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Horák F, Dienstbier J. Dark side of the principles of non-discrimination and proportionality: the case of mandatory vaccination. JOURNAL OF MEDICAL ETHICS 2024:jme-2023-108998. [PMID: 37586831 DOI: 10.1136/jme-2023-108998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023]
Abstract
Deciding the conflict between various rights and interests, especially in medical ethics where health and lives are in question, has significant challenges, and to obtain appropriate outcomes, it is necessary to properly apply the principles of non-discrimination and proportionality. Using the example of mandatory vaccination policies, we show that this task becomes even more difficult when these principles lead us to counterintuitive and paradoxical results. Although the general purpose of these principles is to ensure that decisions and policies seek the highest and broadest possible enjoyment of rights for all (ie, the least restrictive solution), they achieve the complete opposite when applied to mandatory vaccination policies. To highlight and explain these paradoxical results, we present a typology of fifteen hypothetical mandatory vaccination policies containing various degrees of restriction and apply well-established non-discrimination and proportionality tests from constitutional law to each. We argue that mandatory vaccination policies exhibit two characteristics, namely the non-linear relationship between their general purposes and specific goals and the involvement of life and health, suggesting that more restrictive policies should prevail even though less restrictive policies might fail these tests. Using clearly structured and rigorous methodology from constitutional law, the proposed approach delivers a fresh view on the core ethical principles of non-discrimination and proportionality and a potentially useful tool in helping resolve also other challenges encountered in medical ethics beyond mandatory vaccination policies.
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Affiliation(s)
- Filip Horák
- Constitutional Law, Charles University Faculty of Law, Praha, Czech Republic
| | - Jakub Dienstbier
- Constitutional Law, Charles University Faculty of Law, Praha, Czech Republic
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2
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Hussain A, Augustine SW, Pyakurel S, Vempalli H, Dabbara R, O'dare RA, Ayush, Varghese JJ, Inban P, Jayan M, Osigwe EC, Sunkara SM, Khan A. Acute Pancreatitis Induced by COVID-19 Vaccine: A Systematic Review. Cureus 2024; 16:e55426. [PMID: 38571842 PMCID: PMC10990070 DOI: 10.7759/cureus.55426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 04/05/2024] Open
Abstract
Acute pancreatitis, marked by sudden inflammation of the pancreas, presents a complex spectrum of causative factors including gallstone obstruction, alcohol abuse, and viral infections. Recent studies have illuminated the emergence of vaccine-induced acute pancreatitis, notably associated with COVID-19 vaccinations, presenting diverse mechanisms ranging from direct viral-mediated injury to autoimmune reactions. Understanding this link is pivotal for public health, yet challenges persist in identifying and managing cases post-vaccination. Comprehensive literature reviews employing the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement outline the potential pathways and mechanisms leading to vaccine-induced pancreatitis, emphasizing the need for deeper investigations into underlying health conditions and modifications to vaccine components. Notably, the rare occurrences of vaccine-induced pancreatitis extend beyond COVID-19 vaccines, with reports also documenting associations with measles, mumps, and rubella (MMR), human papillomavirus (HPV), and other viral vaccinations. Mechanistically, hypotheses such as molecular mimicry and immunologic injury have been proposed, necessitating ongoing vigilance and exploration. Regulatory agencies play a crucial role in monitoring and communicating vaccine safety concerns, emphasizing transparency to address potential risks and maintain public trust. Understanding and communicating these rare adverse events with transparency remain integral for informed vaccination policies and to allay concerns surrounding vaccine safety.
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Affiliation(s)
- Akbar Hussain
- Internal Medicine, Appalachian Regional Health, Harlan, USA
| | - Sana W Augustine
- Internal Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
| | - Sandhya Pyakurel
- Internal Medicine, University of Science and Technology Chittagong, Chittagong, BGD
| | | | - Rishika Dabbara
- Internal Medicine, Kamineni Institute of Medical Sciences, Hyderabad, IND
| | - Rachel A O'dare
- Nursing, South University, Savannah, USA
- General Medicine, Medical University of Graz, Graz, AUT
| | - Ayush
- Internal Medicine, National Capital Region Institute of Medical Sciences, Meerut, IND
| | | | - Pugazhendi Inban
- General Medicine, Government Medical College, Omandurar Government Estate, Chennai, IND
| | - Malavika Jayan
- Internal Medicine, Bangalore Medical College and Research Institute, Bangalore, IND
| | | | | | - Aadil Khan
- Trauma Surgery, OSF Healthcare Hospital, University of Illinois College of Medicine, Peoria, USA
- Internal Medicine, Lala Lajpat Rai (LLR) Hospital, Kanpur, IND
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3
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Bianchi FP, Tafuri S. Spreading of misinformation on mass media and digital platforms regarding vaccines. A systematic scoping review on stakeholders, policymakers, and sentiments/behavior of Italian consumers. Hum Vaccin Immunother 2023; 19:2259398. [PMID: 37782549 PMCID: PMC10547076 DOI: 10.1080/21645515.2023.2259398] [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: 06/08/2023] [Accepted: 09/12/2023] [Indexed: 10/04/2023] Open
Abstract
Studies on traditional and social media have found that misinformation about vaccines has been widely spread over the last decade, negatively impacting public opinion and people's willingness to get vaccinated. We reviewed the sentiments of Italian users to define the characteristic of anti-vax and pro-vax contents and defined the strategies to deal with the misinformation. Scopus, MEDLINE/PubMed, Google Scholar (up to page 10), and ISI Web of Knowledge databases were systematically searched. Research articles, brief reports, commentaries, and letters published between January 1, 2010 and March 30, 2022 were included in the search. No-vax or ambiguous contents in Italian mass media are not prevalent compared to neutral and pro-vax content; the communication of no-vax groups is significantly simplified, favoring the understanding of the topics by users. Events related to vaccinations are associated with news coverage by media, search engine consultations, and user reactions on social networks. In this context, the activity of no-vax groups is triggered, and misinformation and fake news spread even further. A multifactorial approach is necessary to manage online user sentiment and use mass and social media as health promotion tools.
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Affiliation(s)
| | - Silvio Tafuri
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, Bari, Italy
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Simons RC, Bak MAR, Legemaate J, Ploem C. Towards a less voluntary vaccination policy in the Netherlands? Findings from an expert interview study. Health Policy 2023; 133:104841. [PMID: 37243983 DOI: 10.1016/j.healthpol.2023.104841] [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: 01/17/2023] [Revised: 04/21/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND The Netherlands traditionally favours a voluntary approach to vaccination. However, during the COVID-19 pandemic multiple European countries drastically altered their vaccination policies, which fuelled societal and political debate about the need to make the Dutch vaccination policy less voluntary, particularly by utilising pressure or coercion. AIM To provide insight in expert's views on main normative issues concerning a less voluntary vaccination policy (for adults). Our study adds to the existing debate by addressing this topic from a multidisciplinary viewpoint. METHODS We conducted 16 semi-structured interviews with legal, medical and ethical experts on the Dutch vaccination policy, between November 2021 and January 2022. We analysed interview transcripts through inductive coding. RESULTS Most experts believe a less voluntary vaccination policy is of added value under certain circumstances, as exemplified by the outbreak of COVID-19. For such a policy, a legislative approach might be most effective. However, different views exist on the desirability of a less voluntary approach. Main arguments in favour are based on epidemiological circumstances and a duty towards the collective health interest, whilst arguments against are based on the questionable necessity and adverse effectiveness of such policy. CONCLUSIONS If implemented, a less voluntary vaccination policy should be context-specific and take into account proportionality and subsidiarity. It is recommendable for governments to embed such policy (a priori) in flexible legislation.
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Affiliation(s)
- Rogier C Simons
- Section of Health Law, Department of Ethics, Law & Humanities, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Marieke A R Bak
- Section of Ethics of Care, Department of Ethics, Law & Humanities, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Johan Legemaate
- Section of Health Law, Department of Ethics, Law & Humanities, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Corrette Ploem
- Section of Health Law, Department of Ethics, Law & Humanities, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Mahameed H, Al-Mahzoum K, AlRaie LA, Aburumman R, Al-Naimat H, Alhiary S, Barakat M, Al-Tammemi AB, Salim NA, Sallam M. Previous Vaccination History and Psychological Factors as Significant Predictors of Willingness to Receive Mpox Vaccination and a Favorable Attitude towards Compulsory Vaccination. Vaccines (Basel) 2023; 11:vaccines11050897. [PMID: 37243001 DOI: 10.3390/vaccines11050897] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/17/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
During the ongoing multi-country monkeypox (Mpox) outbreak, healthcare workers (HCWs) have represented a key group in mitigating disease spread. The current study aimed to evaluate the attitude of nurses and physicians in Jordan towards Mpox vaccination, as well as their attitude towards compulsory vaccination against coronavirus disease 2019 (COVID-19), influenza, and Mpox. An online survey was distributed in January 2023 based on the previously validated 5C scale for psychological determinants of vaccination. Previous vaccination behavior was assessed by inquiring about the history of getting the primary and booster COVID-19 vaccination, influenza vaccine uptake during COVID-19, and any history of influenza vaccine uptake. The study sample consisted of 495 respondents: nurses (n = 302, 61.0%) and physicians (n = 193, 39.0%). Four hundred and thirty respondents (86.9%) had heard of Mpox before the study, and formed the final sample considered for Mpox knowledge analysis. Deficiencies in Mpox knowledge were reflected in a mean knowledge score of 13.3 ± 2.7 (out of 20.0 as the maximum score), with significantly lower knowledge among nurses and females. The intention to receive Mpox vaccination was reported by 28.9% of the participants (n = 143), while 33.3% were hesitant (n = 165), and 37.8% were resistant (n = 187). In multivariate analysis, Mpox vaccine acceptance was significantly associated with previous vaccination behavior, reflected in higher vaccine uptake and with higher 5C scores, while Mpox knowledge was not correlated with Mpox vaccination intention. The overall attitude towards compulsory vaccination was neutral, while a favorable attitude towards compulsory vaccination was associated with higher 5C scores and a history of previous vaccination uptake. The current study showed a low intention to get Mpox vaccination in a sample of nurses and physicians practicing in Jordan. The psychological factors and previous vaccination behavior appeared as the most significant determinants of Mpox vaccine acceptance and of attitudes towards compulsory vaccination. The consideration of these factors is central to policies and strategies aiming to promote vaccination among health professionals in efforts to prepare for future infectious disease epidemics.
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Affiliation(s)
- Haneen Mahameed
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | | | | | | | - Hala Al-Naimat
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Sakher Alhiary
- Nursing Department, Jordan University Hospital, Amman 11942, Jordan
| | - Muna Barakat
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11931, Jordan
- MEU Research Unit, Middle East University, Amman 11831, Jordan
| | - Ala'a B Al-Tammemi
- Migration Health Division, International Organization for Migration (IOM), The UN Migration Agency, Amman 11953, Jordan
| | - Nesreen A Salim
- Prosthodontic Department, School of Dentistry, The University of Jordan, Amman 11942, Jordan
- Prosthodontic Department, Jordan University Hospital, Amman 11942, Jordan
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
- Department of Translational Medicine, Faculty of Medicine, Lund University, 22184 Malmö, Sweden
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6
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Sela Y, Grinberg K, Nissanholtz-Gannot R. The Dilemma of Compulsory Vaccinations-Ethical and Legal Considerations. Healthcare (Basel) 2023; 11:healthcare11081140. [PMID: 37107974 PMCID: PMC10138527 DOI: 10.3390/healthcare11081140] [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: 03/08/2023] [Revised: 04/09/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
The high childhood vaccination coverage in Israel leads to a low rate of morbidity from the diseases against which the vaccination in administered. However, during the COVID-19 pandemic, children's immunization rates declined dramatically due to closures of schools and childcare services, lockdowns, and guidelines for physical distancing. In addition, parents' hesitancy, refusals, and delays in adhering to routine childhood immunizations seem to have increased during the pandemic. A decline in routine pediatric vaccine administration might indicate that the entire population faces increased risks for outbreaks of vaccine-preventable diseases. Throughout history, vaccines have raised questions about their safety, efficacy, and need among adults and parents who feared or hesitated to vaccinate their children. Objections derive from various ideological and religious reasons or concerns about the possible inherent dangers. Mistrust in the government and/or economic or political interests also raise concerns among parents. The importance of providing vaccines to maintain public health, as opposed to the autonomy of the individuals over their body and their children, raises ethical questions. In Israel, there is no legal obligation to get vaccinated. It is imperative to find a decisive solution to this situation without delay. Furthermore, where democratically one's principles are sacred and where one's autonomy over one's body is also unquestionable, such a legal solution would not only be unacceptable but also rather impossible to enforce. It seems that some reasonable balance between the necessity to preserve public health and our democratic principles should apply.
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Affiliation(s)
- Yael Sela
- Department of Nursing Sciences, Ruppin Academic Center, Emek- Hefer 4025000, Israel
| | - Keren Grinberg
- Department of Nursing Sciences, Ruppin Academic Center, Emek- Hefer 4025000, Israel
| | - Rachel Nissanholtz-Gannot
- Department of Health Systems Management, Ariel University, Ariel 40700, Israel
- Myers-JDC-Brookdale Institute, Jerusalem 9103702, Israel
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7
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Kyrychko YN, Blyuss KB. Vaccination games and imitation dynamics with memory. CHAOS (WOODBURY, N.Y.) 2023; 33:033134. [PMID: 37003837 DOI: 10.1063/5.0143184] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
In this paper, we model dynamics of pediatric vaccination as an imitation game, in which the rate of switching of vaccination strategies is proportional to perceived payoff gain that consists of the difference between perceived risk of infection and perceived risk of vaccine side effects. To account for the fact that vaccine side effects may affect people's perceptions of vaccine safety for some period of time, we use a delay distribution to represent how memory of past side effects influences current perception of risk. We find disease-free, pure vaccinator, and endemic equilibria and obtain conditions for their stability in terms of system parameters and characteristics of a delay distribution. Numerical bifurcation analysis illustrates how stability of the endemic steady state varies with the imitation rate and the mean time delay, and this shows that it is not just the mean duration of memory of past side effects, but also the actual distribution that determines whether disease will be maintained in the population at some steady level, or if sustained periodic oscillations around this steady state will be observed. Numerical simulations illustrate a comparison of the dynamics for different mean delays and different distributions, and they show that even when periodic solutions are observed, there are differences in their amplitude and period for different distributions. We also investigate the effect of constant public health information campaigns on vaccination dynamics. The analysis suggests that the introduction of such campaigns acts as a stabilizing factor for endemic equilibrium, allowing it to remain stable for larger values of mean time delays.
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Affiliation(s)
- Y N Kyrychko
- Department of Mathematics, University of Sussex, Brighton BN1 9QH, United Kingdom
| | - K B Blyuss
- Department of Mathematics, University of Sussex, Brighton BN1 9QH, United Kingdom
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8
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Evans-Gilbert T, Lewis-Bell KN, Irons B, Duclos P, Gonzalez-Escobar G, Ferdinand E, Figueroa JP. A review of immunization legislation for children in English- and Dutch-speaking Caribbean countries. Rev Panam Salud Publica 2023; 47:e19. [PMID: 36686892 PMCID: PMC9847406 DOI: 10.26633/rpsp.2023.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/12/2022] [Indexed: 01/19/2023] Open
Abstract
Objective To assess the legislative frameworks concerning childhood vaccination in the English- and Dutch-speaking Caribbean and propose a model legislative framework for Caribbean countries. Methods This study included a survey of 22 countries and territories in the Caribbean regarding legal vaccination mandates for school entry, budget allocations, sanctions, or exemptions. A legal consultant conducted a comprehensive search and analysis of legislation regarding vaccination among 13 Caribbean countries/territories. A comparative analysis of the legislation under five themes-legislative structure, mandatory vaccination, national immunization schedule, sanctions, and exemptions-formed the basis for the proposed model legislation. Results Among the 22 Caribbean countries/territories, 17 (77%) had legislation mandating vaccination, 16 (94%) mandated vaccination for school entry, 8 (47%) had a dedicated budget for immunization programs, and 13 (76%) had no legislated national schedules. The source of legislation includes six (35%) using the Education Act, eight (47%) the Public Health Act, and five (29%) a free-standing Vaccination Act. Three countries/territories-Jamaica, Montserrat, and Saint Lucia-had immunization regulations. In 12 (71%) of the 17 countries with legislation, sanctions were included, and 10 (59%) permitted exemptions for medical or religious/philosophical beliefs. Conclusions Several countries in the Caribbean have made failure to vaccinate a child an offense. By summarizing the existing legislative frameworks and approaches to immunization in the Caribbean, the analysis guides policymakers in making effective changes to immunization legislation in their own countries.
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Affiliation(s)
- Tracy Evans-Gilbert
- University of the West IndiesKingstonJamaicaUniversity of the West Indies, Kingston, Jamaica,Tracy Evans-Gilbert,
| | - Karen N. Lewis-Bell
- Pan American Health OrganizationParamariboSurinamePan American Health Organization, Paramaribo, Suriname.
| | - Beryl Irons
- Pan American Health OrganizationRetired Immunization AdvisorBridgetownBarbadosPan American Health Organization, (Retired Immunization Advisor, Bridgetown, Barbados).
| | - Philippe Duclos
- University of GenevaGenevaSwitzerlandUniversity of Geneva, Geneva, Switzerland.
| | - Gabriel Gonzalez-Escobar
- Pan American Health OrganizationCaracasVenezuelaPan American Health Organization, Caracas, Venezuela.
| | - Elizabeth Ferdinand
- University of the West IndiesCave HillBarbadosUniversity of the West Indies, Cave Hill, Barbados.
| | - J. Peter Figueroa
- University of the West IndiesKingstonJamaicaUniversity of the West Indies, Kingston, Jamaica
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9
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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.
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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.
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Herrmann-Werner A, Festl-Wietek T, Gille C, Zipfel S, Wiechers S. Medical student attitudes on vaccination relevance: A mixed-method study. PLoS One 2022; 17:e0273529. [PMID: 36001609 PMCID: PMC9401119 DOI: 10.1371/journal.pone.0273529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background and objectives The study aims to investigate the attitudes of medical students regarding the importance and relevance of vaccinations, whether vaccinations should be compulsory and how to employ a new teaching concept to deal with vaccination-critical parents. Methods This mixed-method study consists of a quantitative questionnaire and focus groups. Quantitative data were analysed by calculating the descriptive statistics, and interviews were analysed using Mayring’s content analysis. Results A total of 170 medical students completed the questionnaire, and 59 students participated in 9 focus groups. Students reported that they felt more confident dealing with vaccination-critical parents after learning the new teaching concept. Similar results were found for medical students prior to and during the pandemic. During the pandemic, medical students viewed vaccinations for several diseases, such as measles or COVID-19, as important (range: M = 3.56, SD = 0.54 to M = 3.97, SD = 0.17). Similar results were found for medical students prior to the pandemic (range: M = 3.26, SD = 0.77 to M = 3.94, SD = 0.24). In the focus groups, however, medical students displayed controversial attitudes regarding compulsory vaccinations. Conclusions While the medical students agreed on the use of vaccination for highly infectious diseases, their level of agreement decreased depending on the severity of the disease. Practical recommendations that come out of the study are creating a trustful relationship with and delivering information to patients.
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Affiliation(s)
- Anne Herrmann-Werner
- Tübingen Institute for Medical Education, University of Tuebingen, Tuebingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine, University Hospital Tuebingen, Tuebingen, Germany
- * E-mail:
| | - Teresa Festl-Wietek
- Tübingen Institute for Medical Education, University of Tuebingen, Tuebingen, Germany
| | - Christian Gille
- Department of Neonatology, Pediatrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Steffen Wiechers
- Private Practice for Pediatrics, Adolescent Medicine, Pediatric Pulmonology, Tuebingen, Germany
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Recio-Román A, Recio-Menéndez M, Román-González MV. Political Populism, Institutional Distrust and Vaccination Uptake: A Mediation Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063265. [PMID: 35328952 PMCID: PMC8955402 DOI: 10.3390/ijerph19063265] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022]
Abstract
Politics is ubiquitous in public health, but vaccines had never been weaponized to instill distrust to gain political advantage. In pandemic and post-pandemic scenarios, populist political parties could use vaccine-related issues to generate distrust in evidence-based knowledge. Therefore, some questions arise. What impact could populist political parties impinge on vaccination uptake rates through sowing political discontent? What could the medical institutions do to avoid the adverse effects that these political strategies could infringe? For answering these research questions, we first hypothesized that vaccine uptake was negatively associated with distrust in the institutions. Furthermore, we analyzed whether populism mediates this relationship. In doing so, we hypothesized a positive association between distrust and populism, because populists, mainly fueled by politically discontent citizens, offer hope of a better future, blaming their misfortune on the actions of the elite. Additionally, we hypothesized that those citizens with a higher level of political dissatisfaction, following the claims of the populist political parties, will have lower vaccine uptake results, because they will be discouraged from making the efforts to counter the pandemic. Based on a survey carried out by the European Commission that covered 27 E.U. + U.K. countries (totaling 27,524 respondents), this paper proves that an individual’s political discontent fully mediates the relationship between distrust in institutions and vaccine uptake. Targeting the vaccine-hesitant population is quite convenient for populists because they only need to convince a minority of citizens not to be vaccinated to achieve their destabilizing goals. New outbreaks will appear if the minimum herd immunity coverage is not reached, reinforcing a vicious circle of distrust in elites, in consequence. For tackling this matter, recommendations are given to institutional managers from a social marketing standpoint.
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12
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Factors influencing SARS-CoV-2 infection rate in Belgian nursing homes' residents during the first wave of COVID-19 pandemic. Epidemiol Infect 2022; 150:e72. [PMID: 35403594 PMCID: PMC9002144 DOI: 10.1017/s0950268822000334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
In April 2020, Belgium experienced high numbers of fatal COVID-19 cases among nursing home (NH) residents. In response, a mass testing campaign was organised testing all NH residents and staff. We analysed the data of Flemish NHs to identify institutional factors associated with increased SARS-CoV-2 infection rates among NH residents. Cross-sectional study was conducted between 8 April and 15 May 2020. Data collected included demographics, group category (i.e. staff or resident), symptom status and test result. We retrieved additional data: number of beds and staff, type of beds (level of dependency of residents) and ownership (public, private for profit/non-profit institutions). Risk factor analysis was performed using negative binomial regression. In total, 695 NHs were included, 282 (41%) had at least one resident tested positive. Higher infection rate among residents was associated with a higher fraction of RVT beds, generally occupied by more dependent residents (incidence rate ratio (IRR) 1.97; 95% CI 1.00–3.86) and higher staff infection rate (IRR 1.89; 95% CI 1.68–2.12). No relationship was found between other investigated NH characteristics and infection rate among residents. Staff-resident interactions are key in SARS-CoV-2 transmission dynamics. Vaccination, regular staff testing, assessment of infection prevention and control strategies in all NHs are needed to face future SARS-CoV-2 epidemics in these settings.
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Cordingley TJ, Wilson MAG, Weston KM. The success of Australia's 'No Jab, No Pay' policy at a local level; retrospective clinical audit of a single medical practice assessing incidence of catch-up vaccinations. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:353-359. [PMID: 33970550 DOI: 10.1111/hsc.13408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 03/05/2021] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
Vaccination is a vital health care initiative to prevent individual and population infection. To increase vaccination rates the federal government implemented the 'No Jab, No Pay' policy, where eligibility for several government benefits required children to be fully vaccinated by removing 'conscientious objections' and expanding the age range of children whose families receive benefits. This study assesses the impact of this policy at a local area within a single medical practice community in NSW, Australia. A retrospective clinical audit was performed between 2012 and 2017 on a single general practice's vaccination records for children ≤19 years. Catch-up vaccinations were assessed based on age at vaccination. Incidence of catch-up vaccinations was assessed for each of four years before and two years after the implementation of the 'No Jab, No Pay' policy in January 2016, along with the age of children and vaccination(s) given. Catch-up vaccinations were assessed temporally either side of implementation of 'No Jab, No Pay'. Comparing the average annual vaccination catch-up incidence rate of 6.2% pre-implementation (2012-2015), there was an increase to 9.2% in 2016 (p < .001) and 7.8% in 2017 (p = .027). Secondary outcome measurement of catch-up vaccination incidence rates before (2012-2015) and after (2016-2017) 'No Jab, No Pay' implementation showed statistically significant increases for children aged 8-11 years (3.2%-5.6%, p = .038), 12-15 years (7.5%-14.7%, p < .001) and 16-19 years (3.3%-10.2%, p < .001) along with a statistically significant reduction in children aged 1-3 years (11.4%-6.2%, p = .015). Also, catch-up rates for DTPa significantly increased after program implementation. This study demonstrates that the Australian federal government vaccination policy 'No Jab, No Pay' was coincident with an increase in catch-up vaccinations within a rural NSW community served by one medical practice, especially for older children.
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Affiliation(s)
- Timothy J Cordingley
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Mark A G Wilson
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kathryn M Weston
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
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Considering a COVID-19 vaccine mandate for pediatric kidney transplant candidates. Pediatr Nephrol 2022; 37:2559-2569. [PMID: 35333972 PMCID: PMC8949834 DOI: 10.1007/s00467-022-05511-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 12/02/2022]
Abstract
The world continues to face the effects of the SARS-CoV-2 pandemic. COVID-19 vaccines are safe and effective in protecting recipients, decreasing the risk of COVID-19 acquisition, transmission, hospitalization, and death. Transplant recipients may be at greater risk for severe SARS-CoV-2 infection. As a result, transplant programs have begun instituting mandates for COVID-19 vaccine for transplant candidacy. While the question of mandating COVID-19 vaccine for adult transplant candidates has garnered attention in the lay and academic press, these discussions have not explicitly addressed children who may be otherwise eligible for kidney transplants. In this paper we seek to examine the potential ethical justifications of a COVID-19 vaccine mandate for pediatric kidney transplant candidacy through an examination of relevant ethical principles, analogous cases of the use of mandates, differences between adult and pediatric kidney transplant candidates, and the role of gatekeeping in transplant vaccine mandates. At present, it does not appear that pediatric kidney transplant centers are justified to institute a COVID-19 vaccine mandate for candidates. Finally, we will offer suggestions to be considered prior to the implementation of a COVID-19 vaccine mandate.
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15
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Ritschl V, Eibensteiner F, Mosor E, Omara M, Sperl L, Nawaz FA, Siva Sai C, Cenanovic M, Devkota HP, Hribersek M, De R, Klager E, Schaden E, Kletecka-Pulker M, Völkl-Kernstock S, Willschke H, Aufricht C, Atanasov AG, Stamm T. Mandatory vaccination against COVID-19: A Twitter poll analysis on public health opinion (Preprint). JMIR Form Res 2021; 6:e35754. [PMID: 35617671 PMCID: PMC9217155 DOI: 10.2196/35754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/27/2022] [Accepted: 04/19/2022] [Indexed: 11/15/2022] Open
Abstract
Background On January 30, 2020, the World Health Organization Emergency Committee declared the rapid worldwide spread of COVID-19 a global health emergency. By December 2020, the safety and efficacy of the first COVID-19 vaccines had been demonstrated. However, international vaccination coverage rates have remained below expectations (in Europe at the time of manuscript submission). Controversial mandatory vaccination is currently being discussed and has already been introduced in some countries (Austria, Greece, and Italy). We used the Twitter survey system as a viable method to quickly and comprehensively gather international public health insights on mandatory vaccination against COVID-19. Objective The purpose of this study was to better understand the public’s perception of mandatory COVID-19 vaccination in real time using Twitter polls. Methods Two Twitter polls were developed (in the English language) to seek the public’s opinion on the possibility of mandatory vaccination. The polls were pinned to the Digital Health and Patient Safety Platform’s (based in Vienna, Austria) Twitter timeline for 1 week in mid-November 2021, 3 days after the official public announcement of mandatory COVID-19 vaccination in Austria. Twitter users were asked to participate and retweet the polls to reach the largest possible audience. Results Our Twitter polls revealed two extremes on the topic of mandatory vaccination against COVID-19. Almost half of the 2545 respondents (n=1246, 49%) favor mandatory vaccination, at least in certain areas. This attitude contrasts with the 45.7% (n=1162) who categorically reject mandatory vaccination. Over one-quarter (n=621, 26.3%) of participating Twitter users said they would never get vaccinated, as reflected by the current Western European and North American vaccination coverage rate. Concatenating interpretation of these two polls should be done cautiously as participating populations might substantially differ. Conclusions Mandatory vaccination against COVID-19 (in at least certain areas) is favored by less than 50%, whereas it is opposed by almost half of the surveyed Twitter users. Since (social) media strongly influences public perceptions and views, and social media discussions and surveys are specifically susceptible to the “echo chamber effect,” the results should be interpreted as a momentary snapshot. Therefore, the results of this study need to be complemented by long-term surveys to maintain their validity.
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Affiliation(s)
- Valentin Ritschl
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Fabian Eibensteiner
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Erika Mosor
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Maisa Omara
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Lisa Sperl
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Faisal A Nawaz
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | | | | | - Hari Prasad Devkota
- Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
- Program for Leading Graduate Schools, Kumamoto University, Kumamoto, Japan
| | - Mojca Hribersek
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Ronita De
- Indian Council of Medical Research-National Institute of Cholera and Enteric Diseases, West Bengal, India
| | - Elisabeth Klager
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Eva Schaden
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Maria Kletecka-Pulker
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Institute for Ethics and Law in Medicine, University of Vienna, Vienna, Austria
| | - Sabine Völkl-Kernstock
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Harald Willschke
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Institute for Ethics and Law in Medicine, University of Vienna, Vienna, Austria
| | - Christoph Aufricht
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Atanas G Atanasov
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzebiec, Poland
| | - Tanja Stamm
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
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Ajovalasit S, Dorgali VM, Mazza A, d’Onofrio A, Manfredi P. Evidence of disorientation towards immunization on online social media after contrasting political communication on vaccines. Results from an analysis of Twitter data in Italy. PLoS One 2021; 16:e0253569. [PMID: 34242253 PMCID: PMC8270452 DOI: 10.1371/journal.pone.0253569] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/08/2021] [Indexed: 01/12/2023] Open
Abstract
Background In Italy, in recent years, vaccination coverage for key immunizations as MMR has been declining to worryingly low levels, with large measles outbreaks. As a response in 2017, the Italian government expanded the number of mandatory immunizations introducing penalties to unvaccinated children’s families. During the 2018 general elections campaign, immunization policy entered the political debate with the government in-charge blaming oppositions for fuelling vaccine scepticism. A new government (formerly in the opposition) established in 2018 temporarily relaxed penalties and announced the introduction of forms of flexibility. Objectives and methods First, we supplied a definition of disorientation, as the “lack of well-established and resilient opinions among individuals, therefore causing them to change their positions as a consequence of sufficient external perturbations”. Second, procedures for testing for the presence of both short and longer-term collective disorientation in Twitter signals were proposed. Third, a sentiment analysis on tweets posted in Italian during 2018 on immunization topics, and related polarity evaluations, were used to investigate whether the contrasting announcements at the highest political level might have originated disorientation amongst the Italian public. Results Vaccine-relevant tweeters’ interactions peaked in response to main political events. Out of retained tweets, 70.0% resulted favourable to vaccination, 16.4% unfavourable, and 13.6% undecided, respectively. The smoothed time series of polarity proportions exhibit frequent large changes in the favourable proportion, superimposed to a clear up-and-down trend synchronized with the switch between governments in Spring 2018, suggesting evidence of disorientation among the public. Conclusions The reported evidence of disorientation for opinions expressed in online social media shows that critical health topics, such as vaccination, should never be used to achieve political consensus. This is worsened by the lack of a strong Italian institutional presence on Twitter, calling for efforts to contrast misinformation and the ensuing spread of hesitancy. It remains to be seen how this disorientation will impact future parents’ vaccination decisions.
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Affiliation(s)
- Samantha Ajovalasit
- Department of Economics and Business, University of Catania, Catania, Italy
- Department of Environmental Science, Informatics, and Statistics, Ca’ Foscari University of Venice, Venice, Italy
- * E-mail:
| | - Veronica Maria Dorgali
- Department of Statistics, Computer Science, Applications "G. Parenti" (DISIA), University of Florence, Florence, Italy
| | - Angelo Mazza
- Department of Economics and Business, University of Catania, Catania, Italy
| | - Alberto d’Onofrio
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom
- International Prevention Research Institute, Lyon, France
| | - Piero Manfredi
- Department of Economics and Management, University of Pisa, Pisa, Italy
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Affiliation(s)
| | - Allyson M Pollock
- Institute of Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
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18
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BOCCALINI SARA, PANATTO DONATELLA, MENNINI FRANCESCOSAVERIO, MARCELLUSI ANDREA, BINI CHIARA, AMICIZIA DANIELA, LAI PIEROLUIGI, MICALE ROSANNATINDARA, FRUMENTO DAVIDE, AZZARI CHIARA, RICCI SILVIA, BONITO BENEDETTA, DI PISA GIULIA, IOVINE MARIASILVIA, LODI LORENZO, GIOVANNINI MATTIA, MOSCADELLI ANDREA, PAOLI SONIA, PENNATI BEATRICEMARINA, PISANO LAURA, BECHINI ANGELA, BONANNI PAOLO. [ Health Technology Assessment (HTA) of the introduction of additional cohorts for anti-meningococcal vaccination with quadrivalent conjugate vaccines in Italy]. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E1-E128. [PMID: 34622076 PMCID: PMC8452280 DOI: 10.15167/2421-4248/jpmh2021.62.1s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- SARA BOCCALINI
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
- Autore corrispondente: Sara Boccalini, Dipartimento di Scienze della Salute, Università degli Studi di Firenze, 50134 Firenze, Italia - Tel.: 055-2751084 E-mail:
| | - DONATELLA PANATTO
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - FRANCESCO SAVERIO MENNINI
- Economic Evaluation and HTA - CEIS (EEHTA - CEIS), Facoltà di Economia, Università di Roma "Tor Vergata"
- Institute for Leadership and Management in Health, Kingston University, London, UK
| | - ANDREA MARCELLUSI
- Economic Evaluation and HTA - CEIS (EEHTA - CEIS), Facoltà di Economia, Università di Roma "Tor Vergata"
| | - CHIARA BINI
- Economic Evaluation and HTA - CEIS (EEHTA - CEIS), Facoltà di Economia, Università di Roma "Tor Vergata"
| | - DANIELA AMICIZIA
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - PIERO LUIGI LAI
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | | | - DAVIDE FRUMENTO
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - CHIARA AZZARI
- Immunologia, Clinica Pediatrica II, AOU Meyer, Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - SILVIA RICCI
- Immunologia, Clinica Pediatrica II, AOU Meyer, Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - BENEDETTA BONITO
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - GIULIA DI PISA
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | | | - LORENZO LODI
- Immunologia, Clinica Pediatrica II, AOU Meyer, Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - MATTIA GIOVANNINI
- Immunologia, Clinica Pediatrica II, AOU Meyer, Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - ANDREA MOSCADELLI
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - SONIA PAOLI
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | | | - LAURA PISANO
- Immunologia, Clinica Pediatrica II, AOU Meyer, Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - ANGELA BECHINI
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - PAOLO BONANNI
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
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D’Errico S, Turillazzi E, Zanon M, Viola RV, Frati P, Fineschi V. The Model of "Informed Refusal" for Vaccination: How to Fight against Anti-Vaccinationist Misinformation without Disregarding the Principle of Self-Determination. Vaccines (Basel) 2021; 9:vaccines9020110. [PMID: 33535717 PMCID: PMC7912813 DOI: 10.3390/vaccines9020110] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/15/2022] Open
Abstract
Vaccines are arguably a public health success story as well as an incredibly cost-effective medical resource. Despite this, worldwide concerns about their safety are growing, with the risk of increased morbidity and mortality in vaccine-preventable diseases because of vaccine refusal. The global political trend in developed countries is to increasingly reduce mandates and the compulsory nature of vaccination programs. This is due to strong opposition from anti-vaccination movements and groups. While these have existed since the beginnings of vaccinology, they have recently gained a strong foothold through massive exploitation of the media and especially the internet. This has led to widespread misinformation and greater difficulty for governments and health institutions in dealing with parents’ concerns and misconceptions. Common strategies in order to maintain a high degree of public acceptance of vaccines include the enhancement of adverse effect reporting systems, the enrichment of scientific literature, and the dissemination of targeted information to parents and health care providers. Vaccine risk perception, in fact, largely exceeds the evidence and is linked to well-known general population cognitive bias, which must be recognized and corrected. Although there is no doubt about the convenience of universal vaccination, a lively international debate is underway with regard to the legitimacy of mandatory vaccination programs. Most scientists agree that the individual’s right to self-determination should be preserved. The only way to simultaneously protect the right to health is to introduce an informed refusal model, which aims to guarantee the highest coverage rates for vaccination.
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Affiliation(s)
- Stefano D’Errico
- Department of Surgery, Medicine and Health, University of Trieste, 34149 Trieste, Italy; (S.D.); (M.Z.)
| | - Emanuela Turillazzi
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Martina Zanon
- Department of Surgery, Medicine and Health, University of Trieste, 34149 Trieste, Italy; (S.D.); (M.Z.)
| | - Rocco Valerio Viola
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (R.V.V.); (P.F.)
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (R.V.V.); (P.F.)
- IRCCS (Istituto di Ricerca e Cura a Carattere Scientifico) Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (R.V.V.); (P.F.)
- IRCCS (Istituto di Ricerca e Cura a Carattere Scientifico) Neuromed Mediterranean Neurological Institute, Via Atinense 18, 86077 Pozzilli, Italy
- Correspondence: ; Tel.: +39-06-49912722
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Almond J, Hacker J, Harwood C, Pizza M, Rappuoli R, Ron EZ, Sansonetti P, Vanderslott S, Wieler LH. Development of vaccines at the time of COVID-19. ACTA ACUST UNITED AC 2020; 1:uqaa003. [PMID: 34235437 PMCID: PMC7798935 DOI: 10.1093/femsml/uqaa003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/10/2020] [Indexed: 12/13/2022]
Abstract
In December 2019, a working group of the European Academy of Microbiology assembled to discuss various aspects of vaccines and vaccinations. The meeting was organised by Jörg Hacker and Eliora Z. Ron and took place in the offices of the Leopoldina (German National Academy of Sciences Leopoldina). Several important issues were addressed and a major part of the discussion focused on the need to develop new vaccines, especially to protect against pathogens that constitute a pandemic threat. Following the rapid and unpredicted spread of COVID-19 in the first seven months of 2020, the need to develop vaccines for pandemic viruses rapidly has been clearly established. Thus, this paper will concentrate on points that were highlighted by the recent COVID-19 pandemic and lessons learnt therefrom.
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Affiliation(s)
- Jeffrey Almond
- The Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford OX1 3RE, UK
| | - Jörg Hacker
- German National Academy of Science Leopoldina, Jägerberg 1, 06108 Halle, Germany
| | - Colin Harwood
- Centre for Bacterial Cell Biology, Biosciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne NE2 4AX, UK
| | | | - Rino Rappuoli
- GSK Vaccines, Via Fiorentina, 1, 53100 Siena SI, Italy
| | - Eliora Z Ron
- The Shmunis School of Biomedicine and Cancer Research, Faculty of Life Sciences, Tel Aviv University, PO Box 39040, Tel Aviv 6997801, Israel
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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: 19] [Impact Index Per Article: 4.8] [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.
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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.
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The role of alternative and complementary medical practices in vaccine hesitancy among nurses: A cross-sectional survey in Brittany. Infect Dis Now 2020; 52:159-163. [PMID: 33039553 DOI: 10.1016/j.medmal.2020.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 09/28/2020] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Given today's increasing calling into question of vaccination, we have studied possible connections between alternative and complementary medical practices (CAM) and vaccine hesitancy (VH) among nurses. METHOD Ours was a cross-sectional study by self-administered online questionnaire addressed to a panel of nurses in Brittany. After adjustment for other proximal and distal determinants of VH, we examined the impact of CAM use. RESULTS Multivariate logistic regressions confirmed the existence of a link between CAM and VH. While trust in medical institutions seems to have an important role, CAM use appears largely independent of VH. CONCLUSION Association between CAM and VH in nurses raises the question not only of their training with respect to these alternative practices, but also of the role of medical institutions in the training of practitioners availing themselves of the latter.
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Zuo S, Zhang D, Mu Q, Dai L, Du W, Xu F, Feng J, Heffelfinger JD. Increasing vaccination coverage: The school entry vaccination record check program in Guizhou Province China, 2003–2018. Vaccine 2020; 38:7379-7383. [DOI: 10.1016/j.vaccine.2020.08.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 08/04/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
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Plans-Rubió P. Are the Objectives Proposed by the WHO for Routine Measles Vaccination Coverage and Population Measles Immunity Sufficient to Achieve Measles Elimination from Europe? Vaccines (Basel) 2020; 8:vaccines8020218. [PMID: 32414021 PMCID: PMC7349949 DOI: 10.3390/vaccines8020218] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/30/2020] [Accepted: 05/06/2020] [Indexed: 12/20/2022] Open
Abstract
Background: The World Health Organization (WHO) proposed two-dose measles vaccination coverage of at least 95% of the population and percentages of measles immunity in the population of 85%−95% in order to achieve measles elimination in Europe. The objectives of this study were: (1) to determine the measles vaccination coverage required to establish herd immunity against measles viruses with basic reproduction numbers (Ro) ranging from 6 to 60, and (2) to assess whether the objectives proposed by the WHO are sufficient to establish herd immunity against measles viruses. Methods: The herd immunity effects of the recommended objectives were assessed by considering the prevalence of protected individuals required to establish herd immunity against measles viruses with Ro values ranging from 6 to 60. Results: The study found that percentages of two-dose measles vaccination coverage from 88% to 100% could establish herd immunity against measles viruses with Ro from 6 to 19, assuming 95% measles vaccination effectiveness. The study found that the objective of 95% for two-dose measles vaccination coverage proposed by the WHO would not be sufficient to establish herd immunity against measles viruses with Ro ≥ 10, assuming 95% measles vaccination effectiveness. By contrast, a 97% measles vaccination coverage objective was sufficient to establish herd immunity against measles viruses, with Ro values from 6 to 13. Measles immunity levels recommended in individuals aged 1−4 years (≥85%) and 5−9 years (≥90%) might not be sufficient to establish herd immunity against most measles viruses, while those recommended in individuals aged 10 or more years (≥95%) could be sufficient to establish herd immunity against measles viruses with Ro values from 6 to 20. Conclusion: To meet the goal of measles elimination in Europe, it is necessary to achieve percentages of two-dose measles vaccination coverage of at least 97%, and measles immunity levels in children aged 1−9 years of at least 95%.
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Affiliation(s)
- Pedro Plans-Rubió
- Public Health Agency of Catalonia, Department of Health of Catalonia, Barcelona 08005, Spain;
- Ciber of Epidemiology and Public Health (CIBERESP), Madrid 28028, Spain
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Affiliation(s)
- Elena Conis
- Graduate School of Journalism and Center for Science, Technology, Medicine, and Society, University of California, Berkeley, Berkeley, California; and Department of Anthropology, History, and Social Medicine, University of California, San Francisco, San Francisco, California
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Abstract
Maintaining high vaccination coverage is important in order to protect the individual and the community. Mandatory vaccination is an option in case of declining coverage. Widely used in the USA, it is considered a rather controversial issue in Europe. In Italy, after a decrease of vaccination coverage for the hexavalent and the MPR vaccine under the optimal threshold, a new law, which extended the number of mandatory vaccines from 4 to 10 and reinforced coercive measures, was introduced in July 2017. After 2 years, vaccination coverage increased for all mandatory vaccines and for the other two recommended vaccines (anti-pneumococcal and anti-meningococcal C). Although it is not possible to disentangle the role of other factors contributing to the positive outcome, consistently with the results of studies conducted in the USA, vaccine mandates appeared to be successful in increasing vaccination coverage in Italy. The long-term sustainability of the effect of mandatory vaccination and the potential negative drawbacks of the coercive measures need to be evaluated to generate scientific evidence in public health.
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Affiliation(s)
- Giovanni Rezza
- Department of Infectious Diseases, Istituto Superiore di Sanità, Roma, Italy
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Vrdelja M, Učakar V, Kraigher A. From mandatory to voluntary vaccination: intention to vaccinate in the case of policy changes. Public Health 2019; 180:57-63. [PMID: 31855620 DOI: 10.1016/j.puhe.2019.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/06/2019] [Accepted: 10/30/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of the study was to assess the association between sociodemographic characteristics and attitudes according to health belief model (HBM) attributes with the intention to vaccinate children in cases of non-mandatory vaccination to support informed decisions in planned revision of our vaccination policy. STUDY DESIGN This is a cross-sectional study carried out on a random sample of 3,854 women with young children in Slovenia. METHODS The participants' attitudes were grouped within six HBM attributes (perceived susceptibility, severity, benefits, barriers, clue to action and self-efficacy). Possible associations between the intention to vaccinate children in cases of non-mandatory vaccination and sociodemographic characteristics or attitudinal attributes according to HBM were explored in univariate analyses by calculating odds ratios (ORs) with 95% confidence interval (CI) estimates. RESULTS Just more than half (56.2%; 95% CI: 53.8-58.5%) of the women reported on their intention to vaccinate their children in the case of non-mandatory vaccination, and 23.4% (95% CI: 21.4-25.5%) were undecided. There were no significant sociodemographic predictor variables in relation to this intention. Those who perceived higher susceptibility to vaccine-preventable diseases or the benefits of vaccination were more likely to intend to vaccinate in the case of non-mandatory vaccination (OR = 5.70; 95% CI: 4.64-7.00) and (OR = 7.62; 95% CI: 5.96-9.76). Perceived barriers to vaccinate (fear of side-effects or lack of comprehensive information from physicians) and parents not getting enough useful information in general as a clue to action were significant predictors of an intention not to vaccinate. CONCLUSIONS Our results show that a mandatory vaccination policy is an important factor in ensuring high levels of vaccination coverage in Slovenia. In future, more comprehensive communication activities focused on vaccine-preventable diseases and the benefits and safety of vaccination (for the education of parents and their healthcare providers) are needed to diminish the reliance on a mandatory vaccination policy.
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Affiliation(s)
- M Vrdelja
- National Institute of Public Health, Trubarjeva 2, 1000, Ljubljana, Slovenia.
| | - V Učakar
- National Institute of Public Health, Trubarjeva 2, 1000, Ljubljana, Slovenia
| | - A Kraigher
- Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, 1000 Ljubljana, Slovenia
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McCoy CA. Adapting Coercion: How Three Industrialized Nations Manufacture Vaccination Compliance. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2019; 44:823-854. [PMID: 31408878 DOI: 10.1215/03616878-7785775] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CONTEXT This research examines the development of vaccination policy in Britain, the United States, and Australia to begin to understand the different forms of coercion that industrialized states utilize to achieve vaccination compliance from the majority of their citizens. METHODS This research applies a comparative-historical analysis of the three countries listed, using a combination of primary and secondary documents. FINDINGS The different degrees of compulsion in the vaccination policies of Britain, the United States, and Australia is explained through an analysis of the path-dependent ways that each nation adapted coercion in response to civil society resistance. Each nation has moved up and down a continuum of coercion searching for a policy that balances overcoming passive noncompliance without engendering active resistance. Arriving at different balancing points between these two objectives, the three nations have now institutionalized policies with different degrees of coercion. CONCLUSIONS This research shows that vaccination policy is not just created top-down by the state, but through an ongoing interactive process with citizens and civil society. Furthermore, as vaccination is a "wicked problem" that faces ongoing civil society resistance, states will need to perpetually adapt the coerciveness of their policies into the foreseeable future.
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Funk S, Knapp JK, Lebo E, Reef SE, Dabbagh AJ, Kretsinger K, Jit M, Edmunds WJ, Strebel PM. Combining serological and contact data to derive target immunity levels for achieving and maintaining measles elimination. BMC Med 2019; 17:180. [PMID: 31551070 PMCID: PMC6760101 DOI: 10.1186/s12916-019-1413-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaccination has reduced the global incidence of measles to the lowest rates in history. However, local interruption of measles virus transmission requires sustained high levels of population immunity that can be challenging to achieve and maintain. The herd immunity threshold for measles is typically stipulated at 90-95%. This figure does not easily translate into age-specific immunity levels required to interrupt transmission. Previous estimates of such levels were based on speculative contact patterns based on historical data from high-income countries. The aim of this study was to determine age-specific immunity levels that would ensure elimination of measles when taking into account empirically observed contact patterns. METHODS We combined estimated immunity levels from serological data in 17 countries with studies of age-specific mixing patterns to derive contact-adjusted immunity levels. We then compared these to case data from the 10 years following the seroprevalence studies to establish a contact-adjusted immunity threshold for elimination. We lastly combined a range of hypothetical immunity profiles with contact data from a wide range of socioeconomic and demographic settings to determine whether they would be sufficient for elimination. RESULTS We found that contact-adjusted immunity levels were able to predict whether countries would experience outbreaks in the decade following the serological studies in about 70% of countries. The corresponding threshold level of contact-adjusted immunity was found to be 93%, corresponding to an average basic reproduction number of approximately 14. Testing different scenarios of immunity with this threshold level using contact studies from around the world, we found that 95% immunity would have to be achieved by the age of five and maintained across older age groups to guarantee elimination. This reflects a greater level of immunity required in 5-9-year-olds than established previously. CONCLUSIONS The immunity levels we found necessary for measles elimination are higher than previous guidance. The importance of achieving high immunity levels in 5-9-year-olds presents both a challenge and an opportunity. While such high levels can be difficult to achieve, school entry provides an opportunity to ensure sufficient vaccination coverage. Combined with observations of contact patterns, further national and sub-national serological studies could serve to highlight key gaps in immunity that need to be filled in order to achieve national and regional measles elimination.
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Affiliation(s)
- Sebastian Funk
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Jennifer K. Knapp
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA USA
| | - Emmaculate Lebo
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA USA
| | - Susan E. Reef
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA USA
| | - Alya J. Dabbagh
- World Health Organization, Avenue Appia 20, Geneva, Switzerland
| | | | - Mark Jit
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
- Modelling and Economics Unit, National Infections Service, Public Health England, 61 Colindale Avenue, London, UK
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Hong Kong SAR, China
| | - W. John Edmunds
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Peter M. Strebel
- GAVI Alliance, Chemin du Pommier 40, Le Grand-Saconnex, Switzerland
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Ghedamu TB, Meier BM. Assessing National Public Health Law to Prevent Infectious Disease Outbreaks: Immunization Law as a Basis for Global Health Security. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2019; 47:412-426. [PMID: 31560619 DOI: 10.1177/1073110519876174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Immunization plays a crucial role in global health security, preventing public health emergencies of international concern and protecting individuals from infectious disease outbreaks, yet these critical public health benefits are dependent on immunization law. Where public health law has become central to preventing, detecting, and responding to infectious disease, public health law reform is seen as necessary to implement the Global Health Security Agenda (GHSA). This article examines national immunization laws as a basis to implement the GHSA and promote the public's health, analyzing the scope and content of these laws to prevent infectious disease across Sub-Saharan Africa. Undertaking policy surveillance of national immunization laws in 20 Sub-Saharan African countries, this study: (1) developed a legal framework to map the legal attributes relevant to immunization; (2) created an assessment tool to determine the presence of these attributes under national immunization law; and (3) applied this assessment tool to code national legal landscapes. An analysis of these coded laws highlights legal attributes that govern vaccine requirements, supply chains, vaccine administration standards, and medicines quality and manufacturer liability. Based upon this international policy surveillance, it will be crucial to undertake legal epidemiology research across countries, examining the influence of immunization law on vaccination rates and disease outbreaks.
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Affiliation(s)
- Tsion Berhane Ghedamu
- Tsion Berhane Ghedamu, M.S.P.H, is a Program Manager at the Aspen Institute. Benjamin Mason Meier, J.D., LL.M., Ph.D., is an Associate Professor of Global Health Policy at the University of North Carolina at Chapel Hill and a Scholar at the O'Neill Institute for National and Global Health Law
| | - Benjamin Mason Meier
- Tsion Berhane Ghedamu, M.S.P.H, is a Program Manager at the Aspen Institute. Benjamin Mason Meier, J.D., LL.M., Ph.D., is an Associate Professor of Global Health Policy at the University of North Carolina at Chapel Hill and a Scholar at the O'Neill Institute for National and Global Health Law
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Porat T, Garaizar P, Ferrero M, Jones H, Ashworth M, Vadillo MA. Content and source analysis of popular tweets following a recent case of diphtheria in Spain. Eur J Public Health 2019; 29:117-122. [PMID: 30084926 DOI: 10.1093/eurpub/cky144] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Despite major progress in global vaccination coverage, immunization rates are falling, resulting in outbreaks of vaccine-preventable diseases. This study analyses content and source of the most popular tweets related to a recent case in Spain where an unvaccinated child contracted and later died from diphtheria. Understanding the characteristics of these tweets in the context of vaccination could inform efforts by health promotion professionals to increase their reach and impact. Methods We extracted tweets containing keywords related to the diphtheria case (from 1 May to 15 July 2015). We explored the prevalence of terms relating to policy and misinformation and manually coded the 194 most popular tweets (retweeted 100 or more times) with regard to source, topic, tone and sentiment. Results A total of 722 974 tweets were collected. Prevalence of terms relating to policy and misinformation increased at the onset of the case and after the death of the child. Popular tweets (194) were either pro-vaccination (58%) or neutral, with none classified as anti-vaccination. Popular topics included criticism towards anti-vaccination groups (35%) and effectiveness of immunization (22%). Popular tweets were informative (47%) or opinions (53%), which mainly expressed frustration (24%) or humour/sarcasm (23%). Popular Twitter accounts were newspaper and TV channels (15%), as well as individual journalists and authors of popular science (13.4%). Conclusions Healthcare organizations could collaborate with popular journalists or news outlets and employ authors of popular science to disseminate health information on social media, while addressing public concerns and misinformation in accessible ways.
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Affiliation(s)
- Talya Porat
- Dyson School of Design Engineering, Imperial College London, London, UK.,School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Pablo Garaizar
- Department of Computer Engineering, University of Deusto, Bilbao, Spain
| | - Marta Ferrero
- Department of Experimental Psychology, University College London, London, UK
| | - Hilary Jones
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Mark Ashworth
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Miguel A Vadillo
- School of Population Health & Environmental Sciences, King's College London, London, UK.,Departamento de Psicología Básica, Universidad Autónoma de Madrid, Madrid, Spain
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Greyson D, Vriesema-Magnuson C, Bettinger JA. Impact of school vaccination mandates on pediatric vaccination coverage: a systematic review. CMAJ Open 2019; 7:E524-E536. [PMID: 31431485 PMCID: PMC6703989 DOI: 10.9778/cmajo.20180191] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Mandated vaccination for school attendance is a growing strategy internationally. Our aim was to investigate the effects of implementing school vaccination mandates on pediatric population vaccine coverage. METHODS In this systematic review, we searched MEDLINE, Embase, CINAHL, the Education Resources Information Center (ERIC) and the PAIS Index for empirical studies of implementation of a primary or secondary school vaccination requirement published in any language through March 2019 with vaccination rates as an outcome. We sought additional studies by consulting experts, reference lists and grey literature sources. Included studies were too heterogeneous for meta-analysis; thus, we extracted data using a standardized rubric and synthesized the results narratively. RESULTS Among the 4232 citations obtained, 20 studies met the inclusion criteria. Eighteen were conducted with US data, 1 with Italian data, and 1 with Australian data. Four studies examined school-entry mandates, and 16 examined adolescent requirements. An uncontrolled before-after design was used in 10 studies, cross-sectional analysis in 7, a retrospective cohort design in 2, and a prospective cohort in 1. In many cases, increased documentation of coverage followed the addition of new requirements. The exception to this was human papillomavirus vaccination mandates, which were highly controversial, in the United States. The studies contained notable risks of bias, with cointerventions rarely acknowledged or accounted for, and subpopulations often excluded. A substantial risk of ecological fallacy existed for most studies. INTERPRETATION Vaccination mandates appear largely associated with increased vaccination coverage, but it is not possible to attribute causality to the mandate in most studies. High-quality implementation research that uses whole-population coverage data and takes into consideration cointerventions, confounders, clustering of unvaccinated populations and context is required.
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Affiliation(s)
- Devon Greyson
- Department of Communication (Greyson), University of Massachusetts, Amherst, Mass.; Vaccine Evaluation Center (Greyson, Bettinger), BC Children's Hospital Research Institute; Department of Pediatrics (Greyson, Bettinger) and School of Library, Archival and Information Studies (Vriesema-Magnuson), University of British Columbia, Vancouver, BC
| | - Chris Vriesema-Magnuson
- Department of Communication (Greyson), University of Massachusetts, Amherst, Mass.; Vaccine Evaluation Center (Greyson, Bettinger), BC Children's Hospital Research Institute; Department of Pediatrics (Greyson, Bettinger) and School of Library, Archival and Information Studies (Vriesema-Magnuson), University of British Columbia, Vancouver, BC
| | - Julie A Bettinger
- Department of Communication (Greyson), University of Massachusetts, Amherst, Mass.; Vaccine Evaluation Center (Greyson, Bettinger), BC Children's Hospital Research Institute; Department of Pediatrics (Greyson, Bettinger) and School of Library, Archival and Information Studies (Vriesema-Magnuson), University of British Columbia, Vancouver, BC
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Dascalu S. Measles Epidemics in Romania: Lessons for Public Health and Future Policy. Front Public Health 2019; 7:98. [PMID: 31073518 PMCID: PMC6496956 DOI: 10.3389/fpubh.2019.00098] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/08/2019] [Indexed: 11/13/2022] Open
Abstract
Measles is a highly infectious viral disease that continues to be a challenge for many countries worldwide. Although significant improvements have been observed since the introduction of vaccines, measles remains endemic in Romania. Contributing factors include vaccine hesitancy, difficulties in delivering doses to the population, and even the lack of sufficient vaccine supplies. These problems are further exacerbated by an inadequate implementation of public health measures, ranging from inefficient communication programs to the absence of a legislative framework concerning immunization. Moreover, many of the recent outbreaks were associated with chains of transmission in other countries, thus making the control of measles in Romania relevant at an international level. As many difficulties exist, understanding the key factors that limit the success of public health programs may provide guidance in shaping future strategies. Because similar issues are being faced in various other countries, the management of measles in Romania offers valuable lessons for researchers and policy-makers alike.
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Affiliation(s)
- Stefan Dascalu
- Department of Zoology, University of Oxford, Oxford, United Kingdom.,Avian Influenza Virus, Pirbright Institute (BBSRC), Woking, United Kingdom
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35
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Luyten J, Bruyneel L, van Hoek AJ. Assessing vaccine hesitancy in the UK population using a generalized vaccine hesitancy survey instrument. Vaccine 2019; 37:2494-2501. [PMID: 30940484 DOI: 10.1016/j.vaccine.2019.03.041] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 03/12/2019] [Accepted: 03/20/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND In many regions of the world, vaccine hesitancy has become an important concern to public health. A key part of any effective solution to it is to gain an in-depth understanding of the problem: its scope, who holds hesitant views and for which reasons. METHODS We adapt the original 10-item Vaccine Hesitancy Scale (VHS), which targets parental attitudes, to a more generic version that captures general attitudes to vaccination. We use this adapted VHS in a sample of 1402 British citizens, selected from a large online panel (N > 1,000,000) based on quota for age, gender, educational attainment and region (response rate 43%). The existence of VHS subscales is evaluated via exploratory and confirmatory factor analysis. We describe the extent of vaccine hesitancy in the sample, and use simple and multiple regression analysis to examine associations between respondent characteristics and vaccine hesitancy. RESULTS Despite ambiguities in defining hesitancy, we found that a substantial part of our sample held hesitant views about vaccination, particularly for those items reflecting aversion to risks of side effects. Four percent responded in a hesitant way to all ten items and ninety to at least one of the ten items. In line with recent studies in other populations, we identified two subscales within the VHS: lack of confidence in the need for vaccines and aversion to the risk of side effects. We found significant associations between hesitancy and various respondent characteristics but the predictive power of these associations remained limited. CONCLUSION Our study suggests that whereas a substantial percentage of the British population is vaccine hesitant, these views are not clustered in typical demographic features. The small but important adaptation of the VHS to target general attitudes seems to result in highly similar psychometric characteristics as the original scale that exclusively targets parents. We provide suggestions for further validation of the VHS.
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Affiliation(s)
- Jeroen Luyten
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium.
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium
| | - Albert Jan van Hoek
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; Centre for Infectious Diseases, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, the Netherlands
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Zhang EJ, Chughtai AA, Heywood A, MacIntyre CR. Influence of political and medical leaders on parental perception of vaccination: a cross-sectional survey in Australia. BMJ Open 2019; 9:e025866. [PMID: 30914408 PMCID: PMC6475250 DOI: 10.1136/bmjopen-2018-025866] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of this survey was to investigate parental vaccination attitudes and responses to vaccine-related media messages from political and medical leaders. DESIGN This was a cross-sectional study using a semiquantitative questionnaire. Data were analysed using descriptive statistics, X2 tests and logistic regression. SETTING Data were collected from a web-based questionnaire distributed in Australia by a market research company in May of 2017. PARTICIPANTS 411 participants with at least one child under 5 were included in this study. The sample was designed to be representative of Australia in terms of gender and state of residence. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measures were parental attitudes towards childhood immunisation before and after viewing vaccine-related messages from political and medical leaders, including Donald Trump (USA), Pauline Hanson (Australia) and Michael Gannon (Australia). Parents were classified as having 'susceptible' (not fixed) or 'fixed' (positive or negative) views towards vaccination based on a series of questions. RESULTS Parents with fixed vaccination views constituted 23.8% (n=98) of the total sample; 21.7% (n=89) were pro-vaccination and 2.2% (n=9) were anti-vaccination. The remaining 76.2% of participants were classified as having susceptible views towards vaccination. Susceptible parents were more likely to report a change in their willingness to vaccinate after watching vaccine-related messages compared with fixed-view parents, regardless of whether the messaging was positive or negative (Trump OR 2.54, 95% CI (1.29 to 5.00); Hanson OR 2.64, 95% CI (1.26 to 5.52); Gannon OR 2.64, 95% CI (1.26 to 5.52)). Susceptible parents were more likely than fixed-view parents to report increased vaccine hesitancy after viewing negative vaccine messages (Trump OR 2.14, 95% CI (1.11 to 4.14), Hanson OR 2.34, 95% CI (1.21 to 4.50)). CONCLUSIONS The findings suggest that most parents including the vaccinating majorty are susceptible to vaccine messaging from political and medical leaders. Categorising parents as 'fixed-view' or 'susceptible' can be a useful strategy for designing and implementing future vaccine promotion interventions.
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Affiliation(s)
- Elissa J Zhang
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Anita Heywood
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Chandini Raina MacIntyre
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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Quantifying the public's view on social value judgments in vaccine decision-making: A discrete choice experiment. Soc Sci Med 2019; 228:181-193. [PMID: 30925392 DOI: 10.1016/j.socscimed.2019.03.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 03/13/2019] [Accepted: 03/15/2019] [Indexed: 11/22/2022]
Abstract
Vaccination programs generate direct protection, herd protection and, occasionally, side effects, distributed over different age groups. This study elicits the general public's view on how to balance these outcomes in funding decisions for vaccines. We performed an optimal design discrete choice experiment with partial profiles in a representative sample (N = 1499) of the population in the United Kingdom in November 2016. Using a panel mixed logit model, we quantified, for four different types of infectious disease, the importance of a person's age during disease, how disease was prevented-via direct vaccine protection or herd protection-and whether the vaccine induced side effects. Our study shows clear patterns in how the public values vaccination programs. These diverge from the assumptions made in public health and cost-effectiveness models that inform decision-making. We found that side effects and infections in newborns and children were of primary importance to the perceived value of a vaccination program. Averting side effects was, in any age group, weighted three times as important as preventing an identical natural infection in a child whereas the latter was weighted six times as important as preventing the same infection in elderly aged 65-75 years. These findings were independent of the length or severity of the disease, and were robust across respondents' backgrounds. We summarize these patterns in a set of preference weights that can be incorporated into future models. Although the normative significance of these weights remains a matter open for debate, our study can, hopefully, contribute to the evaluation of vaccination programs beyond cost-effectiveness.
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McCullough JM, Sunenshine R, Rusinak R, Mead P, England B. Association of Presence of a School Nurse With Increased Sixth-Grade Immunization Rates in Low-Income Arizona Schools in 2014-2015. J Sch Nurs 2019; 36:360-368. [PMID: 30669932 DOI: 10.1177/1059840518824639] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
School nurses often play large roles in implementation of school vaccination requirements aimed at controlling the spread of communicable disease. We analyzed the association between the presence of a school nurse and school-level vaccination rates in Arizona. Using school-level data from Arizona sixth-grade schools (n = 749), we regressed average sixth-grade school-level immunization rates on presence of a school nurse (registered nurse [RN] or licensed practical nurse [LPN]) and school-level socioeconomic status (SES), controlling for other school- and district-level characteristics. Schools with a nurse had higher overall vaccination rates than those without a nurse (96.1% vs. 95.0%, p < .01). For schools in the lowest SES quartile, the presence of a school nurse was associated with approximately 2 percentage point higher immunization rates. These findings add to the growing literature that defines the impact of school nurses on student health status and outcomes, emphasizing the value of school nurses, especially in lower SES schools.
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Affiliation(s)
- J Mac McCullough
- 27150Maricopa County Department of Public Health, Phoenix, AZ, USA.,College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Rebecca Sunenshine
- 27150Maricopa County Department of Public Health, Phoenix, AZ, USA.,Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Patty Mead
- Mohave County Department of Public Health, Kingman, AZ, USA
| | - Bob England
- 27150Maricopa County Department of Public Health, Phoenix, AZ, USA
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McDonald P, Limaye RJ, Omer SB, Buttenheim AM, Mohanty S, Klein NP, Salmon DA. Exploring California's new law eliminating personal belief exemptions to childhood vaccines and vaccine decision-making among homeschooling mothers in California. Vaccine 2019; 37:742-750. [PMID: 30626531 DOI: 10.1016/j.vaccine.2018.12.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/31/2018] [Accepted: 12/10/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND California's Senate Bill 277 (SB-277) law eliminated the personal belief exemption to school immunization requirements. A potential consequence may be that parents choose homeschooling to avoid immunization. Vaccine attitudes and behaviors have not been well studied among the home-schooling population. This study explored the effect of SB-277 and vaccine decision-making among California home schoolers. METHODS Purposive and snowball sampling were used recruit home-schooling parents through home-schooling Facebook groups based on home school type in high-exemption regions in California for in-depth interviews. Participants had to have a child in a legalized form of homeschooling in California in grades kindergarten-twelfth grade. RESULTS Twenty-four mothers were interviewed. Participants were categorized based on self-reported vaccine attitudes and behavior into three groups: Confident and Accepting, Hesitant and Accepting, and Skeptical and Refusing. All reported the belief that SB-277 is an infringement on parental rights but was not currently impacting them. Confident and Accepting mothers (n = 10) generally believed vaccinations were safe, effective, and posed a lower risk than vaccine preventable disease (VPD). Hesitant and Accepting mothers (n = 5) expressed varying confidence levels in the belief that vaccinations were safe and effective, were not confident in the belief that vaccination posed lower risks than VPD risk, and risk perception affected vaccine decision-making. Skeptical and Refusing mothers (n = 9) generally believed that vaccinations were unsafe and ineffective, refused select vaccines, believed that vaccination posed a more serious risk than VPD risks, and belief of vaccine harm was a salient factor in vaccine decision-making. CONCLUSION Home-schooling mothers were concerned about SB-277 but did not report that it was directly impacting their children, their vaccine decisions, or reason to home school. Vaccine attitudes and beliefs among homeschooling mothers broadly fell into categories similar to parents of non-home-schooled children. Future quantitative studies should measure vaccine hesitancy and refusal prevalence and potential confounders.
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Affiliation(s)
- Pamela McDonald
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Rupali J Limaye
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 N. Wolfe E6608, Baltimore, MD USA.
| | - Saad B Omer
- Emory University Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA USA
| | - Alison M Buttenheim
- University of Pennsylvania School of Nursing, Department of Family and Community Health, Philadelphia, PA USA
| | - Salini Mohanty
- University of Pennsylvania School of Nursing, Department of Family and Community Health, Philadelphia, PA USA
| | | | - Daniel A Salmon
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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40
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Ward JK, Cafiero F, Fretigny R, Colgrove J, Seror V. France's citizen consultation on vaccination and the challenges of participatory democracy in health. Soc Sci Med 2019; 220:73-80. [DOI: 10.1016/j.socscimed.2018.10.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 10/19/2018] [Accepted: 10/31/2018] [Indexed: 11/25/2022]
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41
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Degeling C, Gilbert GL, Annand E, Taylor M, Walsh MG, Ward MP, Wilson A, Johnson J. Managing the risk of Hendra virus spillover in Australia using ecological approaches: A report on three community juries. PLoS One 2018; 13:e0209798. [PMID: 30596719 PMCID: PMC6312203 DOI: 10.1371/journal.pone.0209798] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/11/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hendra virus (HeV) infection is endemic in Australian flying-fox populations. Habitat loss has increased the peri-urban presence of flying-foxes, increasing the risk of contact and therefore viral 'spillovers' into horse and human populations. An equine vaccine is available and horse-husbandry practices that minimize HeV exposure are encouraged, but their adoption is suboptimal. Ecological approaches-such as habitat creation and conservation-could complement vaccination and behavioural strategies by reducing spillover risks, but these are controversial. METHODS We convened three community juries (two regional; one metropolitan) to elicit the views of well-informed citizens on the acceptability of adding ecological approaches to current interventions for HeV risk. Thirty-one participants of diverse backgrounds, mixed genders and ages were recruited using random-digit-dialling. Each jury was presented with balanced factual evidence, given time to ask questions of expert presenters and, after deliberation, come to well-reasoned conclusions. RESULTS All juries voted unanimously that ecological strategies should be included in HeV risk management strategies but concluded that current interventions-including vaccination and changing horse-husbandry practices-must remain the priority. The key reasons given for adopting ecological approaches were: (i) they address underlying drivers of disease emergence, (ii) the potential to prevent spillover of other bat-borne pathogens, and (iii) there would be broader community benefits. Juries differed regarding the best mechanism to create/conserve flying-fox habitat: participants in regional centres favoured direct government action, whereas the metropolitan jury preferred to place the burden on landholders. CONCLUSIONS Informed citizens acknowledge the value of addressing the drivers of bat-borne infectious risks but differ substantially as to the best implementation strategies. Ecological approaches to securing bat habitat could find broad social support in Australia, but disagreement about how best to achieve them indicates the need for negotiation with affected communities to co-develop fair, effective and locally appropriate policies.
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Affiliation(s)
- Chris Degeling
- Australian Centre for Health Engagement Evidence and Values, School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
- * E-mail:
| | - Gwendolyn L. Gilbert
- Sydney Health Ethics, School of Public Health, University of Sydney, Sydney, NSW, Australia
- Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, NSW, Australia
| | - Edward Annand
- Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, NSW, Australia
- Sydney School of Veterinary Science, University of Sydney, Camden, NSW, Australia
- EquiEpiVet, Picton, NSW, Australia
| | - Melanie Taylor
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Michael G. Walsh
- Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, NSW, Australia
- Westmead Clinical School, Sydney Medical School, University of Sydney, Westmead, NSW, Australia
| | - Michael P. Ward
- Sydney School of Veterinary Science, University of Sydney, Camden, NSW, Australia
| | - Andrew Wilson
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia
| | - Jane Johnson
- Sydney Health Ethics, School of Public Health, University of Sydney, Sydney, NSW, Australia
- Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, NSW, Australia
- Westmead Clinical School, Sydney Medical School, University of Sydney, Westmead, NSW, Australia
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MacDonald NE, Harmon S, Dube E, Steenbeek A, Crowcroft N, Opel DJ, Faour D, Leask J, Butler R. Mandatory infant & childhood immunization: Rationales, issues and knowledge gaps. Vaccine 2018; 36:5811-5818. [DOI: 10.1016/j.vaccine.2018.08.042] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/16/2018] [Accepted: 08/15/2018] [Indexed: 01/08/2023]
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MacDonald NE, Butler R, Dubé E. Addressing barriers to vaccine acceptance: an overview. Hum Vaccin Immunother 2018; 14:218-224. [PMID: 29048975 PMCID: PMC5791591 DOI: 10.1080/21645515.2017.1394533] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/14/2017] [Indexed: 12/25/2022] Open
Abstract
Addressing the drivers of vaccine hesitancy and the barriers to vaccine acceptance is a complex but important task. While the percentage of hesitant does vary from country to country and in time few, if any, countries are ever free from this problem. Overcoming hesitancy requires detection, diagnosis and tailored intervention as there is no simple strategy that can address all of the barriers to vaccine acceptance. Immunization program managers and health care workers need to become adept at recognizing and tackling hesitancy in all of its incarnations if high levels of vaccine acceptance are to be achieved but must also actively support immunization acceptors in order to build and support vaccine acceptance resiliency. This paper presents evidence-informed strategies to achieve these goals.
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Affiliation(s)
- Noni E. MacDonald
- Department of Paediatrics, Dalhousie University, Canadian Centre for Vaccinology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Robb Butler
- Division of Communicable Diseases, Health Security and Environment, WHO Regional Office for Europe, Copenhagen Ø, Denmark
| | - Eve Dubé
- Institut National de Santé Publique du Québec, Québec, QC, Canada
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Krok-Schoen JL, Bernardo BM, Weier RC, Peng J, Katz ML, Reiter PL, Richardson MS, Pennell ML, Tatum CM, Paskett ED. Belief About Mandatory School Vaccinations and Vaccination Refusal Among Ohio Appalachian Parents: Do Demographic and Religious Factors, General Health, and Political Affiliation Play a Role? J Rural Health 2017; 34:283-292. [PMID: 29135050 DOI: 10.1111/jrh.12285] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/18/2017] [Accepted: 10/16/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine how demographic, general health, religious, and political characteristics influenced beliefs about mandatory school vaccinations and history of vaccination refusal for children among Ohio Appalachian parents. METHODS In 2013 and 2014, baseline data were obtained from parents (n = 337) of girls aged 9-17 from 12 counties in rural Ohio Appalachia enrolled in the Community Awareness, Resources and Education (CARE II) Project. Multivariate logistic regression models were used to identify correlates of parental beliefs about mandatory school vaccinations and history of refusing a doctor-recommended vaccine for their child(ren). RESULTS About 47% of parents agreed that parents should have the right to refuse mandatory school vaccinations for their child(ren). Participants who reported their political affiliation as Republican (OR = 2.45, 95% CI: 1.28-4.66) or Independent (OR = 3.31, 95% CI: 1.70-6.44) were more likely to agree that parents should have the right to refuse school-mandated vaccinations than parents who reported their political affiliation as Democrat. Approximately 39% of parents reported ever refusing a vaccine for their child(ren). Participants who were female (OR = 3.90, 95% CI: 1.04-14.58) and believed that parents should have the right to refuse mandatory school vaccinations (OR = 3.27, 95% CI: 1.90-5.62) were more likely to report ever refusing a vaccine for their child(ren). CONCLUSION The study findings provide information to better understand factors related to vaccination refusal among parents in Appalachia Ohio that can be used to design interventions to improve vaccination uptake.
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Affiliation(s)
- Jessica L Krok-Schoen
- Division of Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio.,Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | | | | | - Juan Peng
- Center for Biostatistics, Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Mira L Katz
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.,Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Paul L Reiter
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Morgan S Richardson
- Department of Neurology, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Michael L Pennell
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Cathy M Tatum
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Electra D Paskett
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
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45
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Kamin-Friedman S. Would it be legally justified to impose vaccination in Israel? Examining the issue in light of the 2013 detection of polio in Israeli sewage. Isr J Health Policy Res 2017; 6:58. [PMID: 29084599 PMCID: PMC5661933 DOI: 10.1186/s13584-017-0182-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 10/18/2017] [Indexed: 11/25/2022] Open
Abstract
Background The detection of wild poliovirus in Israeli sewage in May 2013 led the health authorities to decide that children who had been vaccinated with IPV would also be vaccinated with OPV. The decision sought to protect vulnerable Israeli individuals who were either not vaccinated with IPV or who suffered from an immune deficiency, to preserve Israel’s status as a polio-free country, to prevent the virus’ “exportation” into vulnerable polio-free countries, and to participate in the global efforts toward the eradication of polio. After a massive public persuasion campaign, 79% of the children born after 2004 were vaccinated as well as 69% of the children residing in central Israel. A 2014 State Comptroller Report stated that the Ministry of Health should draw conclusions from the low compliance rates in certain Israeli regions. Goals The article seeks to examine the legal legitimacy of mandatory vaccination in the service of eradicating a contagious disease (as opposed to preventing a pandemic outbreak), which was one of the objectives in the 2013 Polio case. It more specifically relates to current Israeli law as well as to a hypothetical new public health law which would authorize health officials to oblige vaccination and enforce this through the use of criminal sanctions. Method Qualitative content analysis through the interpretation of court judgements, laws, legislative protocols, health ministry guidelines and documented discussions of the Advisory Committee on Infectious Diseases and Immunization. Main findings and conclusion A mandatory vaccination backed by criminal sanctions in the service of the eradication of contagious diseases would probably be perceived as infringing on the constitutional right to autonomy to a greater extent than necessary according to Israeli law and case law precedents. There may be some added value inherent in a new public health law which would authorize health officials to oblige vaccination where nonrestrictive measures have been ineffective. However, the law should also specify a variety of sanctions to accompany the enforcement of mandatory vaccinations which would be formulated from least to most restrictive according to the “intervention ladder” concept. The law should also describe the circumstances which would justify the implementation of each and every sanction as well as the procedural safeguards designed for established decisions and fairness toward the individual(s) whose rights are infringed by the application of these sanctions.
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Affiliation(s)
- Shelly Kamin-Friedman
- Department of Health Systems Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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46
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Pierik R. On religious and secular exemptions: A case study of childhood vaccination waivers. ETHNICITIES 2017; 17:220-241. [PMID: 28546785 PMCID: PMC5428064 DOI: 10.1177/1468796817692629] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This paper analyses exemptions to general law through the prism of vaccine waivers in the United States. All US states legally require the vaccination of children prior to school or daycare entry; however, this obligation is accompanied with a system of medical, religious, and/or philosophical exemptions. Nonmedical exemptions became subject of discussion after the 2015 Disneyland measles outbreak in California, which unequivocally brought to light what had been brewing below the surface for a while: a slow but steady decline in vaccination rates in Western societies, resulting in the reoccurrence of measles outbreaks. This can be traced back to an increasing public questioning of vaccines by a growing anti-vaccination movement. In reaction to the outbreak and the public outrage it generated, several states proposed-and some already passed-bills to eliminate nonmedical exemptions. I analyze two questions. First, can legal exemptions from mandatory childhood vaccination schemes for parents who are opposed to vaccination (still) be justified? Second, should legal exemptions be limited to religious objections to vaccination, or should they also be granted to secular objections? Although the argument in the paper starts from the example of the US, it seeks to provide a more general philosophical reflection on the question of exemptions from mandatory childhood vaccination.
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Affiliation(s)
- Roland Pierik
- Roland Pierik, Faculty of Law, Paul Scholten Centre for Jurisprudence, University of Amsterdam, P.O. box 1030, 1000BA Amsterdam, The Netherlands.
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Gibney KB, Brahmi A, O'Hara M, Morey R, Franklin L. Challenges in managing a school-based measles outbreak in Melbourne, Australia, 2014. Aust N Z J Public Health 2016; 41:80-84. [PMID: 27960246 DOI: 10.1111/1753-6405.12620] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/01/2016] [Accepted: 08/01/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To identify barriers to control of a Victorian primary school-based measles outbreak. METHODS Confirmed measles cases notified in Victoria in 2014 were reviewed. Surveillance data, correspondence, and investigation notes for the school-based outbreak were assessed regarding timeliness of diagnosis and notification, and adequacy of school-based immunisation records. RESULTS Twenty-three (31%) of the 75 measles cases notified in 2014 were school-aged (5-18 years); three had documentation of measles vaccination, 17 were unvaccinated, and three had unknown vaccination history. Eight measles outbreaks were identified, including a primary school-based outbreak with ten cases. Of the six unvaccinated pupils in the affected school, five (83%) contracted measles. The proportion of the school's prep students with documented vaccination records, as required by law, ranged from 39% in 2013 to 97% in 2014. CONCLUSIONS Inadequately vaccinated students constitute a vulnerable population and schools are a potential site for measles outbreaks. Inadequate enforcement of school-based immunisation records impact the management and control of school-based measles outbreaks. Implications for Public Health: There is a need to educate clinicians on measles diagnosis and notification, and schools on the requirement to maintain up-to-date vaccination records. School entry is an opportunity to review student vaccination history and offer immunisations.
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Affiliation(s)
- Katherine B Gibney
- Health Protection Branch, Department of Health & Human Services Victoria.,The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Victoria
| | - Aicha Brahmi
- Health Protection Branch, Department of Health & Human Services Victoria
| | - Miriam O'Hara
- Health Protection Branch, Department of Health & Human Services Victoria
| | - Rosemary Morey
- Health Protection Branch, Department of Health & Human Services Victoria
| | - Lucinda Franklin
- Health Protection Branch, Department of Health & Human Services Victoria
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Corben P, Leask J. To close the childhood immunization gap, we need a richer understanding of parents' decision-making. Hum Vaccin Immunother 2016; 12:3168-3176. [PMID: 27564975 PMCID: PMC5215493 DOI: 10.1080/21645515.2016.1221553] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/22/2016] [Accepted: 08/03/2016] [Indexed: 12/22/2022] Open
Abstract
Vaccination is widely acknowledged as one of the most successful public health interventions globally and in most high-income countries childhood vaccination coverage rates are moderately high. Yet in many instances, immunisation rates remain below aspirational targets and have shown only modest progress toward those targets in recent years, despite concerted efforts to improve uptake. In part, coverage rates reflect individual parents' vaccination attitudes and decisions and, because vaccination decision-making is complex and context-specific, it remains challenging at individual and community levels to assist parents to make positive decisions. Consequently, in the search for opportunities to improve immunisation coverage, there has been a renewed research focus on parents' decision-making. This review provides an overview of the literature surrounding parents' vaccination decision-making, offering suggestions for where efforts to increase vaccination coverage should be targeted and identifying areas for further research.
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Affiliation(s)
- Paul Corben
- North Coast Public Health, Mid North Coast Local Health District, Port Macquarie, New South Wales, Australia
| | - Julie Leask
- School of Public Health, University of Sydney, University of Sydney, NSW, Australia
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Abstract
Vaccines are some of if not the most successful public health endeavors ever put into practice. Countless lives have been saved and the occurrences of vaccine preventable diseases are at a fraction of the rate experienced before vaccines. Vaccines and the realization of their compulsory scheduling are highly studied, safe, and purposeful. Despite these realities, there are an alarming number of parents who do not permit the vaccination of their children as scheduled. This is known in the health community as vaccine hesitancy and commonly portrayed in popular media as anti-vaccination sediment. This analysis opens with the topic as it was addressed during a September 2015 debate for the Republic Party's 2016 presidential nomination. Some key historical aspects of vaccine hesitancy are presented. This history leads to a description of the 2014-2015 measles outbreak in California. The factors that aide in the recruitment of under vaccination are then explored. Finally, select strategies to control, combat, and potentially attenuate vaccine hesitancy are presented.
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Affiliation(s)
- David Callender
- a School of Public Health and Health Sciences, University of Massachusetts Amherst , Amherst , MA , USA
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50
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Pugh J, Douglas T. Justifications for Non-Consensual Medical Intervention: From Infectious Disease Control to Criminal Rehabilitation. CRIMINAL JUSTICE ETHICS 2016; 35:205-229. [PMID: 28260832 PMCID: PMC5312796 DOI: 10.1080/0731129x.2016.1247519] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A central tenet of medical ethics holds that it is permissible to perform a medical intervention on a competent individual only if that individual has given informed consent to the intervention. Yet it occasionally seems morally permissible to carry out non-consensual medical interventions on competent individuals for the purpose of infectious disease control (IDC). We describe two different moral frameworks that have been invoked in support of non-consensual IDC interventions and identify five desiderata that might be used to guide assessments of the moral permissibility of such interventions on either kind of fundamental justification. We then consider what these desiderata imply for the justifiability of carrying out non-consensual medical interventions that are designed to facilitate rehabilitation amongst serious criminal offenders. We argue that these desiderata suggest that a plausible case can be made in favor of such interventions.
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Affiliation(s)
| | - Thomas Douglas
- Thomas Douglas is a Senior Research Fellow at the Uehiro Centre for Practical Ethics and the Faculty of Philosophy, University of Oxford, U.K.
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