Public attitudes toward child undervaccination: A randomized experiment on evaluations, stigmatizing orientations, and support for policies

Touching the cornerstone: An illustrative example of the effects of stigma and discrimination on vaccine-hesitant parents

Objectives

The concept of vaccine hesitancy encompasses multiple views on the subject. However, there has been an increasing polarization of the discourse on vaccine hesitancy leading to the stigmatization of those parents who expressed doubts or concerns regarding vaccination practices. The present study aimed to explore the drivers and consequences of polarized discourses on vaccination in the Portuguese context. This paper is part of a broader study which aims to gain a deeper understanding about the phenomenon of vaccine hesitancy at the European level.

Study design

A qualitative research design was used.

Methods

The sample was comprised of thirty-one Portuguese vaccine hesitant parents who were interviewed. A thematic analysis of the transcribed interviews was performed which allowed us to identify key themes.

Results

The results showed that the labelling of vaccine-hesitant parents as 'anti-vaxxers' along with social media play a crucial role in promoting the polarization of vaccine-related attitudes. The stigmatization of vaccine hesitant parents has a disruptive impact on their social network leading them to search for online platforms where they can exchange vaccines-related information without being discriminated.

Conclusions

The stigma and discrimination experienced by vaccine-hesitant parents stimulated that hesitancy becomes more entrenched. Therefore, pluralism should be used to tailor vaccination promotion campaigns to different targets, promoting its reach and efficacy.

Obscured inequity: How focusing on rates of disparities can conceal inequities in the reasons why adolescents are unvaccinated

Traditional sociodemographic disparities in adolescent vaccination initiation for the HPV, Tdap, and MenACWY vaccines have declined in the United States of America. This decline raises the question of whether inequities in access have been successfully addressed. This paper synthesizes research on the resource barriers that inhibit vaccination alongside research on vaccine hesitancy where parents actively refuse vaccination. To do so, I classify the primary reason why teens are unvaccinated in the National Immunization Survey-Teen 2012-2022 into three categories: resource failure, agentic refusal, and other reasons. I use three non-exclusive subsamples of teens who are unvaccinated against the HPV (N = 87,163), MenACWY (N = 54,726), and Tdap (N = 10,947) vaccines to examine the relative importance of resource failure reasons and agentic refusal reasons for non-vaccination across time and teens' sociodemographic characteristics. Results indicate that resource failure reasons continue to explain a substantial portion of the reasons why teens are unvaccinated and disproportionately affect racially/ethnically and economically marginalized teens. Thus, even as sociodemographic inequalities in rates of vaccination have declined, inequities in access remain consequential.

Recruiting a Hard-to-Reach, Hidden and Vulnerable Population: The Methodological and Practical Pitfalls of Researching Vaccine-Hesitant Parents

While recruitment is an essential aspect of any research project, its challenges are rarely acknowledged. We intend to address this gap by discussing the challenges to the participation of vaccine-hesitant parents defined here as a hard-to-reach, hidden and vulnerable population drawing on extensive empirical qualitative evidence from seven European countries. The difficulties in reaching vaccine-hesitant parents were very much related to issues concerning trust, as there appears to be a growing distrust in experts, which is extended to the work developed by researchers and their funding bodies. These difficulties have been accentuated by the public debate around COVID-19 vaccination, as it seems to have increased parents' hesitancy to participate. Findings from recruiting 167 vaccine-hesitant parents in seven European countries suggest that reflexive and sensible recruitment approaches should be developed.

Don't stand so close to me: Perceptions of others' compliance with COVID-19 recommendations and support for strict policy measures in Norway

Many democratically elected governments in states that are otherwise considered liberal have imposed strict policy measures, including policies allowing for coercion and/or punishment of transgressors to prevent the transmission of the new coronavirus (SARS-CoV-2). Previous studies have indicated that trust in government institutions engenders a positive public response during a crisis and that the implementation of strict policy measures in a crisis-measures otherwise considered authoritarian-can increase trust in government institutions, even in liberal democratic states. However, few studies have focused on the relationship between perceived compliance with government-issued recommendations and individual preferences with regard to authoritarian governmental crisis management. The objective of this study was to estimate the association between perceived compliance with government recommendations among citizens and support for strict policy measures in a pandemic setting. We draw on unique data from a cross-sectional survey conducted in the wake of the first COVID-19 wave in Norway (n = 935). Logistic regression analyses indicate a strong negative association between support for strict policy measures and the belief that others are following the government-issued recommendations. Our results suggest that participants would consider strict policy measures less essential if they believed that other citizens were complying with the rules.

[Transmission risk classification for vaccine-preventable diseases in Minas Gerais, Brazil: two years since the onset of the COVID-19 pandemic]

The scope of this study is to analyze the risk classification of transmission of vaccine-preventable diseases (VPDs) in the 853 municipalities in the state of Minas Gerais (MG) two years after the onset of the COVID-19 pandemic. It is an epidemiological study with secondary data on vaccination coverage and dropout rate of ten immuno-biologicals recommended for under 2-year-old children in 2021 in MG. With respect to the dropout rate, this indicator was only evaluated for the multidose vaccines. After calculating all the indicators, the municipalities of the state were classified according to the transmission risk of VPDs into five categories: very low, low, medium, high, and very high risk. Minas Gerais had 80.9% of municipalities classified as high transmission risk for VPDs. Regarding the homogeneity of vaccination coverage (HCV), large municipalities had the highest percentage of HCV classified as very low, and 100% of these municipalities were classified as high or very high risk for transmission of VPDs, with statistical significance. The use of immunization indicators by municipality is effective for the classification of the scenario of each territory and the proposal of public policies seeking to increase vaccination coverage.

Trusted information sources in the early months of the COVID-19 pandemic predict vaccination uptake over one year later

INTRODUCTION

COVID-19 vaccine uptake has been a major barrier to stopping the pandemic in many countries with vaccine access. This longitudinal study examined the capability to predict vaccine uptake from data collected early in the pandemic before vaccines were available.

METHODS

493 US respondents completed online surveys both at baseline (March 2020) and wave 6 (June 2021), while 390 respondents completed baseline and wave 7 (November 2021) surveys. The baseline survey assessed trust in sources of COVID-19 information, social norms, perceived risk of COVID-19, skepticism about the pandemic, prevention behaviors, and conspiracy beliefs. Multivariable logistic models examined factors associated with the receipt of at least one COVID-19 vaccine dose at the two follow-ups.

RESULTS

In the adjusted model of vaccination uptake at wave 6, older age (aOR = 1.02, 95 %CI = 1.00-1.04) and greater income (aOR = 1.69, 95 %CI = 1.04-2.73) was associated with positive vaccination status. High trust in state health departments and mainstream news outlets at baseline were positively associated with vaccination at wave 6, while high trust in the Whitehouse (aOR = 0.42, 95 %CI = 0.24-0.74) and belief that China purposely spread the virus (aOR = 0.66, 95 %CI = 0.46-0.96) at baseline reduced the odds of vaccination. In the adjusted model of vaccination uptake at wave 7, increased age was associated with positive vaccination status, and Black race (compared to white) was associated with negative vaccination status. High trust in the CDC and mainstream news outlets at baseline were both associated with being vaccinated at wave 7, while high trust in the Whitehouse (aOR = 0.24, 95 %CI = 0.11-0.51) and belief that the virus was spread purposefully by China (aOR = 0.60, 95 %CI = 0.39-0.93) were negatively associated with vaccination.

CONCLUSIONS

These findings indicated that vaccine uptake could be predicted over a year earlier. Trust in specific sources of COVID-19 information were strong predictors, suggesting that future pandemic preparedness plans should include forums for news media, public health officials, and diverse political leaders to meet and develop coherent plans to communicate to the public early in a pandemic so that antivaccine attitudes do not flourish and become reinforced.

Support for a vaccination documentation mandate in British Columbia, Canada

BACKGROUND

In recent years, Canadian provinces have been discussing, implementing, and tightening vaccination "mandate" policies for school enrolment. British Columbia (BC), Canada's westernmost province, implemented a Vaccination Status Reporting Regulation (VSRR) in September 2019, which requires the vaccination status of children in public, private, and home schooling be reported to a provincial vaccination registry and education for parents who refuse to vaccinate. Legal vaccination mandates can carry the risk of backlash, thereby making it important to monitor public attitudes across policy implementation windows. The present study aimed to evaluate public support for this new provincial mandate following implementation.

METHODS

An online panel of BC adults (n = 1301) was surveyed about 15 vaccine-promotion policy options in April 2020 following mandate implementation. Respondents were representative of the provincial population by gender, age, geographic residence, and percentage of households with children younger than 19 years of age. Poisson regression was used to estimate predictors of policy endorsement, and support for the VSRR.

RESULTS

Strong support existed for the VSRR with 88.2% of respondents agreeing or strongly agreeing that parents should be required to provide their children's immunization records at school entry, and 74.6% supporting required education sessions for parents who refuse to vaccinate their children. Overall, the sample was supportive of vaccination, and pro-vaccine attitudes were associated with strong agreement for nearly all vaccine policy options. Policies to impose rewards (e.g., tax credits) and penalties (e.g., fines) were the least likely to receive strong agreement from respondents.

CONCLUSIONS

Near the end of the first school year in British Columbia subject to the Vaccination Status Reporting Regulation, support for both the mandated documentation and mandated education elements of the policy are high, and associated with pro-vaccine attitudes. There are not marked differences in strong support based on gender, age, parenting, education level, or income.

Cognitive underpinnings of COVID-19 vaccine hesitancy

RATIONALE

Vaccines save lives. Despite the undisputed value of vaccination, vaccine hesitancy continues to be a major global challenge, particularly throughout the COVID-19 global pandemic. Since vaccination decisions are counter-intuitive and cognitively demanding, we propose that vaccine hesitancy is associated with executive function-a group of high-level cognitive skills including attentional control, working memory, inhibition, self-regulation, cognitive flexibility, and strategic planning.

OBJECTIVE

We set out to test (i) whether vaccine hesitancy is driven by individual differences in executive function beyond established socio-demographic factors (e.g., education, political orientation, gender, ethnicity, age, religiosity) and depressed mood, and (ii) whether this relationship is exacerbated by situational stress.

METHODS

Two studies were conducted with U.S. residents. Using a cross-sectional design, Study 1 examined the associations between executive function, socio-demographic factors, COVID-19 conspiracy beliefs, trust in health authorities, and COVID-19 vaccine hesitancy. Using an experimental design, Study 2 focused solely on unvaccinated individuals and tested the interactive effect of executive function and stress on willingness to receive a COVID-19 vaccine. We used ordinal logistic regressions to analyze the data.

RESULTS

Individual differences in executive function predicted participants' COVID-19 conspiracy beliefs, trust in health authorities, and their willingness to vaccinate against COVID-19. Importantly, the unique contribution of executive function to vaccine hesitancy could not be explained by socio-demographic factors or depressed mood. Furthermore, Study 2 revealed that weaker executive function had detrimental effects on COVID-19 vaccine acceptance and trust in health authorities mainly under heightened stress.

CONCLUSIONS

Individual differences in executive function and situational stress jointly impact COVID-19 vaccination decisions and need to be considered together when designing health communications aimed at reducing COVID-19 vaccine hesitancy. Interventions that lower stress and promote trust have the potential to increase vaccine acceptance, especially for individuals with weaker executive function.

Understanding how the Australian vaccine-refusal movement perceives itself

Public health responses to the vaccine-refusal (VR) movement are hindered by inadequate research about the movement's aims, identity and perceived value for its members. This study examined how members of the VR movement in Australia described the movement and what being part of it meant to them. Descriptions of the VR movement by 696 members from across Australia were collected between January and May in 2017 via an online survey. The data were analysed using thematic discourse analysis. Members' understandings of the movement and the beliefs underpinning these understandings were examined. Vaccine refusal was underpinned by distinct epistemic beliefs. Participants believed that mainstream vaccine promotion relies on dishonest communication of compromised research. They saw the VR movement as a science-based movement, researching both 'mainstream' and 'hidden' knowledge, promoting scientific values and advocating for better vaccine studies. Participants believed responsible parenting requires personally researching healthcare choices. Participants constructed the movement's identity in relation to common criticisms of vaccine refusal. These were discredited and repurposed to portray the movement as being brave and righteous. Participants believed people in the movement are astute, informed, responsible and courageous. They believed many members were impacted by vaccine-related harms, from which the movement now saves others. They saw themselves as fighting for an inconvenient truth that the mainstream ignores. Vaccine promotion needs to address the epistemic beliefs associated with vaccine refusal, yet these have been inadequately understood. Our findings contribute to understanding these beliefs. Furthermore, our findings suggest what messages targeting vaccine-refusing people should focus on. This may include acknowledging the significant effort that vaccine-refusing people invest in trying to protect their children, catering to vaccine-refusing people's high engagement and desire for detailed information, and avoiding stigmatising or confrontational vaccine-promotion strategies.

What Determines Vaccine Hesitancy: Recommendations from Childhood Vaccine Hesitancy to Address COVID-19 Vaccine Hesitancy

Vaccine hesitancy is a prevalent and ongoing issue. However, due to the COVID-19 pandemic, additional attention has been brought to the topic of vaccine hesitancy. Vaccine hesitancy is a threat to the population's health globally. This article aims to acquire insights from previous literature to determine what works to increase vaccine uptake and how we can apply this knowledge to increase COVID-19 vaccine uptake. Research has focused chiefly on childhood vaccination and the hesitancy of caregivers. After conducting an extensive literature review, we have created a conceptual model of indicators that influence vaccine uptake for health providers and caregivers, which can also be used for vaccine recipients. Overall, the reasons for vaccine hesitancy are complex; therefore, a multifaceted approach is needed to address it. Understanding the factors that affect vaccine hesitancy will aid in addressing hesitancy and, in turn, lead to an increase in vaccine uptake.

Association of public explanations of why children struggle and support for policy solutions using a national sample

Purpose

Despite evidence showing the importance of structural determinants for child well-being and the existence of policies that can promote child well-being, many communities are not adopting these policies. Limited awareness of structural determinants may explain this gap. This study establishes the public's recognition of structural determinants and their associations with support for policies that promote child well-being.

Methods

Secondary analyses of survey data collected in 2019 from a random sample of 2496 adults in the United States. This survey asked why some children "struggle" (e.g., do poorly in school, use drugs, or get involved in crime). Respondents could select individual (e.g., lack of effort) and structural (e.g., low wages) explanations. Respondents were also asked about their support for policies that are supportive of children and families.

Results

Stronger beliefs of structural explanations were associated with greater support for policies that strengthen family economics, family-friendly work, and afford access to high-quality early childcare and education. Beliefs in individual explanations were inversely associated with support for these policies.

Conclusions

These findings suggest increasing recognition of the structural determinants that hinder child development may help increase support for policies that are effective in improving children's outcomes.

Stigmatized for standing up for my child: A qualitative study of non-vaccinating parents in Australia

BACKGROUND

Vaccine refusal is highly polarizing in Australia, producing a challenging social landscape for non-vaccinating parents. We sought to understand the lived experience of non-vaccinating parents in contemporary Australia.

METHODS

We recruited a national sample of non-vaccinating parents of children <18 yrs, advertising on national radio, in playgrounds in low vaccination areas, and using snowballing. Grounded Theory methodology guided data collection (via semi-structured interviews). Inductive analysis identified stigmatization as a central concept; stigma theory was adopted as an analytical lens.

RESULTS

Twenty-one parents from regional and urban locations in five states were interviewed. Parent's described experiences point to systematic stigmatization which can be characterized using Link & Phelan's five-step process. Parents experienced (1) labelling and (2) stereotyping, with many not identifying with the "anti-vaxxers" portrayed in the media and describing frustration at being labelled as such, believing they were defending their child from harm. Participants described (3) social "othering", leading to relationship loss and social isolation, and (4) status loss and discrimination, feeling "brushed off" as incompetent parents and discriminated against by medical professionals and other parents. Finally, (5) legislative changes exerted power over their circumstances, rendering them unable to provide their children with the same financial and educational opportunities as vaccinated children, often increasing their steadfastness in refusing vaccination.

CONCLUSION

Non-vaccinating Australian parents feel stigmatized for defending their child from perceived risk of harm, reporting a range of social and psychological effects, as well as financial effects from policies which disadvantaged their children through differential financial treatment, and diminished early childhood educational opportunities. While it might be argued that social stigma and exclusionary policies directed a small minority for the greater good are justified, other more nuanced approaches based on better understandings of vaccine rejection could achieve comparable public health outcomes without the detrimental effect on unvaccinated families.

Detecting Medical Misinformation on Social Media Using Multimodal Deep Learning

In 2019, outbreaks of vaccine-preventable diseases reached the highest number in the US since 1992. Medical misinformation, such as antivaccine content propagating through social media, is associated with increases in vaccine delay and refusal. Our overall goal is to develop an automatic detector for antivaccine messages to counteract the negative impact that antivaccine messages have on the public health. Very few extant detection systems have considered multimodality of social media posts (images, texts, and hashtags), and instead focus on textual components, despite the rapid growth of photo-sharing applications (e.g., Instagram). As a result, existing systems are not sufficient for detecting antivaccine messages with heavy visual components (e.g., images) posted on these newer platforms. To solve this problem, we propose a deep learning network that leverages both visual and textual information. A new semantic- and task-level attention mechanism was created to help our model to focus on the essential contents of a post that signal antivaccine messages. The proposed model, which consists of three branches, can generate comprehensive fused features for predictions. Moreover, an ensemble method is proposed to further improve the final prediction accuracy. To evaluate the proposed model's performance, a real-world social media dataset that consists of more than 30,000 samples was collected from Instagram between January 2016 and October 2019. Our 30 experiment results demonstrate that the final network achieves above 97% testing accuracy and outperforms other relevant models, demonstrating that it can detect a large amount of antivaccine messages posted daily. The implementation code is available at https://github.com/wzhings/antivaccine_detection.

The effects of scientific messages and narratives about vaccination

A fundamental challenge complicates news decisions about covering vaccine side effects: although serious vaccine side effects are rare, less severe ones do occur occasionally. The study was designed to test whether a side effect message could induce vaccine hesitancy and whether that could be countered by pro-vaccine messages about vaccine safety. A large (N = 2,345), nationally representative experiment was conducted by randomly exposing participants to one of six videos about the measles, mumps, and rubella (MMR) vaccine edited from news programs produced during the 2019 measles outbreak in the United States. The design was a 2x3 factorial crossing the presence or absence of a hesitancy-inducing narrative message with a pro-vaccine science-supporting message (i.e., no message, science-supporting expert message, or pro-vaccine narrative message), leading to a total of six conditions. A general linear model was used to assess the effects of these videos on respondents’ (1) vaccine risk perceptions, (2) policy views on vaccination, (3) willingness to encourage others to vaccinate their children, and (4) intention to send a pro-vaccine letter to their state representative. Findings indicated that the science-supporting expert message about vaccine safety led to higher pro-vaccine evaluations relative to other conditions [e.g., b = -0.17, p < .001, a reduction in vaccine risk perceptions of 0.17 as compared to the control]. There was also suggestive evidence that the hesitancy-inducing narrative may limit the effectiveness of a science-supporting expert message, although this finding was not consistent across different outcomes. When shown alone the hesitancy-inducing narrative did not shift views and intentions, but more research is needed to ascertain whether exposure to such messages can undercut the pro-vaccine influence of science-supporting (expert) ones. All in all, however, it is clear that science-supporting messages are effective and therefore worthwhile in combating vaccine misinformation.

Policy Views and Negative Beliefs About Vaccines in the United States, 2019

Objectives. To determine whether holding vaccine misconceptions, in the form of negative beliefs about vaccines, correlates with opposing governmental action at all levels designed to increase vaccination (e.g., removing personal belief and religious vaccine exemptions).Methods. Drawing on data from a nationally representative survey of 1938 US adults, we assessed the relation between negative beliefs about vaccines and provaccination policies.Results. Beyond sociodemographic and policy-relevant variables, such as gender and partisan affiliation, questionable negative beliefs about vaccines are the strongest predictor of opposition to policies designed to increase vaccination.Conclusions. Negative beliefs about vaccines in the general population may thwart the passage or implementation of policies designed to increase vaccination. Implementing strategies that reduce these negative beliefs should be a priority of educators and public health officials.

Vaccination discourses among chiropractors, naturopaths and homeopaths: A qualitative content analysis of academic literature and Canadian organizational webpages

Vaccine hesitancy–the reluctance to receive recommended vaccination because of concerns and doubts about vaccines–is recognized as a significant threat to the success of vaccination programs and has been associated with recent major outbreaks of vaccine-preventable diseases. Moreover, the association between complementary and alternative medicine (CAM) use and vaccine hesitancy and/or refusal has been frequently reported in the literature. To date, significant gaps persist in our understanding of contemporary Canadian CAM providers’ beliefs regarding vaccination and how socio-professional influences may shape their vaccine-related attitudes and behaviours. To address the latter gap, the current study aims to explore the content of professional guidelines, recommendations and other discourses among CAM providers as they concern vaccination by analyzing both academic, peer-reviewed literature and Canadian organizational webpages prepared by and/or for practicing chiropractors, naturopaths and homeopaths. In the academic literature, we identified a number of complex and diverging views on vaccination that spanned topics of effectiveness; safety; theoretical, empirical, and ethical soundness; political justifiability; and compatibility with CAM philosophy and professional boundaries. However, in its current state the CAM literature cannot be described in broad strokes as being either pro- or anti-vaccination without considering finer areas of disagreement. Compared to the academic literature, which focuses more on the conceptual and evidentiary basis of vaccination, a greater proportion of vaccine-related content on Canadian CAM organizations’ webpages seems to be dedicated to offering specific directives and prescriptions to providers. Guidelines and standards of practice address a number of issues, including vaccine administration, counsel, education and marketing. As CAM organizations further evolve in Canada and elsewhere as part of a broader “professionalization” initiative, greater attention will need to be directed at their role in shaping providers’ beliefs and practices that both support and undermine vaccine promotion efforts.

State Legislators' Support for Behavioral Health Parity Laws: The Influence of Mutable and Fixed Factors at Multiple Levels

Policy Points When communicating with state legislators, advocates for state behavioral health parity laws should emphasize that the laws do not increase insurance premiums. Legislators' opinions about the impacts of state behavioral health parity laws and the effectiveness of behavioral health treatment have more influence on support for the laws than do their political party affiliation or state-level contextual factors. Reducing legislators' stigma toward people with mental illness could increase their support for state behavioral health parity laws CONTEXT: Comprehensive state behavioral health parity legislation (C-SBHPL) is an evidence-based policy that improves access and adherence to behavioral health treatments. However, adoption of C-SBHPL by state legislators is low. Little is known about how C-SBHPL evidence might be most effectively disseminated to legislators or how legislators' fixed characteristics (eg, ideology), mutable characteristics (eg, beliefs about the policy's impact), and state-level contextual factors might influence their support for behavioral health policies. The purpose of our study is (1) to describe the associations between legislators' fixed and mutable characteristics, state-level contextual factors, and support for C-SBHPL; and (2) to identify the mutable characteristics of legislators independently associated with C-SBHPL support.

METHODS

We conducted a multimodal (post mail, email, telephone) survey of US state legislators in 2017 (N = 475). The dependent variable was strong support for C-SBHPL, and the independent variables included legislators' fixed and mutable characteristics and state-level contextual factors. We conducted multivariable, multilevel (legislator, state) logistic regression.

FINDINGS

Thirty-nine percent of the legislators strongly supported C-SBHPL. After adjustment, the strongest predictors of C-SBHPL support were beliefs that C-SBHPL increases access to behavioral health treatments (aOR = 5.85; 95% CI = 2.41, 14.20) and does not increase insurance premiums (aOR = 2.70; 95% CI = 1.24, 5.90). Stigma toward people with mental illness was inversely associated with support (aOR = 0.86; 95% CI = 0.78, 0.95). After adjustment, ideology was the only fixed characteristic significantly associated with support for C-SBHPL. State-level contextual factors did not moderate associations between mutable characteristics and support for C-SBHPL.

CONCLUSIONS

Legislators' mutable characteristics are stronger predictors of C-SBHPL support than are most of their fixed characteristics and all state-level contextual factors, and thus should be targeted by dissemination efforts.

The mad leading the blind: Perceptions of the vaccine-refusal movement among Australians who support vaccination

BACKGROUND

Vaccine refusal is shaped by the social ecology in which it occurs. How people who refuse vaccines are communicated to and treated may affect the nature and strength of their negative vaccine beliefs, and their responsiveness to health promotion messages. Yet little is known about how people who refuse vaccines are perceived by the public. Our research examined perceptions among pro-vaccine Australians of the vaccine-refusal movement.

METHODS

Descriptions of the vaccine-refusal movement by 2666 pro-vaccine Australians were analysed using thematic discourse analysis. Descriptive themes were identified via inductive, iterative coding. Discourse analysis techniques were then used to interpret latent beliefs about the vaccine-refusal movement.

RESULTS

Participants had negative and stigmatising perceptions of the vaccine-refusal movement. They believed the movement is dangerous, misinformed, and comprised of charlatans and fools who are unintelligent, selfish, overly emotional, conspiratorial and scientifically illiterate. Discursive analysis showed that these perceptions were underpinned by beliefs that people would have to be defective in some way to believe anti-vaccine rhetoric. Furthermore, perceptions were underpinned by beliefs that the movement spreads not only disease, but also dangerous ideas that were seen to attack the social order, institutions, values and reason. Participants' intensely-negative views related to their inability to imagine why someone would refuse vaccines.

CONCLUSIONS

This research provides a focused, qualitative account of public perceptions of the vaccine-refusal movement. The findings are concerning: stigma towards vaccine-refusing people may adversely affect their wellbeing and entrench their negative vaccine beliefs. The research suggests that more compassionate, nuanced discussion of vaccine refusal in the public sphere is needed. It also supports the need to systematically examine public attitudes towards vaccine refusal as a determinant of vaccine confidence.

Parent psychology and the decision to delay childhood vaccination

OBJECTIVE

The study of vaccine hesitancy identifies parental decisions to delay childhood vaccinations as an important public health issue, with consequences for immunization rates, the pursuit of nonmedical exemptions in states, and disease outbreaks. While prior work has explored the demographic and social underpinnings of parental decisions to delay childhood vaccinations, little is known about how the psychological dispositions of parents are associated with this choice. We analyze public opinion data to assess the role of psychological factors in reported parental decisions to delay childhood vaccination.

RATIONALE

We anticipate that parents with certain psychological characteristics will be more likely to delay childhood vaccination. Specifically, we explore the roles of conspiratorial thinking, dispositions towards needle sensitivity, and moral purity; expecting that parents with high levels of any of these characteristics will be more likely to delay vaccinating their children.

METHOD

In an original survey of 4010 American parents weighted to population benchmarks, we asked parents about delay-related vaccination behavior, demographic questions, and several psychological batteries. We then developed a vaccination delay scale and modeled delay as a function of conspiratorial thinking, needle sensitivity, moral purity, and relevant demographic controls. We then re-specified our models to look specifically at the predictors of delaying HPV vaccination, which has a low uptake rate in the United States.

RESULTS

Controlling for other common predictors of hesitant behavior, we find that parents with high levels of conspiratorial thinking and needle sensitivity are more likely to report pursuing alternative vaccination schedules. When analyzing the specific decision by parents to delay HPV vaccination, we find that tendencies towards moral purity and, in turn, sexual deviance are also associated with vaccine seeking behavior.

CONCLUSION

Parental decisions to delay childhood vaccinations are an important public health concern that are associated with conspiratorial thinking and needle sensitivity.

Why do some Korean parents hesitate to vaccinate their children?

OBJECTIVES

Vaccinations for infectious diseases are opposed despite their achievement, and this opposition has recently been revealed in Korea. However, research in Korea has not been vigorous. The authors studied why some Korean parents hesitate to vaccinate their children by applying the health belief model.

METHODS

Parents who hesitate to vaccinate and parents who do not were surveyed in alternative education preschools and elementary schools. They were classified into four types of hesitancy and statistically compared.

RESULTS

Among the 129 subjects, 43 vaccinated without hesitancy, 20 vaccinated on time with hesitancy, 32 vaccinated with a deliberate delay of one month or longer, and 34 did not vaccinate. Vaccination increased with an increase in the awareness that severe outcomes can occur when unvaccinated. Concerns about adverse reactions from vaccinations or direct/indirect experiences affected refusal. Furthermore, perceptions of the lack of meaningfulness of vaccinations, distrust of policy and safety management, influence of leaders or activists in joined organizations, and experts of Korean traditional or alternative medicine affected refusal. Explanations by doctors, text messages and mails from institutions, and concerns about disadvantages caused by not complying with government policies increased vaccination.

CONCLUSIONS

The reasons for vaccine hesitancy and acceptance were similar to the results of international research. Health authorities and professionals should communicate sufficiently and appropriately with hesitant parents and find ways to rationally resolve social conflicts. However, this sample was small and there is little Korean research, so more in-depth and diverse researchs are needed.

Perspectives of public health nurses on the ethics of mandated vaccine education

BACKGROUND

Since 2015, Michigan has required parents who request nonmedical exemptions (NMEs) from school or daycare immunization mandates to receive education from local public health staff (usually nurses). This is unlike most other US states that have implemented mandatory immunization counseling, which require physicians to document immunization education, or which provide online instruction.

PURPOSE

To attend to the activity and dispositions of the public health staff who provide "waiver education".

METHOD

This study reports results of focus group interviews with 39 of Michigan's vaccine waiver educators (37 nurses), conducted during 2016 and 2017, and analyzed in 2018.

FINDINGS

Four themes emerged from analysis of the transcripts of these interviews: Participants had (1) complex and nuanced observations and evaluations of parents' judgments and feelings about vaccines and vaccine education; (2) sympathetic attitudes about alternative vaccine schedules; (3) critical and supportive evaluations of institutional policies and the background political context of immunization education; and (4) consistent commitments to respect parents, affirm their values, and protect their rights.

DISCUSSION

These results show that public health nurses are sensitive to the burdens mandatory immunization education places on families, the motivations for parents' requests for nonmedical exemptions, and the values implicated by personal immunization decisions and government immunization policies. In light of the unique training, experiences, and public reputation of nurses, there is good reason for additional investigation into the roles that nurses can play in immunization education and in vaccine mandate policies, more generally.

Understanding non-vaccinating parents' views to inform and improve clinical encounters: a qualitative study in an Australian community

OBJECTIVES

To explain vaccination refusal in a sample of Australian parents.

DESIGN

Qualitative design, purposive sampling in a defined population.

SETTING

A geographically bounded community of approximately 30 000 people in regional Australia with high prevalence of vaccination refusal.

PARTICIPANTS

Semi structured interviews with 32 non-vaccinating parents: 9 fathers, 22 mothers and 1 pregnant woman. Purposive sampling of parents who had decided to discontinue or decline all vaccinations for their children. Recruitment via local advertising then snowballing.

RESULTS

Thematic analysis focused on explaining decision-making pathways of parents who refuse vaccination. Common patterns in parents' accounts included: perceived deterioration in health in Western societies; a personal experience introducing doubt about vaccine safety; concerns regarding consent; varied encounters with health professionals (dismissive, hindering and helpful); a quest for 'the real truth'; reactance to system inflexibilities and ongoing risk assessment.

CONCLUSIONS

We suggest responses tailored to the perspectives of non-vaccinating parents to assist professionals in understanding and maintaining empathic clinical relationships with this important patient group.

Support for policy options to increase vaccination coverage in British Columbia, Canada: an electronic survey

BACKGROUND

Motivated by concerns of inadequate vaccination coverage and the potential for outbreaks of vaccine-preventable diseases, Canadian provinces have been discussing, implementing and tightening policies requiring documentation of vaccination for school enrolment. We sought to understand the acceptability of 14 potential vaccination policy levers among parents and other adults in British Columbia.

METHODS

A representative online panel of 1308 adults in BC was surveyed in April 2017. Respondents were representative of the BC population by sex, age, geographic residence and percentage of household with children younger than 19 years. We used Poisson regression to estimate predictors of policy endorsement.

RESULTS

Most respondents (> 80%) held positive attitudes toward vaccination. Policies such as mandatory documentation of vaccination at school entry were supported by more than 75% of all respondents. Punitive policies, such as denial of child tax benefits for nonvaccination, were supported by less than 40% of respondents. In multivariable regression, respondents with positive attitudes toward vaccination were significantly more likely to strongly support all potential policies. Additionally, female respondents and respondents with postsecondary education were significantly more likely to strongly support policies involving additional requirements for parents.

INTERPRETATION

Most adults in BC held favourable attitudes toward vaccination, and strong support existed for policies designed to support vaccination. This study provides evidence that most adults in BC are supportive of vaccination and, when presented with a wide range of options, would likely be supportive of information and requirement policy options designed to increase vaccination uptake.

"We are fierce, independent thinkers and intelligent": Social capital and stigma management among mothers who refuse vaccines

Despite measurable benefits of childhood vaccines, mothers with high levels of social privilege are increasingly refusing some or all vaccines for their children. These mothers are often clustered geographically or networked socially, providing information, emotional support, and validation for each other. Mothers who reject vaccines may face disapproval from others, criticism in popular culture, negative interactions with healthcare providers, and conflicts with people they know, which serve to stigmatize them. This article uses qualitative data from in-depth interviews with parents who reject vaccines, ethnographic observations, and analyses of online discussions to examine the role of social capital in networks of vaccine-refusing mothers. Specifically, this article explores how mothers provide each other information critical of vaccines, encourage a sense of one's self as empowered to question social expectations around vaccination, provide strategies for managing stigma that results from refusing vaccines, and define a sense of obligation to extend social capital to other mothers. In examining these strategies and tensions, we see how social capital can powerfully support subcultural norms that contradict broader social norms and provide sources of social support. Even as these forces are experienced as positive, they work in ways that actively undermine community health, particularly for those who are the most socially vulnerable to negative health outcomes from infection.