School staff and immunization governance: Missed opportunities for public health promotion

From speculative to real: community attitudes towards government COVID-19 vaccine mandates in Western Australia from May 2021 to April 2022

Many governments employed mandates for COVID-19 vaccines, imposing consequences upon unvaccinated people. Attitudes towards these policies have generally been positive, but little is known about how discourses around them changed as the characteristics of the disease and the vaccinations evolved. Western Australia (WA) employed sweeping COVID-19 vaccine mandates for employment and public spaces whilst the state was closed off from the rest of the country and world, and mostly with no COVID-19 in the community. This article analyses WA public attitudes during the mandate policy lifecycle from speculative to real. Qualitative interview data from 151 adults were analysed in NVivo 20 via a novel chronological analysis anchored in key policy phases: no vaccine mandates, key worker vaccine mandates, vaccine mandates covering 75% of the workforce and public space mandates. Participants justified mandates as essential for border reopening and, less frequently, for goals such as protecting the health system. However, public discourse focusing on 'getting coverage rates up' may prove counter-productive for building support for vaccination; governments should reinforce end goals in public messaging (reducing suffering and saving lives) because such messaging is likely to be more meaningful to vaccination behaviour in the longer term.

Education components of school vaccine mandates: An environmental scan

BACKGROUND

School vaccine mandates (SVMs) are population health interventions that require monitoring and communicating about vaccination of school-aged children, with an aim of controlling infectious disease outbreaks. While 43 % of World Health Organization member states report having some sort of SVM, their details vary. A newer element of some SVMs is an "education component" requiring compulsory information, education, or counseling of parents/guardians who decline to vaccinate their children for non-medical reasons.

METHODS

This environmental scan sought, mapped, and synthesized evidence on the existence, format, and impacts of education components of SVMs in 18 affluent Organization for Economic Co-operation and Development comparator countries.

FINDINGS

We found current SVMs in nine of the 18 comparator countries, but education components to those SVMs only in Canada (n = 2) and the U.S. (n = 9), where such policies were made at the provincial/state level. The earliest was implemented in 2011 and most recent has not yet been implemented. Education components were used as requirements for obtaining non-medical exemptions from SVMs, and involved either an informational paper to be read and signed, a counseling or information session from a health professional (public health worker or licensed provider such as family doctor), or an online module to be completed. Peer-reviewed research on in-person sessions suggests association with at least short-term increased vaccine uptake and reduction of non-medical exemptions. Available data on online module education components suggests similar impacts, but research to date is limited.

CONCLUSION

SVMs with educational components are uncommon but have been increasing since 2011. The details of these education components vary, although topics covered in online modules are relatively consistent. Evidence to date suggests at least short-term reduction in non-medical exemptions associated with implementation of SVM education components, but additional research is required to follow-up and confirm, especially as regards online education modules.

School staff as vaccine advocates: Perspectives on vaccine mandates and the student registration process

Recently, several states in the US have made it more difficult to receive nonmedical exemptions to school vaccine mandates in the hope of better orienting parents towards vaccination. However, little is known about how public-facing school staff implement and enforce mandate policies, including why or how often they steer parents towards nonmedical exemptions. This study focused on Michigan, which has recently added an additional burden for families seeking nonmedical exemptions. We used an anonymous online survey to assess Michigan public-school employees (n = 157) about their knowledge, attitudes, and behaviors regarding Michigan's school enrollment vaccine mandate policy. Our main conclusions are that frontline school staff are generally knowledgeable about vaccines and immunization policy, but are at best ambivalent about their role in immunization governance, believing that other agents should be responsible for ensuring that children are vaccinated. Furthermore, some respondents indicated low vaccine confidence, which was associated with increased ambivalence about, or opposition to, their role in immunization governance. As more jurisdictions within and beyond the US consider introducing or tightening childhood vaccine mandates, it is increasingly important to understand how these policies can be improved by attending to the attitudes and roles of relevant frontline actors.

Consolidating a research agenda for vaccine mandates

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.