Physicians' rhetorical strategies for motivating HPV vaccination

"Do not inject our babies": a social listening analysis of public opinion about authorizing pediatric COVID-19 vaccines

Designing effective childhood vaccination counseling guidelines, public health campaigns, and school-entry mandates requires a nuanced understanding of the information ecology in which parents make vaccination decisions. However, evidence is lacking on how best to "catch the signal" about the public's attitudes, beliefs, and misperceptions. In this study, we characterize public sentiment and discourse about vaccinating children against SARS-CoV-2 with mRNA vaccines to identify prevalent concerns about the vaccine and to understand anti-vaccine rhetorical strategies. We applied computational topic modeling to 149 897 comments submitted to regulations.gov in October 2021 and February 2022 regarding the Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee's emergency use authorization of the COVID-19 vaccines for children. We used a latent Dirichlet allocation topic modeling algorithm to generate topics and then used iterative thematic and discursive analysis to identify relevant domains, themes, and rhetorical strategies. Three domains emerged: (1) specific concerns about the COVID-19 vaccines; (2) foundational beliefs shaping vaccine attitudes; and (3) rhetorical strategies deployed in anti-vaccine arguments. Computational social listening approaches can contribute to misinformation surveillance and evidence-based guidelines for vaccine counseling and public health promotion campaigns.

Individual and social determinants of COVID-19 vaccine hesitancy and uptake in Northwest Syria

INTRODUCTION

The COVID-19 outbreak devastated the fragmented health system in Syria, a war-torn country, and exaggerated the demands for humanitarian assistance. COVID-19 vaccination was rolled out in Northwest Syria, an area out of government control, in May 2021. However, vaccine acceptance rates are still minimal, which is reflected in the meager percentage of vaccinated people. The study aims to investigate the effectiveness of the humanitarian actors' plans to address the COVID-19 vaccine hesitancy and conclude practical strategies for boosting vaccine uptake in Northwest Syria.

METHODS AND MATERIALS

Two questionnaires were developed to collect data from humanitarian organizations involved in the COVID-19 vaccination campaign and people from northwest Syria. Data analysis was performed using SPSS 22 data analysis program.

RESULTS

According to the findings, 55.5% of people refused the COVID-19 vaccine. The results showed a knowledge gap and lack of evidence regarding humanitarian actors' strategies to address the vaccine's low uptake. Besides, it was found that doctors and medical workers were reliable sources of information about the vaccine. However, they were not systematically engaged in community mobilization and risk communication to promote people's perspectives on the vaccine.

CONCLUSION

Risk communication and community engagement programs were not significantly associated with increasing the COVID-19 acceptance rate. Humanitarian actors must reconsider their strategies to address vaccine hesitancy in Northwest Syria. These strategies should engage medical professionals through dialogue sessions on the realities of the pandemic and vaccine development mechanism based on a compelling and evidence-based approach.

Urban and rural healthcare providers' perspectives on HPV vaccination in Minnesota

Human papillomavirus (HPV) vaccination can dramatically reduce the incidence of HPV-associated cancers. However, HPV vaccination coverage in rural areas is lower than in urban areas, and overall HPV vaccination coverage in the United States remains lower than other adolescent vaccines. We conducted 20 qualitative interviews with adolescent healthcare providers and clinic staff in urban and rural Minnesota and assessed their perspectives on HPV vaccination. Guiding interview topics included: strategies to persuade families to vaccinate their children, the impact of the patient-provider relationship and the clinical environment on vaccination uptake, and provider perceptions of parents' vaccine attitudes. In thematic analysis, all participants reported using common vaccination strategies, such as framing the HPV vaccine in terms of cancer prevention. The analysis also revealed three themes described as occurring uniquely or more intensely in rural communities than urban communities: the rural value of choice or independence, the spread of misinformation, and close-knit, multifaceted patient-provider relationships in clinical practice. Interventions aimed at increasing HPV vaccination should consider the distinctive circumstances of rural healthcare providers and patients.

Mothers' perceptions and attitudes about HPV vaccination initiation among 9- and 10-year-olds

HPV vaccination has potential to prevent 90% of HPV-associated cancers. The Advisory Committee on Immunization Practices recommends HPV vaccination for 11- and 12-year-olds, but vaccine initiation can start at age 9. The purpose of this study was to explore perceptions about starting HPV vaccination at a younger age to inform future interventions that promote initiation at ages 9 and 10 years. This was part of a larger study about vaccine hesitancy among racially/ethnically diverse parents of adolescents in the Greater Newark Area of New Jersey. We thematically analyzed transcripts from 16 interviews with English- and Spanish-speaking mothers who had at least one child ≤ 10 years. Analyses focused on perceptions of HPV-related disease risk, attitudes toward HPV vaccination need, and vaccine confidence specifically for 9- and 10-year-olds. Few parents with young adolescents reported receiving vaccination recommendations, and only one reported series initiation before age 11. Mothers' hesitation about younger HPV vaccination initiation revolved around: 1) low perceived necessity among English-speaking mothers due to young adolescents not being sexually active, 2) concerns about potential side effects associated with vaccinating prepubescent adolescents, and 3) a desire for adolescents to be old enough to provide assent. Participants were not opposed to younger initiation but wanted and relied on pediatricians to inform them about vaccination for younger adolescents. These findings suggest mothers are willing to vaccinate at younger ages after clear provider recommendations. Equipping providers with evidence about vaccine safety and cancer prevention communication strategies may promote initiation and timely completion at younger ages.

Primary care physicians' strategies for addressing COVID-19 vaccine hesitancy

OBJECTIVE

To explore the strategies that primary care physicians use to address patient COVID-19 vaccine hesitancy.

METHOD

We administered an online survey to 625 primary care physicians from May 14 to May 25, 2021, to assess the messages that primary care physicians use to encourage hesitant patients to get vaccinated against COVID-19.589 physicians from the total pool of 625 provided open-ended responses. We conducted thematic content analysis on the responses based on previous research and themes identified within the data.

SETTING

The survey was administered online using the survey research firm Dynata.

RESULTS

Eleven primary themes emerged from our analysis, which included, physicians addressing specific concerns about vaccine safety (including costs versus benefits), physicians helping patients understand what it means to remain unvaccinated, or whether physicians try to connect emotionally through the use of guilt, or personal experience, whether physicians use derisive language to communicate with unvaccinated patients. In addition, a small number of physicians indicated they would not attempt to persuade someone who is vaccine hesitant.

CONCLUSIONS

Our study shows that while some of the physicians used different strategies to address vaccine hesitancy, some of the physicians used harsh language or did not make any effort to reduce COVID-19 related vaccine hesitancy among their patients. Focused advocacy and training are needed to increase physician engagement in vaccine-related dialogues with their patients. Such efforts will ensure that critical opportunities for patient education and awareness-building are not missed and ensure high levels of vaccination uptake.

Feasibility of using an app-based coaching intervention to improve provider communication about HPV vaccination

Provider communication training is effective for increasing HPV vaccination rates among U.S. adolescents. However, such trainings often rely on in-person meetings, which can be burdensome for providers and costly to implement. To evaluate the feasibility of Checkup Coach, an app-based coaching intervention, to improve provider communication about HPV vaccination. In 2021, we offered Checkup Coach to providers in 7 primary care clinics in a large integrated delivery system. Participating providers (n = 19) attended a 1-h interactive virtual workshop that taught 5 high-quality practices for recommending HPV vaccination. Providers then had 3 months of access to our mobile app, which offered ongoing communication assessments, tailored tips for addressing parents' concerns, and a dashboard of their clinic's HPV vaccination coverage. Online surveys assessed pre-/post-intervention changes in providers' perceptions and communication behaviors. Compared to baseline, more providers reported high-quality HPV vaccine recommendation practices at 3-month follow-up (47% vs. 74%, p < .05). Providers' knowledge, self-efficacy, and shared commitment to improving HPV vaccination also improved (all p < .05). Although we found improvements in several other cognitions after the workshop, these changes did not retain statistical significance at 3 months. About three-quarters (78%) of providers used the mobile app, logging 2.3 sessions on average. Most providers agreed the app was easy to use (mean = 4.7/5.0), a convenient way to get vaccination data (mean = 4.6/5.0), and a tool they would recommend (mean = 4.3/5.0). Our app-based coaching intervention demonstrated feasibility and warrants additional evaluation as a novel mode for training providers to improve their HPV vaccine communication.

What Were the Information Voids? A Qualitative Analysis of Questions Asked by Dear Pandemic Readers between August 2020-August 2021

In the current infodemic, how individuals receive information (channel), who it is coming from (source), and how it is framed can have an important effect on COVID-19 related mitigation behaviors. In light of these challenges presented by the infodemic, Dear Pandemic (DP) was created to directly address persistent questions related to COVID-19 and other health topics in the online environment. This is a qualitative analysis of 3806 questions that were submitted by DP readers to a question box on the Dear Pandemic website between August 30, 2020 and August 29, 2021. Analyses resulted in four themes: the need for clarification of other sources; lack of trust in information; recognition of possible misinformation; and questions on personal decision-making. Each theme reflects an unmet informational need of Dear Pandemic readers, which may be reflective of the broader informational gaps in our science communication efforts.This study highlights the role of an ad hoc risk communication platform in the current environment and uses questions submitted to the Dear Pandemic question box to identify informational needs of DP readers over the course of the COVID-19 pandemic. These findings may help clarify how organizations addressing health misinformation in the digital space can contribute to timely, responsive science communication and improve future communication efforts.

"We don't have the same bodies; we don't react the same way": mothers and adolescent girls' perceptions of the risks and benefits of HPV vaccination in France

Human Papillomavirus (HPV) vaccination is one of the most publicly mistrusted vaccines in Europe, with countries such as France struggling with low vaccine uptake due to parental questioning of vaccine risks and benefits. However, limited evidence exists on adolescent girls' perceptions of the risks and benefits of HPV vaccination. The aim of this qualitative study was to provide an in-depth exploration and comparison of French mothers (n = 21) and adolescent girls' (n = 36) perceptions of the risks and benefits of HPV vaccination. A thematic analysis showed that adolescent girls and mothers perceived the risks and benefits of HPV vaccination differently, with girls reporting positive and beneficial views and emotions toward vaccination and mothers expressing concerns about possible risks. Adolescent girls also reported that both perceptions and actual risks and benefits may vary from one individual to another. Vaccine safety was also understood differently, with mothers reporting a widespread view that vaccines are unsafe and focusing on controversial side effects and girls discussing short-term consequences of vaccination (e.g. pain, fever) and administration and storage issues. Strategies to improve uptake of HPV vaccination should consider and address both the mothers' and daughters' perceptions and understandings of HPV vaccination.

Screening Awareness of HPV-Related Oropharyngeal Cancers and Attitudes and Concerns towards HPV Vaccination Among Parents : HPV and Oropharyngeal Cancer

Baseline population opinions on human papillomavirus (HPV) and HPV vaccination must be understood before physicians can address knowledge gaps in that population and encourage timely vaccination. To determine the opinions of parents of children age 9 to 18 on HPV-related oropharyngeal cancers (OPC); the associations with education level, socioeconomic status, and having a family member/friend with OPC; and the main concerns against having a vaccination., An anonymous survey was created and administered. Parents were asked to complete the survey if they met the inclusion criteria. After the survey, results were tabulated, and the answers for each question were analyzed. The target population was surveyed in the clinic. The target population was parents with children between 9 and 18 years old: the background knowledge and awareness of HPV-related OPC and associations with education level, socioeconomic status, having a family member/friend with OPC, and concerns about vaccination. Our study results showed that the age of parents, education level, marital status, personal vaccination status, and gender of the child are significant factors for background knowledge about HPV-related diseases. Similarly, the education level, the gender of the child, and personal vaccination status are significant factors towards attitudes against having children vaccinated. There is a strong correlation between background knowledge and attitudes. The main issues about vaccination are concerns about effectiveness and side effects, concerns about safe sex experiences, and the cost of vaccination. This is the first study designed to provide information on parents' knowledge of HPV-related cancers, prevalence of HPV vaccination, and attitudes and concerns about HPV vaccination in the USA. The lack of awareness of HPV-related cancers is a significant factor in attitudes against HPV vaccination.

Improving Conversations With COVID-19 Vaccine Hesitant Patients: Action Research to Support Family Physicians

Vaccination delivery and efforts to counter vaccine hesitancy have become focal issues for family medicine teams as the COVID-19 pandemic has evolved. Conducting action research, our team developed an interactive web-based guide to improve clinical conversations around a broad range of vaccine hesitancies presented by patients. The paper presents a step-by-step account of the guide being codesigned with family physicians-its targeted end users-in a process that included validation interviews; role-play interviews; and user-tested design. The validation interviews sought to understand the pragmatic realities of vaccine hesitancy in family medicine clinical practice relative to relevant psychological theories. The role-play interviews drew out conversational strategies and advice from family physicians. The principles of motivational interviewing-an evidence-based approach to vaccine hesitancy conversations that supplements information deficit approaches-were used to codesign the content and layout of the guide. User counts, stakeholder engagement, and web-based analytics indicate the guide is being used extensively. Formal evaluation of the guide is presently underway.Originally published as Annals "Online First" article.

"It's something I'll do until I die": A qualitative examination into why older women in the U.S. continue screening mammography

BACKGROUND

Professional guidelines in the U.S. do not recommend routine screening mammography for women ≥75 years with limited life expectancy and/or poor health. Yet, routine mammography remains widely used in older women. We examined older women's experiences, beliefs, and opinions about screening mammography in relation to aging and health.

METHODS

We performed thematic analysis of transcribed semi-structured interviews with 19 women who had a recent screening visit at a mammography clinic in New York City (average age: 75 years, 63% Hispanic, 53% ≤high school education).

RESULTS

Three main themes emerged: (1) older women typically perceive mammograms as a positive, beneficial, and routine component of care; (2) participation in routine mammography is reinforced by factors at interpersonal, provider, and healthcare system levels; and (3) older women do not endorse discontinuation of screening mammography due to advancing age or poor health, but some may be receptive to reducing screening frequency. Only a few older women reported having discussed mammography cessation or the potential harms of screening with their providers. A few women reported they would insist on receiving mammography even without a provider recommendation.

CONCLUSIONS

Older women's positive experiences and views, as well as multilevel and frequently automated cues toward mammography are important drivers of routine screening in older women. These findings suggest a need for synergistic patient, provider, and system level strategies to reduce mammography overuse in older women.

A Quasi-Experimental Intervention Trial: Testing the Efficacy of Attitudinal Inoculation Videos to Enhance COVID-19 Vaccine Acceptance

BACKGROUND

Over the course of the COVID-19 pandemic, a variety of COVID-19 related misinformation has spread and been amplified online. The spread of misinformation can influence COVID-19 beliefs and protective actions including vaccine hesitancy. Belief in vaccine misinformation is associated with lower vaccination rates and higher vaccine resistance. Attitudinal inoculation is a preventative approach to combating misinformation and disinformation which leverages the power of narrative, rhetoric, values, and emotion.

OBJECTIVE

This study seeks to test inoculation messages in the form of short video messages to promote resistance against persuasion by COVID-19 vaccine misinformation.

METHODS

We designed a series of 30-second inoculation videos and conducted a quasi-experimental study to test the use of attitudinal inoculation in a population of individuals who were unvaccinated (N = 1991). The three intervention videos were distinguished by their script design- with Intervention Video 1 focusing on narrative/rhetorical ("Narrative") presentation of information, Intervention Video 2 focusing on delivering a fact-based information ("Fact"), and Intervention Video 3 using a hybrid design ("Hybrid"). Analysis of covariance (ANCOVA) models were used to compare the main effect of intervention group on the three outcome variables: ability to recognize misinformation tactics ("Recognize", willingness to share misinformation ("Share"), and willingness to take the COVID-19 vaccine ("Willingness").

RESULTS

There were significant effects across all three outcome variables comparing inoculation intervention groups to controls. For the Recognize outcome, the ability to recognize rhetorical strategies, there was a significant intervention group effect (P<.001). For the Share outcome, support for sharing the mis-disinformation, the intervention group main effect was statistically significant ( P=.017). For the Willingness outcome, there was a significant intervention group effect; intervention groups were more willing to get the COVID-19 vaccine compared to controls ( P=.006).

CONCLUSIONS

Across all intervention groups, inoculated individuals showed greater resistance to misinformation than their non-inoculated counterparts. Relative to those who were not inoculated, inoculated participants showed significantly greater ability to recognize and identify rhetorical strategies used in misinformation, were less likely to share false information, and had greater willingness to get the COVID-19 vaccine. Attitudinal inoculation delivered through short video messages should be tested in public health messaging campaigns to counter mis-disinformation.

CLINICALTRIAL

Increasing trust and vaccine uptake: Offering invitational rhetoric as an alternative to persuasion in pediatric visits with vaccine-hesitant parents (VHPs)

Healthcare professionals are increasingly concerned about vaccine hesitancy, an exigency the World Health Organization named one of the ten threats to global health, even before the COVID-19 pandemic. Traditional rhetorical strategies (e.g., persuasion) remain the default to help increase vaccine uptake, despite mounting evidence such techniques may not improve uptake and could alienate families. We offer invitational rhetoric-in which people honor opposing viewpoints rather than trying to change behavior-as an alternative to improve trust and childhood vaccine uptake. We conducted a six-month, mixed methods case study of a small, urban, pediatric healthcare practice in the western United States we believed used invitational methods in discussions with vaccine-hesitant parents (VHPs). We administered pre- and post-visit surveys to families; audio recorded and transcribed their two-month well child checks (WCCs); and facilitated individual interviews with the providers. We analyzed the data looking for patterns in how providers and families use and view traditional persuasion as compared to invitational rhetoric and the effect each has on vaccine uptake, trust, and provider wellbeing. One hundred five (n = 105) families and six healthcare providers participated, with 35 families planning to receive fewer than the CDC-recommended number of vaccinations prior to their WCC. After their visit, however, 37% of VHPs increased their vaccine uptake compared to their pre-visit plans; 80% of VHPs selected top box scores for trust of their providers; and 85% of VHPs who chose to increase their vaccine uptake also selected top box trust scores. Our findings indicate invitational rhetoric may play a meaningful role in increasing vaccine uptake; sustaining or even improving a family's trust in their provider; and positively impacting provider wellbeing. Further research is needed on the use of invitational rhetoric exclusively.

Cultural Variance in Reception and Interpretation of Social Media COVID-19 Disinformation in French-Speaking Regions

Digital communication technology has created a world in which media are capable of crossing national boundaries as never before. As a result, language is increasingly the salient category determining individuals' media consumption. Today, a single social media post can travel around the world, reaching anyone who speaks its language. This poses significant challenges to combatting the spread of disinformation, as an ever-growing pool of disinformation purveyors reach audiences larger than ever before. This dynamic is complicated, however, by the diversity of audience interpretations of message content within a particular language group. Both across and within national boundaries, a single message may be subject to a variety of interpretations depending on the cultural experiences and identities of its recipients. This study explores that dynamic through analysis of French language anti-vaccine and COVID-denialist disinformation. Using qualitative coding methodology, a team of researchers empirically identify common and far-reaching patterns of Francophone COVID disinformation narratives and rhetoric. These narratives and rhetorics are then subjected to hermeneutic close reading to determine likely variations in their reception across different French-speaking cultures. Data were gathered and analyzed between the dates of 24 March 2021 and 27 April 2021. Results of this study indicate the need for awareness on the part of public health officials combatting COVID disinformation online, for both the transnational reach of disinformation targeting speakers of a single language and for variations in meaning and salience across cultures within that language group.

Effect of a School-Based Educational Intervention About the Human Papillomavirus Vaccine on Psychosocial Outcomes Among Adolescents: Analysis of Secondary Outcomes of a Cluster Randomized Trial

IMPORTANCE

Delivery of vaccination to adolescents via a school-based program provides an opportunity to promote their involvement in health decision-making, service provision, and self-efficacy (belief in one's ability to perform a certain behavior).

OBJECTIVE

To examine the effect of a human papillomavirus (HPV) vaccination education and logistical intervention on adolescent psychosocial outcomes.

DESIGN, SETTING, AND PARTICIPANTS

In this cluster randomized trial and process and qualitative evaluation, adolescents aged 12 to 13 years (first year of high school) were recruited at high schools in Western Australia (WA) and South Australia (SA) in 2013 and 2014. Statistical analysis was performed from January 2016 to December 2020.

INTERVENTIONS

The complex intervention consisted of an adolescent intervention to promote knowledge and psychosocial outcomes, shared decisional support tool, and logistical strategies.

MAIN OUTCOMES AND MEASURES

Prespecified secondary outcomes were assessed. The HPV Adolescent Vaccination Intervention Questionnaire (HAVIQ) was used to measure changes in adolescent knowledge (6-item subscale), fear and anxiety (6-item subscale), self-efficacy (5-item subscale), and decision-making (8-item subscale). The hypothesis was that the intervention would improve adolescent involvement in vaccine decision-making (measured before dose 1 only), improve vaccine-related self-efficacy, and reduce vaccine-related fear and anxiety (measured before doses 1, 2, and 3). Mean (SD) scores for each subscale were compared between intervention and control students. In the process evaluation, focus groups were conducted. Analyses of the HAVIQ data were conducted from 2016 to 2020. Qualitative analyses of the focus groups were undertaken from 2017 to 2020.

RESULTS

The trial included 40 schools (21 intervention and 19 control) across sectors with 6967 adolescents (mean [SD] age, 13.70 [0.45] years). There were 3805 students (1689 girls and 2116 boys) in the intervention group and 3162 students (1471 girls and 1691 boys) in the control group. The overall response rate for the HAVIQ was 55%. In WA, where parental consent was required, the response rate was 35% (1676 of 4751 students); in SA, where parental consent was not required, it was 97% (2166 of 2216 students). The mean (SD) score for decision-making in the intervention group before dose 1 was 3.50 (0.42) of 5 points and 3.40 (0.40) in the control group, a small but significant difference of 0.11 point (95% CI, 0.06 to 0.16 point; P < .001). There was a small difference in favor of the intervention group in reduced vaccination-related anxiety (pre-dose 1 difference, -0.11 point [95% CI, -0.19 to -0.02 point]; pre-dose 2 difference, -0.18 point [95% CI, -0.26 to -0.10 point]; pre-dose 3 difference, -0.18 [95% CI, -0.24 to -0.11]) and increased vaccination self-efficacy (pre-dose 1 difference, 4.0 points; [95% CI, 1.0 to 7.0 points]; pre-dose 2 difference, 4.0 points [95% CI, 2.0 to 6.0 points]; pre-dose 3 difference, 3.0 points [95% CI, 1.0 to 5.0 points]). Focus group data from 111 adolescents in 6 intervention and 5 control schools revealed more confidence and less anxiety with each vaccine dose.

CONCLUSIONS AND RELEVANCE

In this cluster randomized trial, there was a small difference in adolescent decisional involvement and vaccine-related confidence and reduced vaccination-related fear and anxiety that was maintained throughout the vaccine course in the intervention vs control groups. Guidelines for vaccination at school should incorporate advice regarding how this outcome can be achieved.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry: ACTRN12614000404628.

Do cognitive styles affect vaccine hesitancy? A dual-process cognitive framework for vaccine hesitancy and the role of risk perceptions

RATIONALE

In this study, we consider cognitive differences in vaccine hesitancy and how perceived risks intervene in this relationship. Recent research agrees on the existence of two cognitive processes, intuitive and analytic cognition. Different individuals lean toward one of these processes with varying degrees of strength, influencing day-to-day behavior, perceptions, and decisions. Thinking dispositions might influence, at the same time, vaccine acceptance and perceived risks of vaccine-preventable disease, but the implications of individuals' cognitive differences for vaccination uptake have seldom been addressed from a sociological standpoint.

OBJECTIVE

We bridge this gap by adopting a dual-process framework of cognition and investigate how thinking styles have a direct association with vaccine hesitancy and an indirect one through perceptions of risk.

METHODS

We use data from original surveys carried out between September and November 2019 on a sample of the Italian population, participating in an online panel run by a major Italian survey company. We use Karlson, Holm, and Breen (KHB) decomposition to compare coefficients of nested-nonlinear models, separate the direct and indirect association of cognitive processes with vaccine hesitancy, and disentangle the contribution of each measure of risk perception.

RESULTS

Net of individual socio-demographic characteristics, intuitive thinking is positively associated with the likelihood of being vaccine hesitant, and this direct association is as important as the indirect one through risk perceptions. Affective risk perceptions account for over half of the indirect association, underlining the centrality of affective versus probabilistic approaches to risk perception.

CONCLUSION

This study contributes to the existing literature by highlighting the importance of including cognitive characteristics in vaccine hesitancy research, and empirically showing individuals' qualitatively complex perceptions of risks. Taking into account individuals' preferred cognitive style and affective concerns might be important in developing better tailored communication strategies to contain vaccine hesitancy.

Development of a Codebook of Online Anti-Vaccination Rhetoric to Manage COVID-19 Vaccine Misinformation

Vaccine hesitancy (delay in obtaining a vaccine, despite availability) represents a significant hurdle to managing the COVID-19 pandemic. Vaccine hesitancy is in part related to the prevalence of anti-vaccine misinformation and disinformation, which are spread through social media and user-generated content platforms. This study uses qualitative coding methodology to identify salient narratives and rhetorical styles common to anti-vaccine and COVID-denialist media. It organizes these narratives and rhetorics according to theme, imagined antagonist, and frequency. Most frequent were narratives centered on "corrupt elites" and rhetorics appealing to the vulnerability of children. The identification of these narratives and rhetorics may assist in developing effective public health messaging campaigns, since narrative and emotion have demonstrated persuasive effectiveness in other public health communication settings.

A Select Bibliography of Actions to Promote Vaccine Literacy: A Resource for Health Communication

In this bibliography, the researchers provide an introduction to the available evidence base of actions to promote vaccine literacy. The research team organized interventions to create a tool that can inform health communicators and practitioners seeking a resource focused on strategy and implementation design for actions that support vaccine literacy. This scoping bibliography is honed specifically to respond to the urgency of the current pandemic, when supporting and increasing vaccine literacy offers promise for achieving the critically needed high levels of vaccination. Over the course of the coming months and year, this bibliography will be a dynamic and "living" document hosted and maintained on vaccineliteracy.com.