics indicated that people network variables were better predictors of parents’ vaccination choices than parents’ own characteristics or the characteristics of their source networks. In fact, the variable most predictive of parents’ vaccination decisions was the percent of parents’ people networks recommending nonconformity.CONCLUSIONS: These results strongly suggest that social networks, and particularly parents’ people networks, play an important role in parents’ vaccination decision-making.

The Impact of Social Networks on Parents’ Vaccination Decisions

10.1177/1529100612451018

The widespread prevalence and persistence of misinformation in contemporary societies, such as the false belief that there is a link between childhood vaccinations and autism, is a matter of public concern. For example, the myths surrounding vaccinations, which prompted some parents to withhold immunization from their children, have led to a marked increase in vaccine-preventable disease, as well as unnecessary public expenditure on research and public-information campaigns aimed at rectifying the situation.We first examine the mechanisms by which such misinformation is disseminated in society, both inadvertently and purposely. Misinformation can originate from rumors but also from works of fiction, governments and politicians, and vested interests. Moreover, changes in the media landscape, including the arrival of the Internet, have fundamentally influenced the ways in which information is communicated and misinformation is spread.We next move to misinformation at the level of the individual, and review the cognitive factors that often render misinformation resistant to correction. We consider how people assess the truth of statements and what makes people believe certain things but not others. We look at people’s memory for misinformation and answer the questions of why retractions of misinformation are so ineffective in memory updating and why efforts to retract misinformation can even backfire and, ironically, increase misbelief. Though ideology and personal worldviews can be major obstacles for debiasing, there nonetheless are a number of effective techniques for reducing the impact of misinformation, and we pay special attention to these factors that aid in debiasing.We conclude by providing specific recommendations for the debunking of misinformation. These recommendations pertain to the ways in which corrections should be designed, structured, and applied in order to maximize their impact. Grounded in cognitive psychological theory, these recommendations may help practitioners—including journalists, health professionals, educators, and science communicators—design effective misinformation retractions, educational tools, and public-information campaigns.

Misinformation and Its Correction: Continued Influence and Successful Debiasing

10.1098/rspb.2013.3172

Mathematical models that couple disease dynamics and vaccinating behaviour often assume that the incentive to vaccinate disappears if disease prevalence is zero. Hence, they predict that vaccine refusal should be the rule, and elimination should be difficult or impossible. In reality, countries with non-mandatory vaccination policies have usually been able to maintain elimination or very low incidence of paediatric infectious diseases for long periods of time. Here, we show that including injunctive social norms can reconcile such behaviour-incidence models to observations. Adding social norms to a coupled behaviour-incidence model enables the model to better explain pertussis vaccine uptake and disease dynamics in the UK from 1967 to 2010, in both the vaccine-scare years and the years of high vaccine coverage. The model also illustrates how a vaccine scare can perpetuate suboptimal vaccine coverage long after perceived risk has returned to baseline, pre-vaccine-scare levels. However, at other model parameter values, social norms can perpetuate depressed vaccine coverage during a vaccine scare well beyond the time when the population's baseline vaccine risk perception returns to pre-scare levels. Social norms can strongly suppress vaccine uptake despite frequent outbreaks, as observed in some small communities. Significant portions of the parameter space also exhibit bistability, meaning long-term outcomes depend on the initial conditions. Depending on the context, social norms can either support or hinder immunization goals.

The influence of social norms on the dynamics of vaccinating behaviour for paediatric infectious diseases

WHO, UNICEF, Gavi and partners are working together to help prepare countries to be ready to introduce a COVID-19 vaccine. Adaptable guidance, tools, trainings, and advocacy materials are being developed to support countries in preparing for COVID-19 vaccination. Please visit this page regularly for updates.We welcome feedback on the existing CRD resources and recommendations for what other materials are needed. You can share your suggestions with the CRD workstream by emailing CRDresources@who.int.

COVID-19 vaccine country readiness and delivery

Strategic considerations in preparing for deployment of COVID-19 vaccine and vaccination in the WHO European Region

10.3390/vaccines8030556

The COVID-19 pandemic response has caused disruption to healthcare services globally, including to routine immunizations. To understand immunization service interruptions specifically for maternal, neonatal and infant vaccines, we captured the local experiences of members of the Immunising Pregnant Women and Infants Network (IMPRINT) by conducting an online survey over 2-weeks in April 2020. IMPRINT is a global network of clinicians and scientists working in maternal and neonatal vaccinology. The survey included discrete questions to quantify the extent of disruption as well as free-text options to explore the reasons behind reported disruptions. Of the 48 responses received, the majority (75%) were from low-and-middle-income countries (LMICs). Of all respondents, 50% or more reported issues with vaccine delivery within their country. Thematic analysis identified three key themes behind immunization disruption: “access” issues, e.g., logistical barriers, “provider” issues, e.g., staff shortages and user “concern” about attending immunization appointments due to COVID-19 fear. Access and provider issues were more commonly reported by LMIC respondents. Overall, respondents reported uncertainty among parents and healthcare providers regarding routine immunization. We conclude that further quantification of routine vaccination disruption is needed, alongside health service prioritization, logistical support and targeted communication strategies to reinforce routine immunizations during the COVID-19 response.

Impact of COVID-19 on Immunization Services for Maternal and Infant Vaccines: Results of a Survey Conducted by Imprint—The Immunising Pregnant Women and Infants Network

10.1016/j.vaccine.2020.10.059

Given the social and economic upheavals caused by the COVID-19 pandemic, political leaders, health officials, and members of the public are eager for solutions. One of the most promising, if they can be successfully developed, is vaccines. While the technological development of such countermeasures is currently underway, a key social gap remains. Past experience in routine and crisis contexts demonstrates that uptake of vaccines is more complicated than simply making the technology available. Vaccine uptake, and especially the widespread acceptance of vaccines, is a social endeavor that requires consideration of human factors. To provide a starting place for this critical component of a future COVID-19 vaccination campaign in the United States, the 23-person Working Group on Readying Populations for COVID-19 Vaccines was formed. One outcome of this group is a synthesis of the major challenges and opportunities associated with a future COVID-19 vaccination campaign and empirically-informed recommendations to advance public understanding of, access to, and acceptance of vaccines that protect against SARS-CoV-2. While not inclusive of all possible steps than could or should be done to facilitate COVID-19 vaccination, the working group believes that the recommendations provided are essential for a successful vaccination program.

The public’s role in COVID-19 vaccination: Human-centered recommendations to enhance pandemic vaccine awareness, access, and acceptance in the United States

10.1007/s10730-019-09383-7

Many parents are hesitant about, or face motivational barriers to, vaccinating their children. In this paper, we propose a type of vaccination policy that could be implemented either in addition to coercive vaccination or as an alternative to it in order to increase paediatric vaccination uptake in a non-coercive way. We propose the use of vaccination nudges that exploit the very same decision biases that often undermine vaccination uptake. In particular, we propose a policy under which children would be vaccinated at school or day-care by default, without requiring parental authorization, but with parents retaining the right to opt their children out of vaccination. We show that such a policy is (1) likely to be effective, at least in cases in which non-vaccination is due to practical obstacles, rather than to strong beliefs about vaccines, (2) ethically acceptable and less controversial than some alternatives because it is not coercive and affects individual autonomy only in a morally unproblematic way, and (3) likely to receive support from the UK public, on the basis of original empirical research we have conducted on the lay public.

Nudging Immunity: The Case for Vaccinating Children in School and Day Care by Default

10.1371/journal.pone.0170550

BackgroundInfluenza vaccine hesitancy is a significant threat to global efforts to reduce the burden of seasonal and pandemic influenza. Potential barriers of influenza vaccination need to be identified to inform interventions to raise awareness, influenza vaccine acceptance and uptake.ObjectiveThis review aims to (1) identify relevant studies and extract individual barriers of seasonal and pandemic influenza vaccination for risk groups and the general public; and (2) map knowledge gaps in understanding influenza vaccine hesitancy to derive directions for further research and inform interventions in this area.MethodsThirteen databases covering the areas of Medicine, Bioscience, Psychology, Sociology and Public Health were searched for peer-reviewed articles published between the years 2005 and 2016. Following the PRISMA approach, 470 articles were selected and analyzed for significant barriers to influenza vaccine uptake or intention. The barriers for different risk groups and flu types were clustered according to a conceptual framework based on the Theory of Planned Behavior and discussed using the 4C model of reasons for non-vaccination.ResultsMost studies were conducted in the American and European region. Health care personnel (HCP) and the general public were the most studied populations, while parental decisions for children at high risk were under-represented. This study also identifies understudied concepts. A lack of confidence, inconvenience, calculation and complacency were identified to different extents as barriers to influenza vaccine uptake in risk groups.ConclusionMany different psychological, contextual, sociodemographic and physical barriers that are specific to certain risk groups were identified. While most sociodemographic and physical variables may be significantly related to influenza vaccine hesitancy, they cannot be used to explain its emergence or intensity. Psychological determinants were meaningfully related to uptake and should therefore be measured in a valid and comparable way. A compendium of measurements for future use is suggested as supporting information.

Barriers of Influenza Vaccination Intention and Behavior – A Systematic Review of Influenza Vaccine Hesitancy, 2005 – 2016

The WHO SAGE values framework for the allocation and prioritization of COVID-19 vaccination is intended to offer guidance on the prioritization of groups for vaccination when vaccine supply is limited.  It provides a values foundation for the objectives of COVID-19 vaccination programmes and links those to target groups for vaccination.  This information is valuable to countries and globally while specific policies will be developed once vaccines become available.  

WHO SAGE values framework for the allocation and prioritization of COVID-19 vaccination

The Guidance on National Deployment and Vaccination Planning is intended to help countries develop their plan for COVID-19 vaccine introduction.

Guidance on developing a national deployment and vaccination plan for COVID-19 vaccines

Vaccination is one of the great achievements of the 20th century, yet persistent public-health problems include inadequate, delayed, and unstable vaccination uptake. Psychology offers three general propositions for understanding and intervening to increase uptake where vaccines are available and affordable. The first proposition is that thoughts and feelings can motivate getting vaccinated. Hundreds of studies have shown that risk beliefs and anticipated regret about infectious disease correlate reliably with getting vaccinated; low confidence in vaccine effectiveness and concern about safety correlate reliably with not getting vaccinated. We were surprised to find that few randomized trials have successfully changed what people think and feel about vaccines, and those few that succeeded were minimally effective in increasing uptake. The second proposition is that social processes can motivate getting vaccinated. Substantial research has shown that social norms are associated with vaccination, but few interventions examined whether normative messages increase vaccination uptake. Many experimental studies have relied on hypothetical scenarios to demonstrate that altruism and free riding (i.e., taking advantage of the protection provided by others) can affect intended behavior, but few randomized trials have tested strategies to change social processes to increase vaccination uptake. The third proposition is that interventions can facilitate vaccination directly by leveraging, but not trying to change, what people think and feel. These interventions are by far the most plentiful and effective in the literature. To increase vaccine uptake, these interventions build on existing favorable intentions by facilitating action (through reminders, prompts, and primes) and reducing barriers (through logistics and healthy defaults); these interventions also shape behavior (through incentives, sanctions, and requirements). Although identification of principles for changing thoughts and feelings to motivate vaccination is a work in progress, psychological principles can now inform the design of systems and policies to directly facilitate action.

10.1177/1529100618760521

Increasing Vaccination: Putting Psychological Science Into Action

10.1542/peds.2016-1764

OBJECTIVE: Improving provider recommendations is critical to addressing low human papillomavirus (HPV) vaccination coverage. Thus, we sought to determine the effectiveness of training providers to improve their recommendations using either presumptive “announcements” or participatory “conversations.”METHODS: In 2015, we conducted a parallel-group randomized clinical trial with 30 pediatric and family medicine clinics in central North Carolina. We randomized clinics to receive no training (control), announcement training, or conversation training. Announcements are brief statements that assume parents are ready to vaccinate, whereas conversations engage parents in open-ended discussions. A physician led the 1-hour, in-clinic training. The North Carolina Immunization Registry provided data on the primary trial outcome: 6-month coverage change in HPV vaccine initiation (≥1 dose) for adolescents aged 11 or 12 years.RESULTS: The immunization registry attributed 17 173 adolescents aged 11 or 12 to the 29 clinics still open at 6-months posttraining. Six-month increases in HPV vaccination coverage were larger for patients in clinics that received announcement training versus those in control clinics (5.4% difference, 95% confidence interval: 1.1%–9.7%). Stratified analyses showed increases for both girls (4.6% difference) and boys (6.2% difference). Patients in clinics receiving conversation training did not differ from those in control clinics with respect to changes in HPV vaccination coverage. Neither training was effective for changing coverage for other vaccination outcomes or for adolescents aged 13 through 17 (n = 37 796).CONCLUSIONS: Training providers to use announcements resulted in a clinically meaningful increase in HPV vaccine initiation among young adolescents.

Announcements Versus Conversations to Improve HPV Vaccination Coverage: A Randomized Trial

10.14745/ccdr.v46i04a06

According to the World Health Organization, vaccine hesitancy is among the top threats to global health and few effective strategies address this growing problem. In Canada, approximatively 20% of parents/caregivers are concerned about their children receiving vaccines. Trying to convince them by simply providing the facts about vaccination may backfire and make parents/caregivers even more hesitant. In this context, how can health care providers overcome the challenge of parental decision-making needs regarding vaccination of their children?Motivational interviewing aims to support decision making by eliciting and strengthening a person’s motivation to change their behaviour based on their own arguments for change. This approach is based on three main components: the spirit to cultivate a culture of partnership and compassion; the processes to foster engagement in the relationship and focus the discussion on the target of change; and the skills that enable health care providers to understand and address the parent/caregiver’s real concerns.With regard to immunization, the motivational interviewing approach aims to inform parents/caregivers about vaccinations, according to their specific needs and their individual level of knowledge, with respectful acceptance of their beliefs. The use of motivational interviewing calls for a respectful and empathetic discussion of vaccination and helps to build a strong relationship.Numerous studies in Canada, including multicentre randomized controlled trials, have proven the effectiveness of the motivational interviewing approach. Since 2018, the PromoVac strategy, an educational intervention based on the motivational interviewing approach, has been implemented as a new practice of care in maternity wards across the province of Quebec through the Entretien Motivationnel en Maternité pour l’Immunisation des Enfants (EMMIE) program.

Motivational interviewing: A powerful tool to address vaccine hesitancy

10.1073/pnas.1103170108

We evaluate the results of a field experiment designed to measure the effect of prompts to form implementation intentions on realized behavioral outcomes. The outcome of interest is influenza vaccination receipt at free on-site clinics offered by a large firm to its employees. All employees eligible for study participation received reminder mailings that listed the times and locations of the relevant vaccination clinics. Mailings to employees randomly assigned to the treatment conditions additionally included a prompt to write down either (i) the date the employee planned to be vaccinated or (ii) the date and time the employee planned to be vaccinated. Vaccination rates increased when these implementation intentions prompts were included in the mailing. The vaccination rate among control condition employees was 33.1%. Employees who received the prompt to write down just a date had a vaccination rate 1.5 percentage points higher than the control group, a difference that is not statistically significant. Employees who received the more specific prompt to write down both a date and a time had a 4.2 percentage point higher vaccination rate, a difference that is both statistically significant and of meaningful magnitude.

Using implementation intentions prompts to enhance influenza vaccination rates

10.1016/j.vaccine.2015.04.085

Vaccination is one of the most effective ways of reducing childhood mortality. Despite global uptake of childhood vaccinations increasing, rates remain sub-optimal, meaning that vaccine-preventable diseases still pose a public health risk. A range of interventions to promote vaccine uptake have been developed, although this range has not specifically been reviewed in early childhood. We conducted a systematic review and meta-analysis of parental interventions to improve early childhood (0–5 years) vaccine uptake. Twenty-eight controlled studies contributed to six separate meta-analyses evaluating aspects of parental reminders and education. All interventions were to some extent effective, although findings were generally heterogeneous and random effects models were estimated.Receiving both postal and telephone reminders was the most effective reminder-based intervention (RD = 0.1132; 95% CI = 0.033–0.193). Sub-group analyses suggested that educational interventions were more effective in low- and middle-income countries (RD = 0.13; 95% CI = 0.05–0.22) and when conducted through discussion (RD = 0.12; 95% CI = 0.02–0.21). Current evidence most supports the use of postal reminders as part of the standard management of childhood immunisations. Parents at high risk of non-compliance may benefit from recall strategies and/or discussion-based forums, however further research is needed to assess the appropriateness of these strategies.

Parental reminder, recall and educational interventions to improve early childhood immunisation uptake: A systematic review and meta-analysisAuthor links open overlay panel

10.1177/1529100618760521

Vaccination is one of the great achievements of the 20th century, yet persistent public-health problems include inadequate, delayed, and unstable vaccination uptake. Psychology offers three general propositions for understanding and intervening to increase uptake where vaccines are available and affordable. The first proposition is that thoughts and feelings can motivate getting vaccinated. Hundreds of studies have shown that risk beliefs and anticipated regret about infectious disease correlate reliably with getting vaccinated; low confidence in vaccine effectiveness and concern about safety correlate reliably with not getting vaccinated. We were surprised to find that few randomized trials have successfully changed what people think and feel about vaccines, and those few that succeeded were minimally effective in increasing uptake. The second proposition is that social processes can motivate getting vaccinated. Substantial research has shown that social norms are associated with vaccination, but few interventions examined whether normative messages increase vaccination uptake. Many experimental studies have relied on hypothetical scenarios to demonstrate that altruism and free riding (i.e., taking advantage of the protection provided by others) can affect intended behavior, but few randomized trials have tested strategies to change social processes to increase vaccination uptake. The third proposition is that interventions can facilitate vaccination directly by leveraging, but not trying to change, what people think and feel. These interventions are by far the most plentiful and effective in the literature. To increase vaccine uptake, these interventions build on existing favorable intentions by facilitating action (through reminders, prompts, and primes) and reducing barriers (through logistics and healthy defaults); these interventions also shape behavior (through incentives, sanctions, and requirements). Although identification of principles for changing thoughts and feelings to motivate vaccination is a work in progress, psychological principles can now inform the design of systems and policies to directly facilitate action.

Increasing Vaccination: Putting Psychological Science Into Action

10.31234/osf.io/ge6uh

Healthcare workers (HCWs) have been recommended to receive first priority for limited COVID-19 vaccines. They have also been identified as potential ambassadors of COVID-19 vaccine acceptance, helping to ensure that sufficient members of a hesitant public accept COVID-19 vaccines to achieve population immunity. Yet HCWs themselves have shown vaccine hesitancy in other contexts and the few prior surveys of U.S. HCW intentions to receive a COVID-19 vaccine report acceptance rates of only 28% to 34%. However, it is unknown whether HCW acceptance remains low following mid-November announcements of the efficacy of the first COVID-19 vaccines and the issuance of two emergency use authorizations (EUA) in December. We report the results of a December 2020 survey (N = 16,158; response rate 61%) administered by a large Pennsylvania health system to determine the intentions of its employees to receive a vaccine when it is offered to them. In a mixed sample of individuals serving in patient-facing and other roles, 55% would decide to receive a COVID-19 vaccine when offered, 16.4% would not, and 28.5% reported being undecided. The distribution of responses varied little across hospital campuses, between those in patient-facing roles and other HCWs, or by area or department of work. The higher rate of COVID-19 vaccine acceptance we observe may reflect the framing and timing of our survey. Among hesitant respondents, an overwhelming majority (90.3%) reported concerns about unknown risks and insufficient data. Other commonly reported concerns included known side effects (57.4%) and wanting to wait until they see how it goes with others (44.4%). We observed a substantial increase in self-reported intent to receive a COVID-19 vaccine after an FDA advisory committee voted to recommend an EUA. Among respondents who completed the survey after that point in time, 79% intend to receive a COVID-19 vaccine (n = 1155). Although only suggestive, this trend offers hope that rates of COVID-19 vaccine acceptance may be higher among HCWs and, perhaps, the general public than more hypothetical survey results have indicated.

Healthcare worker intentions to receive a COVID-19 vaccine and reasons for hesitancy: A survey of 16,158 health system employees on the eve of vaccine distribution

The C.D.C. director will decide by Wednesday whether to accept the recommendation. States aren’t required to follow it, but most are expected to.

Long-Term-Care Residents and Health Workers Should Get Vaccine First, C.D.C. Panel Says

25/ So yes I have worries, but the light at the end of the tunnel is increasingly bright. We just need to get there. How confident am I? First, I’ll get my shot the day I’m eligible. And I just booked a golf trip in Sept. Perhaps living dangerously, I didn’t ask about refunds.

24/ So, yes, I do have worries. But let’s not lose sight of the fact that, on November 1st, we didn’t know for sure that we would have ANY effective vaccines. Today we have at least 2-3 highly effective ones, an impressive safety track record, and millions of doses ready to go.

23/ I worry a bit about how long immunity lasts, but also not too much. We’re now pretty confident that immunity lasts for >1 yr. If it turns out that we need a booster in 2-3 years, that'll be a small price to pay to save tens of thousands of lives and a return to normal life.

22/ I do worry about keeping track of who got which vaccine. Who will remind a pt to come in for a 2nd dose, and be sure that the 2nd dose is the same brand as the first? If we had a national medical record (like the VA or the NHS), this would be easy. But in the U.S., it’s not.

21/ As I’ve said, while I do worry about uptake, I don’t worry too much. Unlike childhood vaccines, many people know friends & family who were sickened or died from Covid, & everybody wants their lives back. I’ll bet that uptake is going to be quite high, esp. in hi-risk groups.

20/ I worry about kids, since we haven’t even begun to test vaccines in them. But if we can reach herd immunity by vaccinating everybody else (incl. teachers), we may not need to obsess about reaching kids, particularly the youngest ones (who are at low risk for illness/spread).

19/ It’s going to get tougher to do placebo-controlled vaccine trials.(Is it ethical to randomize to placebo once 95% effective vaccines are available?). We may be forced to evaluate new vaccine candidates based on their similarities to ones we know work, which is a bit dicey.

8/ I worry about the impact of approved vaccines on ongoing trials. If we can get EUA’s for Pfizer, Moderna & Astra Zeneca, that’s probably a deep enough bench to vaccinate everybody in the U.S. But more would be better, particularly as we think about the vast worldwide needs.

17/ … and, while they’ve managed Operation Warp Speed well, the Trumpers seem poised to throw monkey-wrenches into the handoffs. I doubt this will screw the whole thing up, but even a few weeks’ delay will lead to millions of preventable cases & thousands of preventable deaths.

16/ Other worries: reviewing Biden’s appointees, from Covid task force to chief of staff Ron Klain, I have great confidence in their ability to pull off the logistics effectively, safely, & with minimum drama. But the first month of distribution will be done by Trump's team…

15/ I also worry about next 6 mths – will folks let their guards down because vaccines are coming? That would be a terrible mistake – while vaccines will protect the recipients, they’ll do little to protect others in the community until we reach herd immunity levels next summer.

14/ Whether it’s anti-vaxxers or Russian bots, if somebody wants to turn every post-vaccine illness into a “See, I warned you” canard, there’ll be ample fodder. We’ll need a strong campaign to combat it, ie this https://tinyurl.com/y5ym92c5 Nothing I’ve seen in 2020 reassures me here.

13/ 3rd concern: misinformation. Below: if we vaccinate 10M Americans, how many will develop a serious illness in 2 months after they got their shots. Answer: many thousands (& I’ve only included 4 illnesses, plus death). And the vaccines will have zero to do with any of them.

12/ There will also be post-vaccination issues: when somebody has a post-vaccine fever, do we assume it’s the vaccine? Test for Covid if it lasts for >2 days? Should healthcare or essential workers come to work if they feel sick after their shot? We’ll need super-clear guidance.

11/ …from getting their shots? Probably some, particularly in lower-risk groups – & we’ll need many to take shots to get to herd immunity. Analogous to the challenge of getting low-risk folks to wear masks & buy health insurance – many are too selfish to accept pain for others.

10/ Second issue that keeps me awake is the shot itself. We know that a fair # of folks will have symptoms – arm pain, fever, the blahs – that’ll last for 1-2 days. Seems a small price to pay for immunity to a terrible infection. But will this day of discomfort dissuade people…

9/ …we might not reach 70% protected until Sept., the impact of widespread vaccination will be felt before that. Also, there are tens of millions who are already immune via prior infection (and millions more each week, sadly), which will shorten the path to herd immunity a bit.

8/ Herd immunity, which we should reach at ~70% vaccination, isn’t a magic on-off switch: as we close in on it, there will be fewer cases & fewer severe cases, since there'll be fewer people vulnerable to virus & fewer who'll get very sick if they do get Covid. So, even though…

7/ We'll see how people react to the draft CDC priority list. I’m concerned these decisions will be contentious and – this being Covid – politicized, since it will raise matters of race, homelessness, incarceration, elders, healthcare workers...in other words, myriad hot buttons.

6/ As the graph shows, I estimate it’ll be ~May before we get to all 144M of the high-priority folks. This timeline could shorten if additional vaccines are approved, and lengthen if there are rollout glitches. If demand is low, I assume we’ll just broaden the eligible groups.

5/ And here’s my estimate of how many people in U.S. can be vaccinated at various times in 2021. It’s based on statements made by @Pfizer, @moderna_tx & Op Warp Speed, and assumes we have enough vaccine to vaccinate 20M by Jan 2021, 150M by June, & the entire country by December.

4/ …Namely, there won’t be enough vaccine for all these groups until spring. Thanks to @AriadneLabs, which did the legwork of removing duplicates (people who fit in multiple categories) to estimate the number of people in each of the possible Phase 1 groups. They add up to 144M.

3/ …(like food handlers, police, firefighters, & teachers); and people at high risk for bad outcomes (people over 65 and those w/ preexisting conditions). One can make an argument for all of them to get vaccinated as soon as possible. Alas, we quickly run into a math problem…

2/ First, the question of who gets the vaccine first is tricky. (Breaking news: @CDCgov panel just weighed in: https://tinyurl.com/y53atcys, and I agree.) One can make a case for many groups to be first in line: healthcare workers; people >65 in nursing homes; essential workers…

1/ Covid (@UCSF) Chronicles, Day 259 The vaccine news remains astoundingly positive. Reacting to my upbeat mood, a reporter asked me if there’s anything that keeps me up at night. Aside from the cataclysmic current state of Covid (likely to get worse, I fear), there are a few:

10.31234/osf.io/t3kyx

COVID vaccination intentions vary among the US population. We report the results of a nationally representative survey undertaken in July 2020 (N=889) that examined the association of six vaccine-specific beliefs with intentions to vaccinate. We find that four of the six beliefs have substantial associations with intention (Gammas between .60 and .77), that the associations mostly do not vary with gender, age, race/ethnicity, or misinformation (even though intentions do vary with each of those variables). Also, once adjusted for the vaccine-specific beliefs, level of misinformation is not related to intentions. We consider the implications of these results and argue both that persuasive campaigns can be informed by these specific results, and given rapid changes in vaccine availability, that there is a substantial need for elaborated and repeated follow-up

What Beliefs are Associated with COVID Vaccination Intentions? Implications for Campaign Planning

10.3390/vaccines8040701

Background: This study assesses attitudes towards vaccination in mothers of new-born babies and explores its association with different exposures to communication. Methods: Data were collected through questionnaires administered by means of interviews. Results: Data highlighted that 20% of mothers showed an orientation towards vaccine hesitancy. As for the reasons behind the attitude to vaccine hesitancy, data showed that concern is a common feature. As for the different exposures to communication, 49% of mothers did not remember having received or looked for any information about vaccination during pregnancy and post-partum; 25% stated they received information from several healthcare and non-healthcare sources; 26% declared having received or looked for information by means of healthcare and non-healthcare sources, as well as having taken part in a specific meeting during antenatal classes or at birth centres. The attitude towards vaccine hesitancy tends to reduce as exposure to different communication increases. Conclusions: This study supports the hypothesis that participation in interactive meetings in small groups focused on vaccination during the prenatal course or at the birth point may act as an enabling factor contributing to a decrease in the tendency to experience vaccine hesitation.

Vaccination Attitude and Communication in Early Settings: An Exploratory Study

The Psychological Science Behind Vaccinations Featured research on http://psychologicalscience.org

Faced with outbreaks of influenza and other vaccine-preventable diseases, parents, educators, healthcare providers, and policymakers around the world often want to know how to persuade people to get their vaccinations. But a comprehensive review of the scientific findings from research on vaccination behavior shows that the most effective interventions focus directly on shaping patients’ and parents’ behavior instead of trying to change their minds.