1
|
Vigezzi GP, Maggioni E, Bert F, de Vito C, Siliquini R, Odone A. Who is (not) vaccinated? A proposal for a comprehensive immunization information system. Hum Vaccin Immunother 2024; 20:2386739. [PMID: 39103249 DOI: 10.1080/21645515.2024.2386739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 07/27/2024] [Indexed: 08/07/2024] Open
Abstract
The role of immunization in public health is crucial, offering widespread protection against infectious diseases and underpinning societal well-being. However, achieving optimal vaccination coverage is impeded by vaccine hesitancy, a significant challenge that necessitates comprehensive strategies to understand and mitigate its effects. We propose the integration of Population Health Management principles with Immunization Information Systems (IISs) to address vaccine hesitancy more effectively. Our approach leverages systematic health determinants analysis to identify at-risk populations and tailor interventions, thereby promoting vaccination coverage and public health responses. We call for the development of an enhanced version of the Italian National Vaccination Registry, which aims to facilitate real-time tracking of individuals' vaccination status while improving data accuracy and interoperability among healthcare systems. This registry is designed to overcome current barriers by ensuring robust data protection, addressing cultural and organizational challenges, and integrating behavioral insights to foster informed public health campaigns. Our proposal aligns with the Italian National Vaccination Prevention Plan 2023-2025 and emphasizes proactive, evidence-based strategies to increase vaccination uptake and contrast the spread of vaccine-preventable diseases. The ultimate goal is to establish a data-driven, ethically sound framework that enhances public health outcomes and addresses the complexities of vaccine hesitancy within the Italian context and beyond.
Collapse
Affiliation(s)
- Giacomo Pietro Vigezzi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Elena Maggioni
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Fabrizio Bert
- Department of Public Health and Pediatrics Sciences, University of Torino, Torino, Italy
| | - Corrado de Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Roberta Siliquini
- Department of Public Health and Pediatrics Sciences, University of Torino, Torino, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Medical Direction, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| |
Collapse
|
2
|
Werdin S, Neufeind J. The implementation of a new measles vaccine mandate in Germany: A qualitative study in local health departments. PLoS One 2024; 19:e0306003. [PMID: 38917137 PMCID: PMC11198778 DOI: 10.1371/journal.pone.0306003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 06/08/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Measles is a highly contagious disease with the potential for severe complications. Despite the availability of effective vaccines, there have been recurrent measles outbreaks in Germany over the past decades. In response, a new measles vaccine mandate was introduced on March 1, 2020, aimed at closing vaccination gaps in high-risk populations. This study evaluates the mandate's implementation, identifies operational challenges, assesses the impact of the Coronavirus disease 2019 pandemic, and investigates expert attitudes towards the new policy. METHODS Semi-structured expert interviews were conducted with staff members of 16 different local health departments in Germany. The interviews, carried out in April and May 2021, were electronically recorded, transcribed verbatim, and analyzed using the Framework method. RESULTS The implementation of the measles vaccine mandate in local health departments varied substantially. Challenges in implementing the mandate primarily arose from uncertainties regarding procedural specifics, such as handling fraudulent medical certificates and imposing sanctions, leading to a call from many interviewees for uniform guidelines to ensure coherent implementation. At the time the measles vaccine mandate came into force, managing the Coronavirus disease 2019 pandemic was a priority in most local health departments, often delaying the implementation of the mandate. Despite the difficulties encountered, most experts considered the mandate to be an effective step towards measles elimination. CONCLUSIONS The measles vaccine mandate has imposed a new responsibility on staff in German local health departments, which is associated with implementation challenges such as procedural uncertainties and vaccine hesitancy, but also the Coronavirus disease 2019 pandemic as a contextual impediment. Significant differences in the implementation approach underscore the need for harmonization to enhance implementation efficiency and public acceptance of the mandate. Despite the mandate's potential to increase vaccination rates, our findings advocate for a comprehensive approach, incorporating public education, accessible vaccination, and measures to address social disparities.
Collapse
Affiliation(s)
- Sophia Werdin
- Swiss Tropical and Public Health Institute, Swiss Centre for International Health, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Julia Neufeind
- Immunisation Unit, Robert Koch Institute, Berlin, Germany
| |
Collapse
|
3
|
Al-Abdulla O, Alaref M, Kallström A, Kauhanen J. Individual and social determinants of COVID-19 vaccine hesitancy and uptake in Northwest Syria. BMC Health Serv Res 2024; 24:265. [PMID: 38429739 PMCID: PMC10908183 DOI: 10.1186/s12913-024-10756-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 02/19/2024] [Indexed: 03/03/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Orwa Al-Abdulla
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, The University of Eastern Finland, 70211, Kuopio, P.O. Box 1627, Finland.
| | - Maher Alaref
- Strategic Research Center (Öz SRC), Incili Pinar MAH, Gazi Muhtar Paşa BUL, Doktorlar Sitesi, 38E, 104, 27090, Sehitkamil, Gaziantep, Türkiye
| | - Agneta Kallström
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, The University of Eastern Finland, 70211, Kuopio, P.O. Box 1627, Finland
- Strategic Research Center (Öz SRC), Incili Pinar MAH, Gazi Muhtar Paşa BUL, Doktorlar Sitesi, 38E, 104, 27090, Sehitkamil, Gaziantep, Türkiye
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, The University of Eastern Finland, 70211, Kuopio, P.O. Box 1627, Finland
| |
Collapse
|
4
|
Rzymski P, Gwenzi W. Respiratory syncytial virus immunoprophylaxis: Novel opportunities and a call for equity. J Med Virol 2024; 96:e29453. [PMID: 38305000 DOI: 10.1002/jmv.29453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/20/2023] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Abstract
With the approval of the first vaccines against respiratory syncytial virus (RSV) and a novel RSV-neutralizing antibody, 2023 has been perceived as a game-changing year in preventing severe outcomes of RSV infections in infants and the elderly. However, the costs of these pharmaceuticals are high, while RSV disproportionately impacts populations of low-to-middle-income regions, which may continue to suffer from a lack of pharmaceutical measures for RSV prevention under health and socioeconomic disparities. This paper presents an overview of the characteristics, clinical results, and approval status of various RSV vaccines and anti-RSV antibodies. It posits that wealthy nations cannot monopolize RSV immunoprophylaxis and should work jointly to make it available to lower-income countries. An approach toward RSV immunoprophylaxis equity based on five points is offered: (1) integration of RSV vaccines and antibodies into the existing global humanitarian distribution systems, (2) using affordable RSV vaccine pricing models, (3) enforcing equity as a part of national and global public health strategy, (4) implementing equitable allocation frameworks for RSV immunoprophylaxis, and (5) promoting local manufacturing. Such a plan needs to be put into action as soon as possible to avoid delays in serving the populations with the highest needs related to RSV burden.
Collapse
Affiliation(s)
- Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Willis Gwenzi
- Biosystems and Environmental Enginering Research Group, Harare, Zimbabwe
- Alexander von Humboldt Fellow and Guest Professor at Grassland Science and Renewable Plant Resources, Faculty of Organic Agricultural Sciences, Universität Kassel, Witzenhausen, Germany
| |
Collapse
|
5
|
Ozawa S, Schuh HB, Nakamura T, Yemeke TT, Lee YFA, MacDonald NE. How to increase and maintain high immunization coverage: Vaccination Demand Resilience (VDR) framework. Vaccine 2023; 41:6710-6718. [PMID: 37798209 DOI: 10.1016/j.vaccine.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Resilience in vaccination demand is ever more critical as the COVID-19 pandemic has increased our understanding of the importance of vaccines on health and well-being. Yet timid demand for COVID-19 vaccines where available and reduced uptake of routine immunizations globally further raise the urgent need to build vaccination resilience. We demonstrate the complexity of vaccination demand and resilience in a framework where relevant dimensions are intertwined, fluid, and contextual. METHODS We developed the Vaccination Demand Resilience (VDR) framework based on a literature review on vaccination demand and expert consultation. The matrix framework builds on three main axes: 1) vaccination attitudes and beliefs; 2) vaccination seeking behavior; and 3) vaccination status. The matrix generated eight quadrants, which can help explain people's levels of vaccination demand and resilience. We selected four scenarios as examples to demonstrate different interventions that could move people across quadrants and build vaccination resilience. RESULTS Incongruence between individuals' attitudes and beliefs, vaccination behavior, and vaccination status can arise. For example, an individual can be vaccinated due to mandates but reject vaccination benefits and otherwise avoid seeking vaccination. Such incongruence could be altered by interventions to build resilience in vaccination demand. These interventions include information, education and communication to change individuals' vaccination attitudes and beliefs, incentive programs and reminder-recalls to facilitate vaccination seeking, or by strengthening healthcare provider communications to reduce missed opportunities. CONCLUSIONS Vaccination decision-making is complex. Individuals can be vaccinated without necessarily accepting the benefits of vaccination or seeking vaccination, threatening resilience in vaccination demand. The VDR framework can provide a useful lens for program managers and policy makers considering interventions and policies to improve vaccination resilience. This would help build and sustain confidence and demand for vaccinations, and help to continue to prevent disease, disability, and death from vaccine-preventable diseases.
Collapse
Affiliation(s)
- Sachiko Ozawa
- Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Maternal Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Holly B Schuh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Tomoka Nakamura
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom; Nagasaki University, School of Tropical Medicine and Global Health, Nagasaki, Japan
| | - Tatenda T Yemeke
- Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yi-Fang Ashley Lee
- Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Noni E MacDonald
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
6
|
Karlsson LC, Garrison A, Holford D, Fasce A, Lewandowsky S, Taubert F, Schmid P, Betsch C, Rodrigues F, Fressard L, Verger P, Soveri A. Healthcare professionals' attitudes to mandatory COVID-19 vaccination: Cross-sectional survey data from four European countries. Hum Vaccin Immunother 2023; 19:2256442. [PMID: 37724556 PMCID: PMC10512846 DOI: 10.1080/21645515.2023.2256442] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023] Open
Abstract
Mandatory vaccinations are widely debated since they restrict individuals' autonomy in their health decisions. As healthcare professionals (HCPs) are a common target group of vaccine mandates, and also form a link between vaccination policies and the public, understanding their attitudes toward vaccine mandates is important. The present study investigated physicians' attitudes to COVID-19 vaccine mandates in four European countries: Finland, France, Germany, and Portugal. An electronic survey assessing attitudes to COVID-19 vaccine mandates and general vaccination attitudes (e.g. perceived vaccine safety, trust in health authorities, and openness to patients) was sent to physicians in the spring of 2022. A total of 2796 physicians responded. Across all countries, 78% of the physicians were in favor of COVID-19 vaccine mandates for HCPs, 49% favored COVID-19 vaccine mandates for the public, and 67% endorsed COVID-19 health passes. Notable differences were observed between countries, with attitudes to mandates found to be more positive in countries where the mandate, or similar mandates, were in effect. The associations between attitudes to mandates and general vaccination attitudes were mostly small to neglectable and differed between countries. Nevertheless, physicians with more positive mandate attitudes perceived vaccines as more beneficial (in Finland and France) and had greater trust in medical authorities (in France and Germany). The present study contributes to the body of research within social and behavioral sciences that support evidence-based vaccination policymaking.
Collapse
Affiliation(s)
- Linda C. Karlsson
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Amanda Garrison
- Faculté des Sciences Médicales et Paramédicales, Southeastern Health Regional Observatory (Observatoire Régional de la Santé, ORS-PACA), Marseille, France
| | - Dawn Holford
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Angelo Fasce
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Stephan Lewandowsky
- School of Psychological Science, University of Bristol, Bristol, UK
- Department of Psychology, University of Potsdam, Potsdam, Germany
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Frederike Taubert
- Institute for Planetary Health Behavior, Health Communication, University of Erfurt, Erfurt, Germany
- Health Communication Working Group, Implementation Research, Bernhard Nocht Institute for Tropical Medicine, University of Hamburg, Hamburg, Germany
| | - Philipp Schmid
- Institute for Planetary Health Behavior, Health Communication, University of Erfurt, Erfurt, Germany
- Health Communication Working Group, Implementation Research, Bernhard Nocht Institute for Tropical Medicine, University of Hamburg, Hamburg, Germany
- Centre for Language Studies, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Cornelia Betsch
- Institute for Planetary Health Behavior, Health Communication, University of Erfurt, Erfurt, Germany
- Health Communication Working Group, Implementation Research, Bernhard Nocht Institute for Tropical Medicine, University of Hamburg, Hamburg, Germany
| | | | - Lisa Fressard
- Faculté des Sciences Médicales et Paramédicales, Southeastern Health Regional Observatory (Observatoire Régional de la Santé, ORS-PACA), Marseille, France
| | - Pierre Verger
- Faculté des Sciences Médicales et Paramédicales, Southeastern Health Regional Observatory (Observatoire Régional de la Santé, ORS-PACA), Marseille, France
| | - Anna Soveri
- Department of Clinical Medicine, University of Turku, Turku, Finland
| |
Collapse
|
7
|
Attwell K, Hannah A. Convergence on Coercion: Functional and Political Pressures as Drivers of Global Childhood Vaccine Mandates. Int J Health Policy Manag 2022; 11:2660-2671. [PMID: 35397484 PMCID: PMC9818102 DOI: 10.34172/ijhpm.2022.6518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 02/05/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Vaccine hesitancy is a global problem with diverse local policy responses, from voluntaristic to coercive. Between 2015 and 2017, California, Australia, France, and Italy increased the coerciveness of their childhood vaccine regimes. Despite this apparent convergence, there is little evidence of imposition, policy learning, or diffusion - the drivers that are usually discussed in scholarly literature on policy convergence. The fact that the four governments were oriented across the political spectrum, with quite different political and institutional systems, further indicates an empirical puzzle. METHODS To better understand the drivers of enhanced vaccine mandates, a crucial issue during the coronavirus disease 2019 (COVID-19) global rollout, this article engages with four case studies assembled from qualitative analysis of semi-structured in-country interviews and document analysis between November 2018 and November 2020. Key informants had specific expert knowledge or played a role in the introduction or implementation of the new policies. Interview transcripts were coded inductively and deductively, augmented with extensive analysis of legal, policy, academic and media documents. RESULTS The case analysis identifies two key and interacting elements in government decisions to tighten vaccine mandates: functional and political pressures. Policy-makers in Italy and France were primarily driven by functional challenges, with their vaccination governance systems under threat from reduced population compliance. California and Australia did not face systemic threats to the functioning of their systems, but activists utilised local opportunities to heighten political pressure on decision makers. CONCLUSION In four recent cases of high-income jurisdictions making childhood vaccination policies more coercive, vaccine hesitancy alone could not explain why the policies arose in these jurisdictions and not others, while path dependency alone could not explain why some jurisdictions with mandates made them more coercive. Explanation lies in restrictive mandates being attractive for governments, whether they face systemic functional problems in vaccine governance, or political pressures generated by media and activists. Mandates can be framed as targeting whole populations or localised groups of refusers, and implemented without onerous costs or policy complexity.
Collapse
Affiliation(s)
- Katie Attwell
- Political Science and International Relations, School of Social Sciences, University of Western Australia, Perth, WA, Australia
| | | |
Collapse
|
8
|
Healthcare professional and professional stakeholders' perspectives on vaccine mandates in Switzerland: A mixed-methods study. Vaccine 2022; 40:7397-7405. [PMID: 35164988 PMCID: PMC8832463 DOI: 10.1016/j.vaccine.2021.12.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/13/2021] [Accepted: 12/30/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND There currently are no mandatory vaccines in Switzerland. However, Swiss federal legislation allows for vaccination mandates in settings where the risk of transmission to vulnerable groups is high, such as healthcare professionals (HCPs) working with vulnerable patients. Since HCPs are trusted information sources, a priority population for COVID-19 vaccination, and potentially subjected to mandates, we investigated HCP perspectives on mandates. METHODS A national online survey was administered to HCPs (October 2020-March 2021), including vaccine mandates questions concerning patients (measles) and HCPs (influenza). We qualitatively investigated HCP mandate perspectives through: (1) 34 interviews with HCPs, HCP professional society representatives, and health authorities; (2) a focus group discussion (FGD) with complementary medicine (CM) and biomedical physicians, and Swiss Federal Vaccination Commission members. RESULTS 1933 participants (496 physicians, 226 pharmacists, 607 nurses, 604 midwives) responded to the survey. Quantitative results show all professional groups preferred shared parent-HCP measles vaccine decisions (65%, 54%, 50%, 48%, respectively; p for trend < 0.001). Midwives (87%) and nurses (70%) preferred individual influenza vaccination decisions for HCPs, while physicians (49%) and pharmacists (44%) preferred shared employee-employer decisions (p for trend < 0.001). Physicians (p < .001) and pharmacists (p < .01) with CM training favored individual influenza vaccination decisions. Qualitative results show general HCP opposition to vaccine mandates, mainly because participants argued how other approaches, such as HCP training and better information, could encourage uptake. Arguments against COVID-19 mandates included insufficiently documented long-term safety/efficacy data. From participants' perspectives, mandated vaccination should be used as a last resort. Some participants expressed fear that with mandates, notably for influenza and COVID-19, some HCPs might leave their jobs. HCPs were unsure what vaccine mandates would concretely look like in practice, particularly regarding sanctions for non-compliance and enforcement. CONCLUSION In Switzerland, HCPs generally were opposed to vaccination mandates. Clarity and guidance are needed from health authorities to better inform discussions around vaccine mandates.
Collapse
|
9
|
COVID-19 vaccine Mandates: An Australian attitudinal study. Vaccine 2022; 40:7360-7369. [PMID: 34872796 PMCID: PMC8629747 DOI: 10.1016/j.vaccine.2021.11.056] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND The rollout of vaccines against COVID-19 is prompting governments and the private sector to adopt mandates. However, there has been little conceptual analysis of the types of mandates available, nor empirical analysis of how the public thinks about different mandates and why. Our conceptual study examines available instruments, how they have been implemented pre-COVID, and their use for COVID-19 globally. Then, our qualitative study reports the acceptability of such measures in Western Australia, which has experienced very limited community transmission, posing an interesting scenario for vaccine acceptance and acceptability of measures to enforce it. METHOD Our conceptual study developed categories of mandates from extant work, news reports, and legislative interventions globally. Then, our empirical study asked 44 West Australians about their attitudes towards potential mandatory policies, with data analysed using NVivo 12. RESULTS Our novel studies contribute richness and depth to emerging literature on the types and varying acceptability of vaccine requirements. Participants demonstrated tensions and confusion about whether instruments were incentives or punishments, and many supported strong consequences for non-vaccination even if they ostensibly opposed mandates. Those attached to restrictions for disease prevention were most popular. There were similar degrees of support for mandates imposed by employers or businesses, with participants showing little concern for potential issues of accountability linked to public health decisions delegated to the private sector. Participants mostly supported tightly regulated medical exemptions granted by specialists, with little interest in religious or personal belief exemptions. CONCLUSION Our participants are used to being governed by vaccine mandates, and now by rigorous lockdown and travel restrictions that have ensured limited local COVID-19 disease and transmission. These factors appear influential in their general openness to COVID-19 vaccine mandates, especially when linked explicitly to the prevention of disease in high-risk settings.
Collapse
|
10
|
Toll M, Li A. Vaccine mandates on childcare entry without conscientious objection exemptions: A quasi-experimental panel study. Vaccine 2022; 40:7440-7450. [PMID: 35501181 DOI: 10.1016/j.vaccine.2022.03.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Examine the effect of No Jab No Play policies, which linked vaccine status to childcare service entry without allowing for personal belief exemptions, on immunisation coverage. STUDY DESIGN Immunisation coverage rates from the Australian Immunisation Register were linked to regional level covariates from the Australian Bureau of Statistics between January 2016 and December 2019. Differential timings of policy rollouts across states were used to assess changes in coverage with the implementation of policies with generalised linear models. Quantile regression and subgroup analysis were also conducted to explore the variation in policy responses. RESULTS Baseline mean vaccination rates in 2016 were 93.4% for one-year-olds, 91.2% for two-year-olds and 93.2% for five-year-olds. Increases in coverage post-policy were significant but small, at around 1% across age groups, with larger increases in two and five-year-olds. Accounting for aggregate time trends and regional characteristics, implementation of the policies was associated with improved full immunisation coverage rates for age one (post-year 1: 0.15% [95 %CI-0.23; 0.52]; post-year 2: 0.56% [95 %CI 0.05; 1.07]), age two (post-year 1: 0.49 [95 %CI: 0.00; 0.97]; post-year 2: 1.15% [95 %CI: 0.53; 1.77], and age five (post-year 1: 0.38% [95 %CI 0.08; 0.67]; post-year 2: 0.71% [95 %CI 0.25; 1.16]. The policy effect was dispersed and insignificant at the lowest quantiles of the distribution of immunisation coverage, and smaller and insignificant in the highest socioeconomic areas. CONCLUSION Findings suggest that No Jab No Play policies had a small positive impact on immunisation coverage. This policy effect varied according to prior distribution of coverage and socio-economic status. Childcare access equity and unresponsiveness in high socioeconomic areas remain concerns.
Collapse
Affiliation(s)
- Mathew Toll
- Centre for Health Policy, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia.
| | - Ang Li
- Centre for Health Policy, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| |
Collapse
|
11
|
Slotte P, Karlsson LC, Soveri A. Attitudes towards mandatory vaccination and sanctions for vaccination refusal. Vaccine 2022; 40:7378-7388. [PMID: 35688728 DOI: 10.1016/j.vaccine.2022.05.069] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 01/28/2023]
Abstract
AIMS Investigating attitudes towards mandatory vaccination and sanctions for vaccination refusal in an area with insufficient vaccination coverage may help health authorities to assess which strategies for increasing vaccination coverage are appropriate. This study examines attitudes to vaccine mandates and asks questions regarding what kinds of sanctions could legitimately result from vaccination refusal. It seeks to find out if people's attitudes towards mandates and towards sanctions for vaccination refusal are related to their attitudes to vaccines and the degree of trust they feel towards health care professionals and health care authorities. The study also discusses how the observed attitudes towards mandates may be related to perceptions of autonomy, responsibility, and equitability. METHODS Data collection was carried out in Finland through an online survey in a region with suboptimal vaccine uptake. Statistical analysis was conducted on a sample of 1101 respondents, using confirmatory factor analysis and structural regression analysis. RESULTS Persons hold different views on mandates and sanctions. Importantly, the persons who support vaccination mandates and sanctions for vaccination refusal are to a great degree the same people who have positive attitudes to vaccines and high trust in health care professionals and health authorities. CONCLUSION Trust is a key factor which has a bearing on people's attitudes towards mandates and sanctions for noncompliance. A focus on the reasons for lack of trust, and on how to enhance trust, is a more feasible long-term way (than mandates) to promote large- scale compliance with childhood vaccine programmes in the studied country context.
Collapse
Affiliation(s)
- Pamela Slotte
- Faculty of Arts, Psychology and Theology, Åbo Akademi University, Tehtaankatu 2, FI-20500 Turku, Finland; Centre of Excellence in Law, Identity and the European Narratives, Siltavuorenpenger 1A, FI-00014 University of Helsinki, Finland.
| | - Linda C Karlsson
- Department of Clinical Medicine, FI-20014 University of Turku, Turku, Finland.
| | - Anna Soveri
- Department of Clinical Medicine, FI-20014 University of Turku, Turku, Finland.
| |
Collapse
|
12
|
Attwell K, Rizzi M, Paul KT. Consolidating a research agenda for vaccine mandates. Vaccine 2022; 40:7353-7359. [PMID: 36396514 PMCID: PMC9662755 DOI: 10.1016/j.vaccine.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022]
Abstract
A workshop on mandatory vaccination was pitched to the World Public Health Congress in 2019 and the resultant special issue was pitched to Vaccine in 2020. During this project, the COVID-19 pandemic pushed vaccine policy to the forefront of global public health policy, and the imposition of vaccine mandates prompted a new wave of scholarship in the field. This introductory article employs the heuristic of Lasswell's (1956) policy cycle to synthesise the findings of the articles in the special issue. It considers the temporal lifetime of mandates and highlights findings regarding: the emergence of mandates as a policy option, public support and policy instrument design, what matters in the implementation of mandates, and what we can learn from evaluating them. The second half of the paper categorizes the included papers in terms of what aspects of mandates they study and the methods they employ to do so, in order to formulate a guide for future researchers of vaccine mandates. Scholars study either speculative or existing mandates - research can address several stages of the policy cycle or just one of them, ranging from attitudinal research to implementation studies and impact studies. Historical and contextual studies that take deep dives into a particular mandate are a much needed resource for studying emerging mandates, too, and scoping and framework- building work will undoubtedly be valuable in understanding and appreciating the wealth of knowledge production in this growing field. This special issue can serve as a roadmap for a consolidation of this interdisciplinary research agenda, and provide a helpful resource for decisionmakers at this historical juncture.
Collapse
Affiliation(s)
- Katie Attwell
- School of Social Science, The University of Western Australia, Perth, Australia.
| | - Marco Rizzi
- UWA Law School, The University of Western Australia, Perth, Australia
| | - Katharina T Paul
- Department of Political Science, Faculty of Social Sciences, The University of Vienna, Vienna, Austria
| |
Collapse
|
13
|
MacDonald NE, Dubé È, Comeau J. Vaccines, Politics and Mandates: Can We See the Forest for the Trees? Comment on "Convergence on Coercion: Functional and Political Pressures as Drivers of Global Childhood Vaccine Mandates". Int J Health Policy Manag 2022; 12:7572. [PMID: 36404500 PMCID: PMC10125092 DOI: 10.34172/ijhpm.2022.7572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022] Open
Abstract
Under-vaccination is a complex problem that is not simple to address whether this is for routine childhood immunization or for coronavirus disease 2019 (COVID-19) vaccination. Vaccination mandates has been one policy instrument used to try to increase vaccine uptake. While the concept may appear straight forward there is no standard approach. The decision to shift to a more coercive mandated program may be influenced by both functional and/or political needs. With mandates there may be patient and/or public push back. Anti-mandate protests and increased public polarization has been seen with COVID-19 vaccine mandates. This may negatively impact on vaccine acceptance ie, be counterproductive, causing more harm than overall good in the longer term. We need a better understanding of the political and functional needs that drive policy change towards mandates as well as cases studies of the shorter- and longer-term outcomes of mandates in both routine and pandemic settings.
Collapse
Affiliation(s)
- Noni E. MacDonald
- Department of Paediatrics, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ève Dubé
- Direction des Risques Biologiques et de la Santé au Travail, Institut National de Santé Publique du Québec, Québec, QC, Canada
| | - Jeannette Comeau
- Department of Paediatrics, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
14
|
Wirayuda AAB, Al-Mahrezi A, Chan MF. Factors Impacting Life Expectancy in Bahrain: Evidence from 1971 to 2020 Data. INTERNATIONAL JOURNAL OF HEALTH SERVICES : PLANNING, ADMINISTRATION, EVALUATION 2022; 53:207314221129052. [PMID: 36214193 DOI: 10.1177/00207314221129052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
The factors impacting life expectancy (LE) are important to a country as LE reflects the essential quality of its population. Previous studies showed that other than economic factors, health status and resources (HSR) and sociodemographic (SD) also affect LE. This area has not been previously studied in Bahrain, especially in the past five decades. Hence, this study aims to develop an explanatory model for HSR, macroeconomic (ME), and SD factors on LE in Bahrain. The research was a retrospective, time-series design that collected the annual published data on SD, ME, HSR, and LE in Bahrain's population from 1971 to 2020. The data were analyzed using the partial least squares-structural equation modeling (PLS-SEM) method. The result shows that ME (0.463, P < .001) and HSR (0.595, P < .001) have significant direct effects on LE. ME has an indirect effect (0.488, P < .001) on LE via SD and HSR, and SD has an indirect effect (0.496, P < .001) on LE through HSR. During the socioeconomic downturn, the health resources provision should not be reduced as it directly affects LE. An integrated policy addressing socioeconomic and health-related factors could protect the future of Bahrain's population health outcomes.
Collapse
Affiliation(s)
| | - Abdulaziz Al-Mahrezi
- 108707Department of Family Medicine and Public Health, 37611Sultan Qaboos University, Muscat, Oman
| | - Moon Fai Chan
- 108707Department of Family Medicine and Public Health, 37611Sultan Qaboos University, Muscat, Oman
| |
Collapse
|
15
|
Neufeind J, Schmid-Küpke N, Rehfuess E, Betsch C, Wichmann O. How a generally well-accepted measles vaccine mandate may lead to inequities and decreased vaccine uptake: a preregistered survey study in Germany. BMC Public Health 2022; 22:1846. [PMID: 36192739 PMCID: PMC9527387 DOI: 10.1186/s12889-022-14075-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/25/2022] [Indexed: 12/04/2022] Open
Abstract
Background In Germany, a measles vaccine mandate came into effect in March 2020, requiring proof of measles immunization for children attending kindergarten or school and for staff in a variety of facilities. Mandates can be successful if implemented with care and in a context-sensitive manner. They may, however, also lead to inequities and decreased uptake of other vaccines. The aim of this study was to investigate the acceptance and potential unintended consequences of the measles vaccine mandate in Germany. Methods As part of a larger evaluation project on the new mandate, we conducted an online survey among parents in August/September 2020. We assessed differences in knowledge about the mandate and the measles vaccine by socio-economic status. We used linear and logistic regression to estimate how reactance to the mandate was associated with vaccination status and vaccination intention against other diseases. We used mediation analysis to measure how trust in institutions had an impact on the attitude towards the mandate, mediated by level of reactance. Results In total, 4,863 parents participated in the study (64.2% female, mean age = 36.8 years). Of these, 74.1% endorsed a measles vaccine mandate for children. Parents with lower socio-economic status had less knowledge about the mandate and the measles vaccine. The higher parents’ levels of reactance, the lower the vaccination intentions and the likelihood for the child to be vaccinated against other diseases. Furthermore, higher institutional trust decreased the level of reactance and increased positive attitudes towards the mandate (partial mediation). Conclusions The new measles vaccine mandate in Germany, though well accepted by many, might have unintended consequences. Parents with lower socio-economic status, who know less about the mandate and vaccine, might be less likely to comply with it. The mandate may also lead to some parents omitting other childhood vaccines, as a way to restore their freedom. This could decrease vaccination coverage of other vaccines. Any potential loss of trust might provoke more reactance and lower acceptance of mandates. Policymakers should now expand communication activities on the mandate, monitor trends in vaccination coverage carefully and take measures to strengthen trust. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14075-y.
Collapse
Affiliation(s)
- Julia Neufeind
- Immunization Unit, Robert Koch-Institute, Berlin, Germany.
| | | | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany.,Pettenkofer School of Public Health, Munich, Germany
| | - Cornelia Betsch
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany.,Media and Communication Science, University of Erfurt, Erfurt, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Ole Wichmann
- Immunization Unit, Robert Koch-Institute, Berlin, Germany
| |
Collapse
|
16
|
Yalçin SS, Kömürlüoğlu A, Topaç O. Rates of childhood vaccine refusal in Turkey during 2016-2017: Regional causes and solutions. Arch Pediatr 2022; 29:594-598. [PMID: 36167616 DOI: 10.1016/j.arcped.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 04/22/2022] [Accepted: 06/18/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Vaccine hesitancy is a growing problem globally. This study aimed to detect the rates of vaccine refusal (VR) during childhood in each province and region of Turkey from 2016 to 2017 and to evaluate the experiences of Expanded Programme on Immunization (EPI) managers regarding childhood VR and opinions to solve and reduce vaccine hesitancy in Turkey. METHODS VR was defined as the refusal to vaccinate for at least one vaccine in children aged 0-23 months. In this descriptive study, information on notified VR cases and recommended solutions from every province in Turkey was accessed by the local EPI manager for the period 2016-2017. The VR rates were calculated. RESULTS From 80 provinces, 8977 VR cases were detected in 2016 (VR rate 3.5‰) and 14,779 cases in 2017 (VR rate 5.9‰; p<0.001). One quarter of Family Health Units reported at least one case of VR. The highest VR rate in children aged under 2 years was in East Marmara (8.4‰) in 2016, and the West Anatolia Region (10.9‰) and East Marmara region (10.9‰) in 2017. Concerns about the vaccine content, harmfulness, and fears about adverse effects were the most common reasons underlying VR. Educating healthcare workers about vaccines and interpersonal communication skills, increasing patient information with informative brochures, and preventing anti-vaccination publications in the media were the most frequent recommendations to solve VR. CONCLUSIONS In Turkey, VR cases continue to increase. Correct and adequate information, effective communication, and trust between healthcare workers and parents can help reduce VR.
Collapse
Affiliation(s)
- Siddika Songül Yalçin
- Hacettepe University, Faculty of Medicine, Department of Pediatrics, Division of Social Pediatrics, Ankara, Turkey.
| | - Ayça Kömürlüoğlu
- Sivas Cumhuriyet University, Faculty of Medicine, Department of Pediatrics, Sivas, Turkey
| | - Osman Topaç
- Ankara Health Directorate Public Health Presidency, Ankara, Turkey
| |
Collapse
|
17
|
Charrier L, Garlasco J, Thomas R, Gardois P, Bo M, Zotti CM. An Overview of Strategies to Improve Vaccination Compliance before and during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11044. [PMID: 36078757 PMCID: PMC9518554 DOI: 10.3390/ijerph191711044] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 05/14/2023]
Abstract
The debate on vaccination mandate was fuelled over the past two years by the COVID-19 pandemic. This study aimed at overviewing vaccination strategies and corresponding vaccine coverages for childhood vaccinations before the pandemic and for SARS-CoV-2 in high-income countries. A qualitative comparison was also performed between the two contexts: unlike for childhood vaccinations, only one European country (Austria) imposed generalised COVID-19 mandates, most countries preferring targeted mandates for higher-risk categories (Italy, Greece) or workers in key public services (Finland, Australia, New Zealand, UK, Germany). Many countries (Norway, Sweden, Netherlands, Portugal, Spain) confirmed their traditional voluntary vaccination approach also for COVID-19, while others (Slovenia and Hungary), historically relying on compulsory vaccination strategies, surprisingly opted for voluntary SARS-CoV-2 vaccination, with unsatisfactory results in terms of immunisation rates. However, no tangible relationship was generally found between vaccination policies and immunisation coverages: data show that, unlike some countries with mandates, countries where vaccinations are merely recommended could achieve higher coverages, even beyond the recommended 95% threshold. The COVID-19 experience has enriched pre-existent vaccination strategy debates by adding interesting elements concerning attitudes towards vaccines in a novel and unexplored context. Interpreting the available results by considering the different cultural contexts and vaccine hesitancy determinants can help to better understand the complexity of the relationship between policies and achieved coverages.
Collapse
Affiliation(s)
- Lorena Charrier
- Department of Public Health Sciences and Paediatrics, University of Turin, 5/bis Via Santena, I-10126 Turin, Italy
| | - Jacopo Garlasco
- Department of Public Health Sciences and Paediatrics, University of Turin, 5/bis Via Santena, I-10126 Turin, Italy
| | - Robin Thomas
- Northern Metropolitan Department Direction, Local Health Authority Turin 3 (ASL TO3), 152 Via Don Giovanni Sapino, I-10078 Venaria Reale, Italy
| | - Paolo Gardois
- Biblioteca Federata di Medicina “Ferdinando Rossi”, University of Turin, 5/bis Via Santena, I-10126 Turin, Italy
| | - Marco Bo
- Hospital Medical Direction, Local Health Authority Turin 5 (ASL TO5), 1 Piazza Silvio Pellico, I-10023 Chieri, Italy
| | - Carla Maria Zotti
- Department of Public Health Sciences and Paediatrics, University of Turin, 5/bis Via Santena, I-10126 Turin, Italy
| |
Collapse
|
18
|
Valdecantos RL, Palladino R, Lo Vecchio A, Montella E, Triassi M, Nardone A. Organisational and Structural Drivers of Childhood Immunisation in the European Region: A Systematic Review. Vaccines (Basel) 2022; 10:1390. [PMID: 36146467 PMCID: PMC9505321 DOI: 10.3390/vaccines10091390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/29/2022] Open
Abstract
Despite the implementation of widespread vaccination programs, the European Health Systems continue to experience care challenges attributable to organizational and structural issues. This study aimed to review the available data on aspects within the organizational and structural domains that might impact vaccination coverage. We searched a comprehensive range of databases from 1 January 2007 to 6 July 2021 for studies that reported quantitative or qualitative research on interventions to raise childhood vaccine coverage. Outcome assessments comprised organizational and structural factors that contribute to vaccine concern among pediatric parents, as well as data reported influencing the willingness to vaccinate. To analyze the risk of bias, the Ottawa, JBI's (Joanna Briggs Institute) critical appraisal tool, and Amstar quality assessment were used accordingly. The inclusion criteria were met by 205 studies across 21 articles. The majority of the studies were conducted in the United Kingdom (6), the European Union (3), and Italy (3). A range of interventions studied in primary healthcare settings has been revealed to improve vaccination coverage rates including parental engagement and personalization, mandatory vaccination policies, program redesign, supply chain design, administering multiple/combination vaccines, improved vaccination timing and intervals, parental education and reminders, surveillance tools and Supplemental Immunisation Activity (SIA), and information model.
Collapse
Affiliation(s)
- Ronan Lemwel Valdecantos
- Department of Public Health, University “Federico II” of Naples, 80138 Napoli, Italy
- Global Health Workforce Network (GHWN) Youth Hub, World Health Organization, 1211 Geneva, Switzerland
| | - Raffaele Palladino
- Department of Public Health, University “Federico II” of Naples, 80138 Napoli, Italy
- Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University “Federico II” of Naples, 80138 Napoli, Italy
- Department of Primary Care and Public Health, Imperial College, London SW7 2BX, UK
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Section of Pediatrics, University “Federico II” of Naples, 80138 Napoli, Italy
| | - Emma Montella
- Department of Public Health, University “Federico II” of Naples, 80138 Napoli, Italy
| | - Maria Triassi
- Department of Public Health, University “Federico II” of Naples, 80138 Napoli, Italy
- Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University “Federico II” of Naples, 80138 Napoli, Italy
| | - Antonio Nardone
- Department of Public Health, University “Federico II” of Naples, 80138 Napoli, Italy
| |
Collapse
|
19
|
Sadigh K, Fox G, Khetsuriani N, Gao H, Shendale S, Ward K. Policy and practice of checking vaccination status at school in 2018, a global overview. Vaccine 2022; 40:2432-2441. [PMID: 35307229 PMCID: PMC9126824 DOI: 10.1016/j.vaccine.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Checking vaccination status at school is widely recommended as a strategy to strengthen routine childhood vaccination coverage. Documentation of approaches, challenges, strengths, and impact of this strategy in a variety of contexts is key to enhancing adoption and implementation. However, there is limited information about the prevalence of policies and the implementation of checking vaccination status at school globally. METHODS A one-time supplementary survey was circulated with the annual World Health Organization (WHO) and United Nations International Children's Emergency Fund (UNICEF) Joint Reporting Form in 2019 to all WHO member states and non-member state reporting entities. Additional publicly available country-level data, including primary school enrollment, home-based record (HBR) ownership, and World Bank income classification were linked to the supplementary survey responses, which were descriptively analyzed. RESULTS We received survey responses from 130 of the 194 (67%) WHO member states and 15 non-member state reporting entities. Almost half (46%) of the respondents reported having a law requiring proof of vaccination to enter at least one level of education, and 60% of the respondents reported having a law that requires checking vaccination status at school in 2018. Three-quarters of the respondents (77%) reported the practice of routinely checking vaccination status at school. Both laws and the practice of checking were more common in the WHO Region of the Americas and the WHO European Region, and in high- and upper-middle-income countries. Individual HBR was the document most frequently checked. Catch-up vaccination occurred most frequently at health centers. Evaluation of checking vaccination status at school to determine what has worked and its effect was infrequently reported. CONCLUSION Despite widespread implementation of checking vaccination status at school in 2018, documentation of the experiences in planning and implementing this strategy, and its effects remains sparse, particularly in low- and middle-income countries.
Collapse
Affiliation(s)
- Katrin Sadigh
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, U.S. Centers of Disease Control and Prevention, Atlanta, GA 30329, USA; Global Immunization Division, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Garrett Fox
- Global Immunization Division, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Nino Khetsuriani
- Global Immunization Division, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Hongjiang Gao
- Global Immunization Division, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Stephanie Shendale
- Department of Immunization Vaccines and Biologicals, World Health Organization
| | - Kirsten Ward
- Global Immunization Division, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
| |
Collapse
|
20
|
O'Neill J. Case for persuasion in parental informed consent to promote rational vaccine choices. JOURNAL OF MEDICAL ETHICS 2022; 48:106-111. [PMID: 32366701 DOI: 10.1136/medethics-2020-106068] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 06/11/2023]
Abstract
There have been calls for mandatory vaccination legislation to be introduced into the UK in order to tackle the national and international rise of vaccine-preventable disease. While some countries have had some success associated with mandatory vaccination programmes, the Royal College of Paediatrics and Child Health (RCPCH) insist this is not a suitable option for the UK, a country which has seen historical opposition to vaccine mandates. There is a lack of comprehensive data to demonstrate a direct link between mandatory vaccination legislation and increased uptake. While there are examples whereby there has been an improvement, some studies suggest that comparable results can be obtained by strongly recommending vaccinations instead. The RCPCH insist that healthcare workers are ideally placed to engage and inform parents to make every interaction a 'vaccine opportunity'. This paper calls for a principled, rational approach to interpretations of autonomy which underpin parental informed consent. MacLean's concept of mutual persuasion could be a vehicle to ensuring parents are suitably informed of both the material risks associated with vaccine choices and to consider the rationality of their decisions, while ultimately upholding parental autonomy. It is argued that this, alongside infrastructural improvement, could create a more sustainable, long-term improvement in childhood vaccination rates in the UK than mandatory vaccination.
Collapse
Affiliation(s)
- Jennifer O'Neill
- School of Medicine, European University Cyprus, Nicosia, Cyprus
- University of Glasgow, Glasgow, UK
| |
Collapse
|
21
|
Tasar S, Tasar MA, Alioglu B. Vaccination in children with inherited bleeding disorders: Does the use of plasma an d factor affect the response to the vaccine: An institutional registry. Haemophilia 2021; 28:80-85. [PMID: 34799967 DOI: 10.1111/hae.14461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We aimed to evaluate the vaccine seroconversion of paediatric patients with factor deficiency and to complete the missing vaccines. We also emphasize the importance of variables such as recombinant factor and plasma intake frequency. MATERIAL AND METHODS This prospective observational study includes children between 2 and 17 age diagnosed with inhered factor deficiency. Seroconversion of hepatitis A, hepatitis B, varicella, measles, rubella and mumps vaccines were screened according to Ministry of Health Vaccination Schedule, it was completed if there were seronegative vaccines and the vaccine seroconversion was examined after vaccination approximately 1-6 months. RESULTS A total of 61 children were included in the study [mean age 11.2±5.1 years (2-18)], 49 (80.3%) were males. Factor VIII deficiency constituted 60.7%, factor XI 14.8%, factor VII 13.1 %, factor IX 9.8%, factor X 1.6% of the cases. None of the children had clinically important injection site complications such as uncontrollable bleeding or gross hematoma and vaccination does not induce the development of inhibitor. Measles antibody positivity was significantly lower in those who received factor 3 or 4 days times a week compared to those who received it when necessary (p = .049). DISCUSSION AND CONCLUSION This is the first study evaluating the vaccine conversion patients with inherited factor deficiency receiving plasma and plasma derived factor concentrates. It should be considered that children with haemophilia and their families may have vaccination hesitancy; therefore, follow-up of these patients should include a specified vaccination program to ensure adequate immunization of these patients.
Collapse
Affiliation(s)
- Sercin Tasar
- Department of Paediatrics, University of Health Science, Ankara Training and Research Hospital, Ankara, Turkey
| | - Medine Aysin Tasar
- Department of Paediatric Emergency, University of Health Science, Ankara Training and Research Hospital, Ankara, Turkey
| | - Bulent Alioglu
- Department of Paediatric Haematology, University of Health Science, Ankara Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
22
|
Iftekhar EN, Priesemann V, Balling R, Bauer S, Beutels P, Calero Valdez A, Cuschieri S, Czypionka T, Dumpis U, Glaab E, Grill E, Hanson C, Hotulainen P, Klimek P, Kretzschmar M, Krüger T, Krutzinna J, Low N, Machado H, Martins C, McKee M, Mohr SB, Nassehi A, Perc M, Petelos E, Pickersgill M, Prainsack B, Rocklöv J, Schernhammer E, Staines A, Szczurek E, Tsiodras S, Van Gucht S, Willeit P. A look into the future of the COVID-19 pandemic in Europe: an expert consultation. THE LANCET REGIONAL HEALTH. EUROPE 2021; 8:100185. [PMID: 34345876 PMCID: PMC8321710 DOI: 10.1016/j.lanepe.2021.100185] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
How will the coronavirus disease 2019 (COVID-19) pandemic develop in the coming months and years? Based on an expert survey, we examine key aspects that are likely to influence the COVID-19 pandemic in Europe. The challenges and developments will strongly depend on the progress of national and global vaccination programs, the emergence and spread of variants of concern (VOCs), and public responses to non-pharmaceutical interventions (NPIs). In the short term, many people remain unvaccinated, VOCs continue to emerge and spread, and mobility and population mixing are expected to increase. Therefore, lifting restrictions too much and too early risk another damaging wave. This challenge remains despite the reduced opportunities for transmission given vaccination progress and reduced indoor mixing in summer 2021. In autumn 2021, increased indoor activity might accelerate the spread again, whilst a necessary reintroduction of NPIs might be too slow. The incidence may strongly rise again, possibly filling intensive care units, if vaccination levels are not high enough. A moderate, adaptive level of NPIs will thus remain necessary. These epidemiological aspects combined with economic, social, and health-related consequences provide a more holistic perspective on the future of the COVID-19 pandemic.
Collapse
Affiliation(s)
| | - Viola Priesemann
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
| | - Rudi Balling
- University of Luxembourg, Luxembourg, Luxembourg
| | - Simon Bauer
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
| | | | | | | | - Thomas Czypionka
- Institute for Advanced Studies, Vienna, Austria, and London School of Economics, London, UK
| | - Uga Dumpis
- Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia
| | - Enrico Glaab
- University of Luxembourg, Luxembourg, Luxembourg
| | - Eva Grill
- Ludwig-Maximilians-University München, München, Germany
| | - Claudia Hanson
- Karolinska Institute, Stockholm, Sweden, and London School of Hygiene & Tropical Medicine, London, UK
| | - Pirta Hotulainen
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Peter Klimek
- Medical University of Vienna, Vienna, Austria, and Complexity Science Hub Vienna, Vienna, Austria
| | | | - Tyll Krüger
- Wroclaw University of Science and Technology, Wroclaw, Poland
| | | | | | - Helena Machado
- Institute for Social Sciences, University of Minho, Braga, Portugal
| | - Carlos Martins
- Department of Community Medicine, Health Information and Decision Sciences of the Faculty of Medicine, University of Porto, Porto, Portugal
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Armin Nassehi
- Ludwig-Maximilians-University München, München, Germany
| | - Matjaž Perc
- University of Maribor, Maribor, Slovenia, and Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Elena Petelos
- University of Crete, Crete, Greece, and Maastricht University, Maastricht, The Netherlands
| | | | - Barbara Prainsack
- Department of Political Science, University of Vienna, Vienna, Austria
| | - Joacim Rocklöv
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | | | | | | | | | | | - Peter Willeit
- Medical University of Innsbruck, Innsbruck, Austria, and University of Cambridge, Cambridge, UK
| |
Collapse
|
23
|
Decouttere C, De Boeck K, Vandaele N. Advancing sustainable development goals through immunization: a literature review. Global Health 2021; 17:95. [PMID: 34446050 PMCID: PMC8390056 DOI: 10.1186/s12992-021-00745-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/23/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Immunization directly impacts health (SDG3) and brings a contribution to 14 out of the 17 Sustainable Development Goals (SDGs), such as ending poverty, reducing hunger, and reducing inequalities. Therefore, immunization is recognized to play a central role in reaching the SDGs, especially in low- and middle-income countries (LMICs). Despite continuous interventions to strengthen immunization systems and to adequately respond to emergency immunization during epidemics, the immunization-related indicators for SDG3 lag behind in sub-Saharan Africa. Especially taking into account the current Covid19 pandemic, the current performance on the connected SDGs is both a cause and a result of this. METHODS We conduct a literature review through a keyword search strategy complemented with handpicking and snowballing from earlier reviews. After title and abstract screening, we conducted a qualitative analysis of key insights and categorized them according to showing the impact of immunization on SDGs, sustainability challenges, and model-based solutions to these challenges. RESULTS We reveal the leveraging mechanisms triggered by immunization and position them vis-à-vis the SDGs, within the framework of Public Health and Planetary Health. Several challenges for sustainable control of vaccine-preventable diseases are identified: access to immunization services, global vaccine availability to LMICs, context-dependent vaccine effectiveness, safe and affordable vaccines, local/regional vaccine production, public-private partnerships, and immunization capacity/capability building. Model-based approaches that support SDG-promoting interventions concerning immunization systems are analyzed in light of the strategic priorities of the Immunization Agenda 2030. CONCLUSIONS In general terms, it can be concluded that relevant future research requires (i) design for system resilience, (ii) transdisciplinary modeling, (iii) connecting interventions in immunization with SDG outcomes, (iv) designing interventions and their implementation simultaneously, (v) offering tailored solutions, and (vi) model coordination and integration of services and partnerships. The research and health community is called upon to join forces to activate existing knowledge, generate new insights and develop decision-supporting tools for Low-and Middle-Income Countries' health authorities and communities to leverage immunization in its transformational role toward successfully meeting the SDGs in 2030.
Collapse
Affiliation(s)
- Catherine Decouttere
- KU Leuven, Access-To-Medicines research Center, Naamsestraat 69, Leuven, Belgium
| | - Kim De Boeck
- KU Leuven, Access-To-Medicines research Center, Naamsestraat 69, Leuven, Belgium
| | - Nico Vandaele
- KU Leuven, Access-To-Medicines research Center, Naamsestraat 69, Leuven, Belgium
| |
Collapse
|
24
|
Kricorian K, Turner K. COVID-19 Vaccine Acceptance and Beliefs among Black and Hispanic Americans. PLoS One 2021; 16:e0256122. [PMID: 34428216 PMCID: PMC8384224 DOI: 10.1371/journal.pone.0256122] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/29/2021] [Indexed: 12/23/2022] Open
Abstract
The introduction of COVID-19 vaccines is a major public health breakthrough. However, members of US Black and Hispanic communities, already disproportionately affected by the COVID-19 virus, may be less willing to receive the vaccine. We conducted a broad, representative survey of US adults (N = 1,950) in order to better understand vaccine beliefs and explore opportunities to increase vaccine acceptance among these groups. The survey results suggested that Black and Hispanic individuals were less willing than Whites to receive the vaccine. US Blacks and Hispanics also planned to delay receiving the COVID-19 vaccine for a longer time period than Whites, potentially further increasing the risk of contracting COVID-19 within populations that are already experiencing high disease prevalence. Black respondents were less likely to want the COVID-19 vaccine at all compared with Whites and Hispanics, and mistrust of the vaccine among Black respondents was significantly higher than other racial/ethnic groups. Encouragingly, many Black and Hispanic respondents reported that COVID-19 vaccine endorsements from same-race medical professionals would increase their willingness to receive it. These respondents said they would also be motivated by receiving more information on the experiences of vaccine study participants who are of their own race and ethnicity. The results have implications for improved messaging of culturally-tailored communications to help reduce COVID-19 vaccine hesitancy among communities disproportionately impacted by the pandemic.
Collapse
Affiliation(s)
| | - Karin Turner
- MiOra, Encino, California, United States of America
| |
Collapse
|
25
|
Alshammari SZ, AlFayyad I, Altannir Y, Al-Tannir M. Parental Awareness and Attitude about Childhood Immunization in Riyadh, Saudi Arabia: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168455. [PMID: 34444205 PMCID: PMC8393381 DOI: 10.3390/ijerph18168455] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/06/2020] [Accepted: 08/09/2020] [Indexed: 11/25/2022]
Abstract
Parental beliefs about vaccination are one of the main factors in reaching high vaccination rates. This cross-sectional study aims to assess the awareness and attitudes regarding routine childhood immunization among Saudi parents in Riyadh, Saudi Arabia. This survey, with a pretested 18-item questionnaire, was conducted on parents having at least one child from Riyadh, Saudi Arabia, between 1 May 2019 and 1 November 2019. The validated questionnaire consisted of three sections; participants’ demographics, awareness, and attitude regarding the immunization of their children. In total, 1200 parents participated in the study, 883 (73.3%) of the parents scored a good knowledge of childhood immunization, and 93% knew that routine vaccination protects children from infectious diseases and their complications. Around 10% stated that immunization can cause autism. Only parents in age groups 30–39 and 40–49 were 1.76 (p < 0.05) times and 1.92 (p < 0.05) times, respectively, more likely to exhibit good knowledge. About 522 (43.6) of the parents attained a positive attitude toward immunization. Adherence to the immunization schedule was confirmed important by 93%, while 91% presumed that immunization keeps their children healthy. Additionally, immunization was perceived as important by 94% of parents and only 8% agreed that immunization is prohibited by religion. Females were 1.45 (p < 0.05) times more likely to exhibit positive attitudes than males. Parents have good knowledge and a positive attitude towards child immunization. However, parental education should be focused on the fact that religion supports immunization, and more awareness should be focused on the lack of correlation between autism and vaccination.
Collapse
Affiliation(s)
- Shuaa Z. Alshammari
- Research Center, King Fahad Medical City, Riyadh 11525, Saudi Arabia; (S.Z.A.); (I.A.)
| | - Isamme AlFayyad
- Research Center, King Fahad Medical City, Riyadh 11525, Saudi Arabia; (S.Z.A.); (I.A.)
| | - Youssef Altannir
- College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh 11533, Saudi Arabia;
| | - Mohamad Al-Tannir
- Research Center, King Fahad Medical City, Riyadh 11525, Saudi Arabia; (S.Z.A.); (I.A.)
- Correspondence:
| |
Collapse
|
26
|
Holroyd TA, Howa AC, Proveaux TM, Delamater PL, Klein NP, Buttenheim AM, Limaye RJ, Omer SB, Salmon DA. School-level perceptions and enforcement of the elimination of nonmedical exemptions to vaccination in California. Hum Vaccin Immunother 2021; 17:1986-1993. [PMID: 33493075 DOI: 10.1080/21645515.2020.1857202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
In 2015, California passed Senate Bill 277 eliminating all nonmedical exemptions to school vaccinations. We aimed to explore school-level modes of SB277 enforcement, characterize vaccination knowledge, attitudes, and beliefs of school officials, and identify whether school vaccination policies are associated with medical exemptions being granted. Surveys were mailed to a stratified random sample of 1,450 schools in California. School personnel (n = 752) reported their medical training, vaccination beliefs, enforcement of vaccination policies, and school rates of medical exemptions. Multiple logistic regression was used to assess whether school policies are associated with the likelihood of medical exemption requests being granted. Nurses were more likely than non-nurses to hold beliefs recognizing the importance of vaccination. A school where the survey respondent was a nurse was more likely to have granted a medical exemption request compared to a school where the respondent was not a nurse (OR 2.11, 95% CI 1.34-3.36). The training of school officials and school-level practices may impact the enforcement of medical exemptions. Equipping school officials as competent sources of vaccine information for concerned parents will be valuable in improving parental vaccine uptake.
Collapse
Affiliation(s)
- Taylor A Holroyd
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amanda C Howa
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Tina M Proveaux
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Paul L Delamater
- Department of Geography and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Alison M Buttenheim
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Rupali J Limaye
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Saad B Omer
- Yale Institute for Global Health, Yale University, New Haven, CT, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
27
|
Drury J, Mao G, John A, Kamal A, Rubin GJ, Stott C, Vandrevala T, Marteau TM. Behavioural responses to Covid-19 health certification: a rapid review. BMC Public Health 2021; 21:1205. [PMID: 34162364 PMCID: PMC8221819 DOI: 10.1186/s12889-021-11166-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/27/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Covid-status certification - certificates for those who test negative for the SARS-CoV-2 virus, test positive for antibodies, or who have been vaccinated against SARS-CoV-2 - has been proposed to enable safer access to a range of activities. Realising these benefits will depend in part upon the behavioural and social impacts of certification. The aim of this rapid review was to describe public attitudes towards certification, and its possible impact on uptake of testing and vaccination, protective behaviours, and crime. METHOD A search was undertaken in peer-reviewed databases, pre-print databases, and the grey literature, from 2000 to December 2020. Studies were included if they measured attitudes towards or behavioural consequences of health certificates based on one of three indices of Covid-19 status: test-negative result for current infectiousness, test-positive for antibodies conferring natural immunity, or vaccination(s) conferring immunity. RESULTS Thirty-three papers met the inclusion criteria, only three of which were rated as low risk of bias. Public attitudes were generally favourable towards the use of immunity certificates for international travel, but unfavourable towards their use for access to work and other activities. A significant minority was strongly opposed to the use of certificates of immunity for any purpose. The limited evidence suggested that intention to get vaccinated varied with the activity enabled by certification or vaccination (e.g., international travel). Where vaccination is seen as compulsory this could lead to unwillingness to accept a subsequent vaccination. There was some evidence that restricting access to settings and activities to those with antibody test certificates may lead to deliberate exposure to infection in a minority. Behaviours that reduce transmission may decrease upon health certificates based on any of the three indices of Covid-19 status, including physical distancing and handwashing. CONCLUSIONS The limited evidence suggests that health certification in relation to COVID-19 - outside of the context of international travel - has the potential for harm as well as benefit. Realising the benefits while minimising the harms will require real-time evaluations allowing modifications to maximise the potential contribution of certification to enable safer access to a range of activities.
Collapse
Affiliation(s)
- John Drury
- School of Psychology, University of Sussex, Brighton, UK
| | - Guanlan Mao
- School of Psychology, University of Sussex, Brighton, UK
| | - Ann John
- Swansea University, Population Data Science, Swansea, UK
| | - Atiya Kamal
- Department of Psychology, Birmingham City University, Birmingham, UK
| | - G. James Rubin
- Department of Psychological Medicine, King’s College London, London, UK
| | | | - Tushna Vandrevala
- Department of Psychology, Kingston University, Kingston upon Thames, UK
| | - Theresa M. Marteau
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| |
Collapse
|
28
|
Dubé È, Ward JK, Verger P, MacDonald NE. Vaccine Hesitancy, Acceptance, and Anti-Vaccination: Trends and Future Prospects for Public Health. Annu Rev Public Health 2021; 42:175-191. [PMID: 33798403 DOI: 10.1146/annurev-publhealth-090419-102240] [Citation(s) in RCA: 189] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An often-stated public health comment is that "vaccination is a victim of its own success." While the scientific and medical consensus on the benefits of vaccination is clear and unambiguous, an increasing number of people are perceiving vaccines as unsafe and unnecessary. The World Health Organization identified "the reluctance or refusal to vaccinate despite availability of vaccines" as one of the 10 threats to global health in 2019. The negative influence of anti-vaccination movements is often named as a cause of increasing vaccine resistance in the public. In this review, we give an overview of the current literature on the topic, beginning by agreeing on terminology and concepts before looking at potential causes, consequences, and impacts of resistance to vaccination.
Collapse
Affiliation(s)
- Ève Dubé
- Centre de Recherche du CHU de Québec, Université Laval, Québec G1V 4G2, Canada.,Institut National de Santé Publique du Québec, Québec G1E 7G9, Canada;
| | - Jeremy K Ward
- CERMES3, INSERM, CNRS, EHESS, Université de Paris, 94076 Villejuif, France; .,Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME, 13005 Marseille, France;
| | - Pierre Verger
- Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, VITROME, 13005 Marseille, France; .,Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, 13005 Marseille, France
| | - Noni E MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia B3K 6R8, Canada;
| |
Collapse
|
29
|
Attwell K, Harper T, Rizzi M, Taylor J, Casigliani V, Quattrone F, Lopalco P. Inaction, under-reaction action and incapacity: communication breakdown in Italy's vaccination governance. POLICY SCIENCES 2021; 54:457-475. [PMID: 34149101 PMCID: PMC8203395 DOI: 10.1007/s11077-021-09427-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/29/2021] [Indexed: 06/12/2023]
Abstract
This article explores why governments do not respond to public compliance problems in a timely manner with appropriate instruments, and the consequences of their failure to do so. Utilising a case study of Italian vaccination policy, the article considers counterfactuals and the challenges of governing health policy in an age of disinformation. It counterposes two methods of governing vaccination compliance: discipline, which uses public institutions to inculcate the population with favourable attitudes and practices, and modulation, which uses access to public institutions as a form of control. The Italian government ineffectively employed discipline for a number of years. Epistemological and organisational constraints stymied its efforts to tackle a significant childhood vaccination compliance problem. With a loss of control over the information environment, vaccinations were not served well by exogenous crises, the sensationalism of the news cycle and online misinformation. Hampered by austerity, lack of capacity and epistemic shortcomings, the Italian government did not protect the public legitimacy of the vaccination programme. Instead of employing communications to reassure a hesitant population, they focused on systemic and delivery issues, until it was too late to do anything except make vaccinations mandatory (using modulation). The apparent short-term success of this measure in generating population compliance does not foreclose the need for ongoing governance of vaccine confidence through effective discipline. This is evident for the COVID-19 vaccination campaign, with many Italians still indicating that they would not accept a vaccine despite the devastation that the disease has wrought throughout their country.
Collapse
Affiliation(s)
- Katie Attwell
- School of Social Sciences, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Northern Entrance, Perth Children’s Hospital, 15 Hospital Avenue, Nedlands, WA 6009 Australia
| | - Tauel Harper
- School of Social Sciences, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Marco Rizzi
- Law School, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Jeannette Taylor
- School of Social Sciences, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Virginia Casigliani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Filippo Quattrone
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - PierLuigi Lopalco
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| |
Collapse
|
30
|
Smith LE, Hodson A, Rubin GJ. Parental attitudes towards mandatory vaccination; a systematic review. Vaccine 2021; 39:4046-4053. [PMID: 34140173 DOI: 10.1016/j.vaccine.2021.06.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
Uptake of childhood vaccines is decreasing. While mandatory vaccination schemes can increase vaccine uptake rates, they can also cause backlash among some parents. We conducted a systematic review investigating parental beliefs about vaccine mandates and factors associated with support for mandatory vaccination schemes. We searched Embase, Ovid MEDLINE, Global Health, APA PsycINFO and Web of Science from inception to 17th September 2020. Seventeen studies (five qualitative, twelve quantitative) were eligible for inclusion. We synthesised results of qualitative and quantitative studies separately. As quantitative studies were heterogeneous in the mandatory vaccination schemes and associated factors investigated, there was no scope to conduct a meta-analysis. Instead, data were narratively synthesised, considering risk of bias ratings. Qualitative data were synthesised using meta-ethnography, synthesising themes reported across studies included. Quantitative studies reported that support for mandatory vaccination schemes was reasonably high (73% to 88%). However, due to heterogeneity, there was little evidence for any factors being consistently associated with support for mandatory vaccination. Qualitative studies gave an insight into how parents perceive mandatory vaccination. Studies found that parents perceived mandatory vaccination schemes as an infringement of their rights, and particularly disliked schemes offering financial incentives for vaccination. Nevertheless, some parents felt that schemes limiting access to schooling of unvaccinated children gave them "peace of mind." Results should be taken with caution due to the purposive use of non-representative samples. Before deciding to mandate vaccination, it is important to understand the impact it could have on parental beliefs and attitudes about vaccination.
Collapse
Affiliation(s)
- Louise E Smith
- King's College London, Department of Psychological Medicine, United Kingdom; NIHR Health Protection Research Unit in Emergency Preparedness and Response, United Kingdom.
| | - Ava Hodson
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, United Kingdom; King's College London, Department of War Studies, United Kingdom
| | - G James Rubin
- King's College London, Department of Psychological Medicine, United Kingdom; NIHR Health Protection Research Unit in Emergency Preparedness and Response, United Kingdom
| |
Collapse
|
31
|
Franza L, Cianci R. Pollution, Inflammation, and Vaccines: A Complex Crosstalk. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126330. [PMID: 34208042 PMCID: PMC8296132 DOI: 10.3390/ijerph18126330] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/02/2021] [Accepted: 06/09/2021] [Indexed: 12/21/2022]
Abstract
The importance of pollution in determining human health is becoming increasingly clear, also given the dramatic consequences it has had on recent geopolitical events. Yet, the consequences of contamination are not always straightforward. In this paper, we will discuss the effects of different pollutants on different aspects of human health, in particular on the immune system and inflammation. Different environmental pollutants can have different effects on the immune system, which can then promote complex pathologies, such as autoimmune disorders and cancer. The interaction with the microbiota also further helps to determine the consequences of contamination on wellbeing. The pollution can affect vaccination efficacy, given the widespread effects of vaccination on immunity. At the same time, some vaccinations also can exert protective effects against some forms of pollution.
Collapse
Affiliation(s)
- Laura Franza
- Emergency Medicine, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8-00168 Rome, Italy;
| | - Rossella Cianci
- Dipartimento di Medicina e Chirurgia Traslazionale, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8-00168 Rome, Italy
- Correspondence: ; Tel.: +39-06-3015-7597; Fax: +39-06-3550-2775
| |
Collapse
|
32
|
Vanderslott S, Marks T. Charting mandatory childhood vaccination policies worldwide. Vaccine 2021; 39:4054-4062. [PMID: 34119351 DOI: 10.1016/j.vaccine.2021.04.065] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/03/2021] [Accepted: 04/28/2021] [Indexed: 11/15/2022]
Abstract
Mandatory childhood vaccination is becoming an increasingly important policy intervention for governments trying to address low vaccination rates. Mandates require vaccination for a certain purpose, most commonly related to school entry for children. However, the discussion surrounding the extent and impact of mandatory vaccination programmes for babies and children have largely been limited to high-income countries. While many recent publications discuss the issue, they have not been inclusive of low- and middle-income countries. This paper thus presents a comprehensive and updatable database of mandatory childhood vaccination policies worldwide, covering 149 countries. The list indicates whether a country has a mandatory vaccination policy and the strictness of the mandate on a scale ranging across three levels of mandatory, mandatory for school entry or recommended. It draws on extensive desk-based research analysing a variety of sources, supplemented by consultations with experts from various health authorities. The paper provides an overview of the state of mandatory childhood vaccination across different World Health Organization (WHO) regions and with country case studies, setting out the general trends and issues, and engages with a discussion about why, how, and where mandatory vaccination is put in place. Our findings show in-country variation in vaccination policy and a variation between vaccination in policy compared to in practice. We observe, particularly for high-income countries, that the occurrence of recent outbreaks is a major factor for the introduction of mandatory vaccination. Also, many low- and middle- income countries have resorted to mandatory vaccination policies because of a lack of other policy options yet still have lower than targeted vaccination rates due to problems with vaccine supply, delivery, and access. Offering comparisons between countries will provide a useful tool for government decision-makers considering the merits of mandatory vaccination.
Collapse
Affiliation(s)
- Samantha Vanderslott
- Oxford Vaccine Group and Oxford Martin School, University of Oxford, Centre for Clinical Vaccinology and Tropical Medicine (CCVTM), Old Road, Oxford OX3 7LE, United Kingdom.
| | - Tatjana Marks
- Oxford Vaccine Group and Oxford Martin School, University of Oxford, Centre for Clinical Vaccinology and Tropical Medicine (CCVTM), Old Road, Oxford OX3 7LE, United Kingdom
| |
Collapse
|
33
|
Cierco Seira C. The vaccine-condition or vaccination passport and its eventual fit into a broad recommended vaccination framework against COVID-19. VACUNAS (ENGLISH EDITION) 2021. [PMCID: PMC8166534 DOI: 10.1016/j.vacune.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
It is important to think about the eventual application of a COVID-19 vaccination certificate as an eligibility criterion to carry out certain activities and to discuss in advance the problems that the use of this tool may pose in legal terms. To this end, we must begin by stating the assumptions that would be necessary to justify its implantation, including scientific consensus on the scope of the immunity granted by COVID-19 vaccines, especially in blocking transmission in the community. Likewise, it emphasizes the importance of broadening the view in the sense of internalizing that the passport or vaccination pass constitutes only one of the many options within a rich catalog of possibilities when it comes to reinforcing the recommended vaccination model through incentives adopted in the Vaccination Strategy against COVID-19, including the use of nudging. In any case, if conditionality is installed and expanded to the extent of significantly influencing daily life, it could lead to a kind of indirect obligation, with the risk of dysfunctions in terms of equality and systemic coherence if the public powers do not contribute to clearly define the legal limits beforehand and to drive a process that in itself could be dispersed and disorderly.
Collapse
|
34
|
Costagliola G, Spada E, Consolini R. Age-related differences in the immune response could contribute to determine the spectrum of severity of COVID-19. Immun Inflamm Dis 2021; 9:331-339. [PMID: 33566457 PMCID: PMC8014746 DOI: 10.1002/iid3.404] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/24/2020] [Accepted: 12/28/2020] [Indexed: 12/18/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), can present with a wide spectrum of severity. Elderly patients with cardiac, pulmonary and metabolic comorbidities are more likely to develop the severe manifestations of COVID-19, which are observed in less than 5% of the pediatric patients. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is able to induce an immune impairment and dysregulation, finally resulting in the massive release of inflammatory mediators, strongly contributing to the pulmonary and systemic manifestations in COVID-19. In children, the immune dysregulation following SARS-CoV-2 can also be responsible of a severe disease phenotype defined as multisystem inflammatory syndrome in children. As the immune system undergoes a complex process of maturation from birth to adult age, differences in the immune and inflammatory response could have a significant impact in determining the spectrum of severity of COVID-19. Indeed, children show a higher ability to respond to viral infections and a reduced baseline pro-inflammatory state compared with elderly patients. Age and comorbidities contribute to disease severity through immune-mediated mechanisms, since they are associated with a chronic increase of pro-inflammatory mediators, and cause an enhanced susceptibility to develop an immune dysregulation following SARS-CoV-2 infection. Also the expression of ACE2, the receptor of SARS-CoV-2, varies with age, and is linked to the immune and inflammatory response through a complex, and not completely elucidated, network. This paper reviews the peculiar immunopathogenic aspects of COVID-19, with a focus on the differences between adult and pediatric patients.
Collapse
Affiliation(s)
- Giorgio Costagliola
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Section of Rheumatology and Clinical ImmunologyUniversity of PisaPisaItaly
| | - Erika Spada
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Section of Rheumatology and Clinical ImmunologyUniversity of PisaPisaItaly
| | - Rita Consolini
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Section of Rheumatology and Clinical ImmunologyUniversity of PisaPisaItaly
| |
Collapse
|
35
|
Removing conscientious objection: The impact of 'No Jab No Pay' and 'No Jab No Play' vaccine policies in Australia. Prev Med 2021; 145:106406. [PMID: 33388333 DOI: 10.1016/j.ypmed.2020.106406] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 02/07/2023]
Abstract
Vaccine refusal and hesitancy pose a significant public health threat to communities. Public health authorities have been developing a range of strategies to improve childhood vaccination coverage. This study examines the effect of removing conscientious objection on immunisation coverage for one, two and five year olds in Australia. Conscientious objection was removed from immunisation requirement exemptions for receipt of family assistance payments (national No Jab No Pay) and enrolment in childcare (state No Jab No Play). The impact of these national and state-level policies is evaluated using quarterly coverage data from the Australian Immunisation Register linked with regional data from the Australian Bureau of Statistics at the statistical area level between 2014 and 2018. Results suggest that there have been overall improvements in coverage associated with No Jab No Pay, and states that implemented additional No Jab No Play and tightened documentation requirement policies tended to show more significant increases. However, policy responses were heterogeneous. The improvement in coverage was largest in areas with greater socioeconomic disadvantage, lower median income, more benefit dependency, and higher pre-policy baseline coverage. Overall, while immunisation coverage has increased post removal of conscientious objection, the policies have disproportionally affected lower income families whereas socioeconomically advantaged areas with lower baseline coverage were less responsive. More effective strategies require investigation of differential policy effects on vaccine hesitancy, refusal and access barriers, and diagnosis of causes for unresponsiveness and under-vaccination in areas with persistently low coverage, to better address areas with persistent non-compliance with accordant interventions.
Collapse
|
36
|
Solikhah U, Chakim S, Handayani DY. Promotion Media for Children’s Health: Applicable Study of Management Child Illness. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Public understanding of immunization problems, pneumonia cases, and nutrition in children is important to improve children’s health status. Provision of attractive and illustrated media is one option to increase public knowledge in supporting the success of government programs in the health sector.
AIM: The purpose of this study is as a form of promotion effort to support an increase in the immunization movement in infants, a decrease in cases of malnutrition and malnutrition, and a decrease in pneumonia cases in infants.
METHODS: The research method used is qualitative and quantitative study. Researchers analyzed the promoting media and the value of benefits in the community. Qualitative analyze used content analysis to get an assessment of media from cadres and parents of children. Quantitative study used univariable analysis to see understanding of illness prevention effort. Interesting picture books for immunization, pneumonia, and malnutrition are used as the promoting media. The number of samples was 20 cadres and 20 parents of children under five, done by simple random sampling technique.
RESULTS: The results showed that the media used for learning nutrition, immunization, and pneumonia material was effective for cadres and the community about easy to understand, completeness, attractive, assistance, easy to use, and practically. This is evidenced by a positive assessment of the media and increased understanding of the material from 50% to 90%.
CONCLUSION: Thus, it can be said that it is necessary to provide educational media to increase public knowledge and understanding of cases that often arise in the community as a problem.
Collapse
|
37
|
Neufeind J, Betsch C, Zylka-Menhorn V, Wichmann O. Determinants of physician attitudes towards the new selective measles vaccine mandate in Germany. BMC Public Health 2021; 21:566. [PMID: 33752621 PMCID: PMC7986548 DOI: 10.1186/s12889-021-10563-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Germany, a mandatory policy on measles vaccination came into effect in March 2020. Physicians, as the main vaccine providers, have a crucial role in implementing it. Mandatory vaccination changes the preconditions under which patient-provider communication on vaccines occurs. Physicians might or might not favor vaccine mandates depending on, among other factors, their attitudes towards vaccines and capabilities as vaccine providers. The aim of this study was to investigate in different subgroups of physicians the association between various factors and their attitudes towards a mandatory policy. METHODS In total, 2229 physicians participated in a mixed-mode online/paper-pencil survey. Respondents were general practitioners, pediatricians, gynecologists, and internists. Primary determinants were the 5C psychological antecedents of vaccination, communication self-efficacy, patient clientele, projected consequences of the mandate and sociodemographic characteristics. Associations between outcomes and determinants were examined using linear regression analysis. RESULTS Approximately 86% of physicians were in favor of the measles vaccine mandate for children. Regarding the 5C model, physicians were more in favor of vaccine mandates when they scored higher on confidence and collective responsibility, and lower on complacency and calculation. They were more in favor of vaccine mandates when they had higher communication self-efficacy and a more vaccine-positive patient clientele. Pediatricians were less in favor of mandates for children (80.0%) than other physician subgroups (87.1%). They were also less convinced that a mandate would result in more children getting vaccinated (59.3%) than other physician subgroups (78.3%). When controlled for these expected consequences, being a pediatrician no longer lowered the attitude towards the mandate. CONCLUSIONS Physicians in Germany are predominantly in favor of a measles vaccine mandate. Whether or not physicians believe the mandate to be effective in increasing vaccine coverage affects their attitude towards the mandate. In pediatricians, this belief explains their less positive attitude towards the mandate. In addition, physicians need adequate support to communicate well with patients, especially those who are hesitant, to booster their communication self-efficacy. To increase acceptance of vaccine mandates, the 5C model can be used, e.g., collective responsibility can be communicated, to avoid anger stemming from a negative attitude to mandates.
Collapse
Affiliation(s)
- Julia Neufeind
- Immunization Unit, Robert Koch Institute, Berlin, Germany.
- Charité University Medicine Berlin, Berlin, Germany.
| | - Cornelia Betsch
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany
- Media and Communication Science, University of Erfurt, Erfurt, Germany
| | | | - Ole Wichmann
- Immunization Unit, Robert Koch Institute, Berlin, Germany
| |
Collapse
|
38
|
Cierco Seira C. [The vaccine-condition or vaccination passport and its eventual fit into a broad recommended vaccination framework against COVID-19]. ACTA ACUST UNITED AC 2021; 22:82-88. [PMID: 33654478 PMCID: PMC7908842 DOI: 10.1016/j.vacun.2021.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Es importante parar mientes en la eventual aplicación del certificado de vacunación contra la COVID-19 como condición para el ejercicio de actividades y reflexionar de manera anticipada acerca de los problemas que en términos jurídicos puede plantear el empleo de esta técnica. A tal efecto, hay que comenzar por significar los presupuestos que serían necesarios para justificar su activación, incluyendo el consenso científico sobre el alcance de la inmunidad concedida por las vacunas COVID-19, señaladamente en su faceta colectiva de bloqueo de la transmisión. Asimismo, se hace hincapié en la importancia de ampliar las miras en el sentido de interiorizar que el pasaporte o pase de vacunación constituye solo una de las muchas opciones dentro de un rico catálogo de posibilidades a la hora de reforzar, mediante incentivos, el modelo de vacunación recomendada y adoptado en la Estrategia de vacunación contra la COVID-19, contando entre ellas con la utilización del nudging. En todo caso, de instalarse y expandirse al cabo una condicionalidad en grado de influir significativamente en lo cotidiano, podría desembocarse en una suerte de obligatoriedad indirecta, con el riesgo de disfunciones en términos de igualdad y coherencia sistémica si los poderes públicos no contribuyen a perfilar con claridad antes los límites legales y a encauzar un proceso que de suyo podría ser disperso y desordenado.
Collapse
|
39
|
Sağlık Alanında Eğitim Gören Üniversite Öğrencilerinde Aşı Tereddütü. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2021. [DOI: 10.21673/anadoluklin.831919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
40
|
Vaccination Status of Mothers and Children from the 'Mamma & Bambino' Cohort. Vaccines (Basel) 2021; 9:vaccines9020168. [PMID: 33671412 PMCID: PMC7921954 DOI: 10.3390/vaccines9020168] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 01/12/2023] Open
Abstract
According to the evidence demonstrating vaccines’ safety and effectiveness in anticipation of and during pregnancy, several countries have established immunization programs during the periconceptional period. Here, we evaluated vaccination status among 220 mother–child pairs, using data from the ‘Mamma & Bambino’ cohort. The self-reported data were evaluated at delivery, and with planned follow-ups at 1–2 years after delivery. In general, we noted that the vaccination status among the women was heterogeneous, ranging from 8.3% (vaccine against Human Papillomavirus, HPV) to 65.6% (vaccine against Diphtheria Tetanus and Pertussis, DTaP). Excluding the women who contracted the diseases in the past, the main ground for refusal was the lack of information. We also demonstrated that increasing age was associated with higher odds of not being vaccinated against Measles-Mumps-Rubella (MMR; OR = 1.12; 95% CI = 1.04–1.21; p = 0.004), HPV (OR = 1.20; 95% CI = 1.08–1.33; p = 0.001) and DTaP (OR =1.09; 95% CI = 1.01–1.18; p = 0.040). As expected, we showed that the proportion of newborns vaccinated with the Hexavalent and Pneumococcal vaccines was high (99.5% and 98.6%, respectively), while the vaccination coverage against MMRV did not reach the auspicated threshold (84.1%). Overall, these results underlined the need for the improvement of women’s knowledge about the recommendations for vaccination, especially during pregnancy.
Collapse
|
41
|
Savulescu J. Good reasons to vaccinate: mandatory or payment for risk? JOURNAL OF MEDICAL ETHICS 2021; 47:78-85. [PMID: 33154088 PMCID: PMC7848060 DOI: 10.1136/medethics-2020-106821] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 05/09/2023]
Abstract
Mandatory vaccination, including for COVID-19, can be ethically justified if the threat to public health is grave, the confidence in safety and effectiveness is high, the expected utility of mandatory vaccination is greater than the alternatives, and the penalties or costs for non-compliance are proportionate. I describe an algorithm for justified mandatory vaccination. Penalties or costs could include withholding of benefits, imposition of fines, provision of community service or loss of freedoms. I argue that under conditions of risk or perceived risk of a novel vaccination, a system of payment for risk in vaccination may be superior. I defend a payment model against various objections, including that it constitutes coercion and undermines solidarity. I argue that payment can be in cash or in kind, and opportunity for altruistic vaccinations can be preserved by offering people who have been vaccinated the opportunity to donate any cash payment back to the health service.
Collapse
Affiliation(s)
- Julian Savulescu
- Faculty of Philosophy, University of Oxford, Oxford, UK
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Melbourne Law School, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
42
|
MacDonald NE, Comeau J, Dubé È, Graham J, Greenwood M, Harmon S, McElhaney J, Meghan McMurtry C, Middleton A, Steenbeek A, Taddio A. Royal society of Canada COVID-19 report: Enhancing COVID-19 vaccine acceptance in Canada. Facets (Ott) 2021. [DOI: 10.1139/facets-2021-0037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
COVID-19 vaccine acceptance exists on a continuum from a minority who strongly oppose vaccination, to the “moveable middle” heterogeneous group with varying uncertainty levels about acceptance or hesitancy, to the majority who state willingness to be vaccinated. Intention for vaccine acceptance varies over time. COVID-19 vaccination decisions are influenced by many factors including knowledge, attitudes, and beliefs; social networks; communication environment; COVID-19 community rate; cultural and religious influences; ease of access; and the organization of health and community services and policies. Reflecting vaccine acceptance complexity, the Royal Society of Canada Working Group on COVID-19 Vaccine Acceptance developed a framework with four major factor domains that influence vaccine acceptance (people, communities, health care workers; immunization knowledge; health care and public health systems including federal/provincial/territorial/indigenous factors)—each influencing the others and all influenced by education, infection control, extent of collaborations, and communications about COVID-19 immunization. The Working Group then developed 37 interrelated recommendations to support COVID vaccine acceptance nested under four categories of responsibility: 1. People and Communities, 2. Health Care Workers, 3. Health Care System and Local Public Health Units, and 4. Federal/Provincial/Territorial/Indigenous. To optimize outcomes, all must be engaged to ensure co-development and broad ownership.
Collapse
Affiliation(s)
- Noni E. MacDonald
- Department of Pediatrics (Infectious Diseases), Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, Canada
| | - Jeannette Comeau
- Division of Infectious Diseases, Dalhousie University and IWK Health Centre, Halifax, Canada
| | - Ève Dubé
- Scientific Group on Immunization at the Quebec National Institute of Public Health, Québec, Canada
- Department of Anthropology, Université Laval, Québec, QC G1V 0A6, Canada
| | - Janice Graham
- Department of Pediatrics, Division of Infectious Diseases, Dalhousie University, Halifax, NS B3H 2Y9, Canada
| | - Margo Greenwood
- School of Education, University of Northern British Columbia, Prince George, BC V2N 4Z9, Canada
- Department of First Nations Studies, University of Northern British Columbia, Prince George, BC V2N 4Z9, Canada
- National Collaborating Centre for Indigenous Health, Prince George, BC V2N 4Z9, Canada
| | - Shawn Harmon
- Department of Pediatrics, Technoscience and Regulation Research Unit, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Janet McElhaney
- Medical Sciences Division, Northern Ontario School of Medicine, Sudbury, ON P3E 2C6, Canada
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada
| | - C. Meghan McMurtry
- Pediatric Pain, Health and Communication Lab (PPHC), University of Guelph, Guelph, ON N1G 2W1, Canada
- Department of Psychology, University of Guelph, Guelph, ON N1G 2W1, Canada
- Clinical and Health Psychologist with the Pediatric Chronic Pain Program, McMaster Children’s Hospital, Hamilton, ON L8N 3Z5, Canada
| | - Alan Middleton
- Schulich Executive Education Centre, York University, North York, ON M3J 1P3, Canada
| | - Audrey Steenbeek
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Anna Taddio
- Clinical Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| |
Collapse
|
43
|
Gravagna K, Becker A, Valeris-Chacin R, Mohammed I, Tambe S, Awan FA, Toomey TL, Basta NE. Global assessment of national mandatory vaccination policies and consequences of non-compliance. Vaccine 2020; 38:7865-7873. [PMID: 33164808 PMCID: PMC8562319 DOI: 10.1016/j.vaccine.2020.09.063] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Declining vaccination coverage and increasing hesitancy is a worldwide concern. Many countries have implemented mandatory vaccination policies to promote vaccination. However, mandatory vaccination policies differ significantly by country. Beyond case studies, no comprehensive study has compared these policies or the penalties for non-compliance on a global scale. METHODS We conducted extensive keyword, policy, and literature searches to identify mandatory national vaccination policies globally and develop a comprehensive database. A mandatory national vaccination policy was defined as a policy from a national authority that requires individuals to receive at least one vaccination based on age or to access a service. Two reviewers independently evaluated evidence for a mandate and whether non-compliance penalties were incorporated. We categorized penalties into four types, based on the nature of the penalty. These penalties impact an individual's financial, parental rights, educational (i.e., child's school entry and access), and liberty status. We rated the severity within each category. RESULTS Of 193 countries investigated, 54% (n = 105) had evidence of a nationwide mandate as of December 2018. The frequency, types, and severity of penalties varied widely across all regions. We found that 59% (n = 62) of countries with national mandates defined at least one penalty for non-compliance with a vaccine mandate. Among those, educational penalties (i.e., limiting a child's entry or ongoing access to school) were the most common (69%; n = 43), with most countries with educational penalties refusing school enrollment until vaccination requirements are met (81%; n = 35). CONCLUSION We undertook a comprehensive assessment of national mandatory vaccination policies and identified a diversity of penalties in place to promote compliance. Our results highlight the need to critically evaluate the implementation of non-compliance penalties in order to determine their effectiveness and to define best practices for sustaining high vaccination uptake worldwide.
Collapse
Affiliation(s)
- Katie Gravagna
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 Second Street South, Suite 300, Minneapolis, MN 55454, United States
| | - Andy Becker
- Division of Biostatistics, School of Public Health, University of Minnesota, A460 Mayo Building, MMC 303, 420 Delaware St. SE, Minneapolis, MN 55455, United States
| | - Robert Valeris-Chacin
- College of Veterinary Medicine, 301 Veterinary Science Building, 1971 Commonwealth Avenue, Saint Paul, MN 55108, United States
| | - Inari Mohammed
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 Second Street South, Suite 300, Minneapolis, MN 55454, United States
| | - Sailee Tambe
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 Second Street South, Suite 300, Minneapolis, MN 55454, United States
| | - Fareed A Awan
- Biomedical Ethics Unit, School of Population and Global Health, Faculty of Medicine, McGill University, 3647 Peel St, Montreal, Quebec H3A 1X1, Canada
| | - Traci L Toomey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 Second Street South, Suite 300, Minneapolis, MN 55454, United States
| | - Nicole E Basta
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Faculty of Medicine, McGill University, Montreal, Quebec H3A 1A2, Canada.
| |
Collapse
|
44
|
Hull BP, Beard FH, Hendry AJ, Dey A, Macartney K. "No jab, no pay": catch-up vaccination activity during its first two years. Med J Aust 2020; 213:364-369. [PMID: 32951230 PMCID: PMC7692886 DOI: 10.5694/mja2.50780] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/15/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess catch-up vaccination of older children and adolescents during the first two years of the "No jab, no pay" policy linking eligibility for federal family assistance payments with childhood vaccination status. DESIGN, SETTING, PARTICIPANTS Cross-sectional analysis of Australian Immunisation Register data on catch-up vaccination of children aged 5 to less than 7 years before (January 2013 - December 2014; baseline) and during the first two years of "No jab, no pay" (December 2015 - December 2017), and of children aged 7 to less than 10 years and young people aged 10 to less than 20 years ("No jab, no pay" period only). MAIN OUTCOMES Catch-up vaccination rates for measles-mumps-rubella vaccine second dose (MMR2), by age group, Indigenous status, and socio-economic status; catch-up vaccination of children aged 5 to less than 7 years (third dose of diphtheria-tetanus-pertussis vaccine [DTPa3], MMR1), before and after introduction of "No jab, no pay". RESULTS The proportion of incompletely vaccinated children aged 5 to less than 7 years who received catch-up DTPa3 was higher under "No jab, no pay" than during the baseline period (15.5% v 9.4%). Of 407 332 incompletely vaccinated people aged 10 to less than 20 years, 71 502 (17.6%) received catch-up MMR2 during the first two years of "No jab, no pay", increasing overall coverage for this age group from 86.6% to 89.0%. MMR2 catch-up activity in this age group was greater in the lowest socio-economic status areas than in the highest status areas (29.1% v 7.6%), and also for Indigenous than for non-Indigenous Australians (35.8% v 17.1%). MMR2 catch-up activity in 2016 and 2017 peaked mid-year. CONCLUSIONS Linking family assistance payments with childhood vaccination status and associated program improvements were followed by substantial catch-up vaccination activity, particularly in young people from families of lower socio-economic status.
Collapse
Affiliation(s)
- Brynley P Hull
- National Centre for Immunisation Research and Surveillancethe Sydney Children's Hospitals Network
| | - Frank H Beard
- National Centre for Immunisation Research and Surveillancethe Sydney Children's Hospitals Network
- The University of SydneySydneyNSW
| | - Alexandra J Hendry
- National Centre for Immunisation Research and Surveillancethe Sydney Children's Hospitals Network
| | - Aditi Dey
- National Centre for Immunisation Research and Surveillancethe Sydney Children's Hospitals Network
- The University of SydneySydneyNSW
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillancethe Sydney Children's Hospitals Network
- The University of SydneySydneyNSW
| |
Collapse
|
45
|
Immunization governance: Mandatory immunization in 28 Global NITAG Network countries. Vaccine 2020; 38:7258-7267. [PMID: 32988691 PMCID: PMC7519394 DOI: 10.1016/j.vaccine.2020.09.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/06/2020] [Accepted: 09/17/2020] [Indexed: 11/23/2022]
Abstract
International trends currently favour greater use of mandatory immunization. There has been little academic consideration or comparison of the existence and scope of mandatory immunization internationally. In this paper, we examine mandatory immunization in 28 Global NITAG (National Immunization Technical Advisory Group) Network (GNN) countries, including countries from every WHO region and World Bank income level classification. We found that although mandatory immunization programs, or mandatory elements within broader immunization programs, are relatively common, jurisdictions vary significantly with respect to the immunizations required, population groups affected, grounds for exemptions, and penalties for non-compliance. We also observed some loose associations with geography and income level. Based on these data, we categorized policies into a spectrum ranging from Narrow to Broad scope.
Collapse
|
46
|
Malm H, Navin MC. Pox Parties for Grannies? Chickenpox, Exogenous Boosting, and Harmful Injustices. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:45-57. [PMID: 32840450 DOI: 10.1080/15265161.2020.1795528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Some societies tolerate or encourage high levels of chickenpox infection among children to reduce rates of shingles among older adults. This tradeoff is unethical. The varicella zoster virus (VZV) causes both chickenpox and shingles. After people recover from chickenpox, VZV remains in their nerve cells. If their immune systems become unable to suppress the virus, they develop shingles. According to the Exogenous Boosting Hypothesis (EBH), a person's ability to keep VZV suppressed can be 'boosted' through exposure to active chickenpox infections. We argue that even if this hypothesis were true, immunization policies that discourage routine childhood varicella vaccination in order to prevent shingles for other people are unethical. Such policies harm children and treat them as mere means for the benefit of others, and are inconsistent with how parents should treat their children and physicians should treat their patients. These policies also seem incompatible with institutional transparency.
Collapse
Affiliation(s)
| | - Mark Christopher Navin
- Loyola University Chicago
- Oakland University
- Oakland University William Beaumont School of Medicine
| |
Collapse
|
47
|
Rezza G, Ricciardi W. No jab, no pay and vaccine mandates: Do compulsory policies increase vaccination coverage? The Italian experience. Vaccine 2020; 38:5089. [PMID: 32605724 DOI: 10.1016/j.vaccine.2020.05.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/13/2020] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Giovanni Rezza
- Department of Infectious Diseases, Istituto Superiore di Sanità, Roma, Italy.
| | - Walter Ricciardi
- Institute of Hygiene and Public Health, Catholic University-Policlinico Gemelli, Roma, Italy
| |
Collapse
|
48
|
Ferguson E, Shichman R, Tan JHW. When Lone Wolf Defectors Undermine the Power of the Opt-Out Default. Sci Rep 2020; 10:8973. [PMID: 32488105 PMCID: PMC7265288 DOI: 10.1038/s41598-020-65163-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 04/09/2020] [Indexed: 11/09/2022] Open
Abstract
High levels of cooperation are a central feature of human society, and conditional cooperation has been proposed as one proximal mechanism to support this. The counterforce of free-riding can, however, undermine cooperation and as such a number of external mechanisms have been proposed to ameliorate the effects of free-riding. One such mechanism is setting cooperation as the default (i.e., an opt-out default). We posit, however, that in dynamic settings where people can observe and condition their actions on others' behaviour, 'lone wolf' defectors undermine initial cooperation encouraged by an opt-out default, while 'good shepherds' defeat the free-riding encouraged by an opt-in default. Thus, we examine the dynamic emergence of conditional cooperation under different default settings. Specifically, we develop a game theoretical model to analyse cooperation under defaults for cooperation (opt-out) and defection (opt-in). The model predicts that the 'lone wolf' effect is stronger than the 'good shepherd' effect, which - if anticipated by players - should strategically deter free-riding under opt-out and cooperation under opt-in. Our experimental games confirm the existence of both 'lone wolf' defectors and 'good shepherd' cooperators, and that the 'lone wolf'effect is stronger in the context of organ donation registration behaviour. We thus show a potential 'dark side' to conditional cooperation ('lone wolf effect') and draw implications for the adoption of an opt-out organ donation policy.
Collapse
Affiliation(s)
- Eamonn Ferguson
- School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK.
| | - Ruslan Shichman
- Centre for Decision Research and Experimental Economics (CeDEx), University of Nottingham, Nottingham, NG7 2RD, UK
| | - Jonathan H W Tan
- Department of Economics, School of Social Sciences, Nanyang Technological University, 48 Nanyang Avenue, Singapore, 639818, Singapore
| |
Collapse
|
49
|
Costantino C, Casuccio A, Sannasardo CE, Vella C, Scarpitta F, Randazzo MA, Foresta A, Casuccio N, Ventura G, Bono SE, Vitale F, Restivo V. Public health strategies adopted to manage the increase of accesses to vaccination services, as a result of the application of the law 119/2017. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:35-40. [PMID: 32275265 PMCID: PMC7975909 DOI: 10.23750/abm.v91i3-s.9413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/24/2020] [Indexed: 11/25/2022]
Abstract
Background and aim of the work: In response to the alarming reduction of vaccination coverage rates, Italian Ministry of Health approved the law number 119/2017, which has extended the number of mandatory vaccinations, for school attendance, from four to ten. The present study aims to evaluate accesses to the vaccination services of the Palermo Local Health Unit (LHU) and the variation of the vaccination coverage rates for hexavalent and measles, mumps, rubella and varicella (MMRV) vaccines, after the implementation of the law 119/2017. Methods: An extent of opening hours and an involvement of other health-care professionals in the vaccination services of the Palermo LHU have been adopted to manage the excess of accesses after the introduction of 119/2017 law and to limit the discomfort of general population. Vaccination accesses and coverage rates were calculated from the electronic immunization registers. Results: An overall increase of about 15% of single vaccination accesses was observed in the three semester after the introduction of the law in the LHU of Palermo. A peak of 35,516 accesses was observed during the second semester of 2017 (+ 30% compared to the same semesters of 2016 and 2018). From 2016 to 2018, coverage rates for full hexavalent cycle and first dose of MMRV, at 24 and 36 months, and for full MMRV cycle and fourth dose of diphtheria, tetanus, pertussis, poliomyelitis (DTPa+IPV), among 6 years old children, showed considerable increases. Conclusions: Law 199/2017 demonstrated a high efficacy in increase vaccination coverage rates also in Sicily. The synergy established between the LHU and the University of Palermo allowed an excellent management of the accesses to vaccination services, making it possible to respond to the public health needs of the general population.
Collapse
Affiliation(s)
- Claudio Costantino
- University of Palermo - Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE).
| | - Alessandra Casuccio
- University of Palermo - Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE).
| | - Claudia Emilia Sannasardo
- University of Palermo - Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE).
| | - Carlotta Vella
- University of Palermo - Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE).
| | - Francesco Scarpitta
- University of Palermo - Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE).
| | | | - Angelo Foresta
- Local Health Unit of Palermo, Department of Medical Prevention.
| | - Nicolò Casuccio
- Local Health Unit of Palermo, Department of Medical Prevention.
| | - Gianmarco Ventura
- University of Palermo - Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE).
| | - Stefania Enza Bono
- University of Palermo - Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE).
| | - Francesco Vitale
- University of Palermo - Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE).
| | - Vincenzo Restivo
- University of Palermo - Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE).
| |
Collapse
|
50
|
Siciliani L, Wild C, McKee M, Kringos D, Barry MM, Barros PP, De Maeseneer J, Murauskiene L, Ricciardi W. Strengthening vaccination programmes and health systems in the European Union: A framework for action. Health Policy 2020; 124:511-518. [PMID: 32276852 DOI: 10.1016/j.healthpol.2020.02.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Abstract
Vaccination is one of the most cost-effective public health interventions. However, the EU is facing increasing outbreaks of vaccine preventable diseases, with some fatal cases of measles. This paper reviews the main factors influencing vaccination uptake, and assesses measures expected to improve vaccination coverage. Obstacles to vaccination include concerns about vaccine safety and side effects, lack of trust, social norms, exposure to rumours and myths, and access barriers. Responses fall into three broad categories. Regulation, including the introduction of mandatory vaccination, can be justified but it is important to be sure that it is an appropriate solution to the existing problem and does not risk unintended consequences. Facilitation involves ensuring that there is an effective vaccination programme, comprehensive in nature, and reducing the many barriers, in terms of cost, distance, and time, to achieving high levels of uptake, especially for marginalised or vulnerable populations. Information is crucial, but whether in the form of public information campaigns or interactions between health workers and target populations, must be designed very carefully to avoid the risk of backfire. There is no universal solution to achieving high levels of vaccine uptake but rather a range or combinations of options. The choice of which to adopt in each country will depend on a detailed understanding of the problem, including which groups are most affected.
Collapse
Affiliation(s)
- Luigi Siciliani
- Department of Economics and Related Studies, University of York, YO10 5DD, York, UK.
| | - Claudia Wild
- Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090 Vienna, Austria
| | - Martin McKee
- Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Dionne Kringos
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Margaret M Barry
- WHO Collaborating Centre for Health Promotion Research, National University of Ireland Galway, Galway, Ireland
| | | | - Jan De Maeseneer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Liubove Murauskiene
- Public Health Division, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Walter Ricciardi
- Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | | |
Collapse
|