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Boräng F, Carlitz R. The Double Democratic Bind: Challenges to Enacting Mandates and Combating Misinformation. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2024; 49:189-215. [PMID: 37522334 DOI: 10.1215/03616878-10910233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
CONTEXT Wealthy countries vary considerably in terms of how well they have been able to inoculate their populations against COVID-19. In particular, democracies have been constrained in their abilities to implement vaccine mandates, given enshrined protections of civil liberties and individual freedom in such regimes. While scholars have begun addressing the democratic constraint on vaccine mandates, less attention has been paid to the additional challenges democracies face in constraining the spread of vaccine misinformation-particularly misinformation that spreads online. METHODS This study combines large-N cross-country analysis with a case study of Germany to illustrate the "double bind" that democracies face when it comes to containing both the spread of disease and the spread of misinformation through social media. FINDINGS The cross-national analysis confirms that democracies have been less likely to enact vaccine mandates, and they have also been relatively more hesitant to restrict what people can see and share online. The case study of Germany highlights the normative and the procedural constraints underlying such decisions. CONCLUSIONS These findings show that resources are often not the binding constraint on effective disease control, raising questions regarding the ability of high-income democracies to respond effectively to future public health emergencies.
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Abstract
The novel coronavirus (SARS-CoV-2) pandemic has refocused attention on the issue of mandatory vaccination. Some have suggested that vaccines ought to be mandatory, while others propose more moderate alternatives, such as incentives. This piece surveys a range of possible interventions, ranging from mandates through to education. All may have their place, depending on circumstances. However, it is worth clarifying the options available to policymakers, since there is sometimes confusion over whether a particular policy constitutes a mandate or not. Further, I illustrate a different kind of alternative to mandatory vaccination. Rather than seeking less coercive alternatives to a mandate, we might instead employ an alternative mandate, which requires people to do something less than get vaccinated. For instance, we might merely require people to attend an appointment at a vaccine clinic. Whether this mandatory attendance policy is justified will depend on specific circumstances, but it represents another way to promote vaccination, without mandating it. In some cases, this may represent an appropriate balance between promoting public health goals and respecting individual liberty.
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Affiliation(s)
- Ben Saunders
- Corresponding author: Ben Saunders, University of Southampton, Southampton, SO17 1BJ, UK.
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Calabrò GE, D’Ambrosio F, Fallani E, Ricciardi W. Influenza Vaccination Assessment according to a Value-Based Health Care Approach. Vaccines (Basel) 2022; 10:vaccines10101675. [PMID: 36298540 PMCID: PMC9612276 DOI: 10.3390/vaccines10101675] [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: 09/04/2022] [Revised: 10/02/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Seasonal influenza has a considerable public health impact, and vaccination is the key to preventing its consequences. Our aim was to describe how the value of influenza vaccination is addressed in the scientific literature considering a new value framework based on four pillars (personal, allocative, technical, and societal value). Methods: A systematic review was conducted by querying three databases. The analysis was performed on international studies focused on influenza vaccination value, and the four value pillars were taken into consideration for their description. Results: Overall, 40 studies were considered. Most of them focused on influenza vaccination in the general population (27.5%), emphasizing its value for all age groups. Most studies addressed technical value (70.4%), especially in terms of economic models and cost drivers to be considered for the economic evaluations of influenza vaccines, and societal value (63%), whereas few dealt with personal (37%) and allocative values (22.2%). Conclusions: The whole value of influenza vaccination is still not completely recognized. Knowledge and communication of the whole value of influenza vaccination is essential to guide value-based health policies. To achieve this goal, it is necessary to implement initiatives that involve all relevant stakeholders.
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Affiliation(s)
- Giovanna Elisa Calabrò
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- VIHTALI (Value in Health Technology and Academy for Leadership & Innovation), Spinoff of Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence:
| | - Floriana D’Ambrosio
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Elettra Fallani
- Department of Life Sciences, University of Siena, 53100 Siena, Italy
- Seqirus S.R.L., Via del Pozzo 3/A, San Martino, 53035 Monteriggioni, Italy
| | - Walter Ricciardi
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Matouskova K, Vandenberg LN. Towards a paradigm shift in environmental health decision-making: a case study of oxybenzone. Environ Health 2022; 21:6. [PMID: 34998398 PMCID: PMC8742442 DOI: 10.1186/s12940-021-00806-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 11/10/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Technological advancements make lives safer and more convenient. Unfortunately, many of these advances come with costs to susceptible individuals and public health, the environment, and other species and ecosystems. Synthetic chemicals in consumer products represent a quintessential example of the complexity of both the benefits and burdens of modern living. How we navigate this complexity is a matter of a society's values and corresponding principles. OBJECTIVES We aimed to develop a series of ethical principles to guide decision-making within the landscape of environmental health, and then apply these principles to a specific environmental chemical, oxybenzone. Oxybenzone is a widely used ultraviolet (UV) filter added to personal care products and other consumer goods to prevent UV damage, but potentially poses harm to humans, wildlife, and ecosystems. It provides an excellent example of a chemical that is widely used for the alleged purpose of protecting human health and product safety, but with costs to human health and the environment that are often ignored by stakeholders. DISCUSSION We propose six ethical principles to guide environmental health decision-making: principles of sustainability, beneficence, non-maleficence, justice, community, and precautionary substitution. We apply these principles to the case of oxybenzone to demonstrate the complex but imperative decision-making required if we are to address the limits of the biosphere's regenerative rates. We conclude that both ethical and practical considerations should be included in decisions about the commercial, pervasive application of synthetic compounds and that the current flawed practice of cost-benefit analysis be recognized for what it is: a technocratic approach to support corporate interests.
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Affiliation(s)
- Klara Matouskova
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts – Amherst, 171C Goessmann, 686 N. Pleasant Street, Amherst, MA 01003 USA
| | - Laura N. Vandenberg
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts – Amherst, 171C Goessmann, 686 N. Pleasant Street, Amherst, MA 01003 USA
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Valckx S, Crèvecoeur J, Verelst F, Vranckx M, Hendrickx G, Hens N, Van Damme P, Pepermans K, Beutels P, Neyens T. Individual factors influencing COVID-19 vaccine acceptance in between and during pandemic waves (July-December 2020). Vaccine 2022; 40:151-161. [PMID: 34863621 PMCID: PMC8634074 DOI: 10.1016/j.vaccine.2021.10.073] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 08/01/2021] [Accepted: 10/27/2021] [Indexed: 01/20/2023]
Abstract
Background A year after the start of the COVID-19 outbreak, the global rollout of vaccines gives us hope of ending the pandemic. Lack of vaccine confidence, however, poses a threat to vaccination campaigns. This study aims at identifying individuals’ characteristics that explain vaccine willingness in Flanders (Belgium), while also describing trends over time (July–December 2020). Methods The analysis included data of 10 survey waves of the Great Corona Survey, a large-scale online survey that was open to the general public and had 17,722–32,219 respondents per wave. Uni- and multivariable general additive models were fitted to associate vaccine willingness with socio-demographic and behavioral variables, while correcting for temporal and geographical variability. Results We found 84.2% of the respondents willing to be vaccinated, i.e., respondents answering that they were definitely (61.2%) or probably (23.0%) willing to get a COVID-19 vaccine, while 9.8% indicated maybe, 3.9% probably not and 2.2% definitely not. In Flanders, vaccine willingness was highest in July 2020 (90.0%), decreased over the summer period to 80.2% and started to increase again from late September, reaching 85.9% at the end of December 2020. Vaccine willingness was significantly associated with respondents’ characteristics: previous survey participation, age, gender, province, educational attainment, household size, financial situation, employment sector, underlying medical conditions, mental well-being, government trust, knowing someone with severe COVID-19 symptoms and compliance with restrictive measures. These variables could explain much, but not all, variation in vaccine willingness. Conclusions Both the timing and location of data collection influence vaccine willingness results, emphasizing that comparing data from different regions, countries and/or timepoints should be done with caution. To maximize COVID-19 vaccination coverage, vaccination campaigns should focus on (a combination of) subpopulations: aged 31–50, females, low educational attainment, large households, difficult financial situation, low mental well-being and labourers, unemployed and self-employed citizens.
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Affiliation(s)
- Sara Valckx
- Centre for the Evaluation of Vaccination, VAXINFECTIO, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerpen, Belgium.
| | - Jonas Crèvecoeur
- Leuven Biostatistics and statistical Bioinformatics Centre (L-BioStat), Faculty of Medicine, KU Leuven, Kapucijnenvoer 35, building D, box 7001, 3000 Leuven, Belgium; Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BioStat), Data Science Institute, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium.
| | - Frederik Verelst
- Centre for Health Economics Research and Modelling Infectious Diseases, VAXINFECTIO, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerpen, Belgium.
| | - Maren Vranckx
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BioStat), Data Science Institute, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium.
| | - Greet Hendrickx
- Centre for the Evaluation of Vaccination, VAXINFECTIO, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerpen, Belgium.
| | - Niel Hens
- Centre for Health Economics Research and Modelling Infectious Diseases, VAXINFECTIO, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerpen, Belgium; Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BioStat), Data Science Institute, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium.
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, VAXINFECTIO, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerpen, Belgium.
| | - Koen Pepermans
- Faculty of Social Sciences, University of Antwerp, Sint-Jacobstraat 2, 2000 Antwerpen, Belgium.
| | - Philippe Beutels
- Centre for Health Economics Research and Modelling Infectious Diseases, VAXINFECTIO, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerpen, Belgium.
| | - Thomas Neyens
- Leuven Biostatistics and statistical Bioinformatics Centre (L-BioStat), Faculty of Medicine, KU Leuven, Kapucijnenvoer 35, building D, box 7001, 3000 Leuven, Belgium; Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BioStat), Data Science Institute, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium.
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Shen X, Dong H, Feng J, Jiang H, Dowling R, Lu Z, Lv C, Gan Y. Assessing the COVID-19 vaccine hesitancy in the Chinese adults using a generalized vaccine hesitancy survey instrument. Hum Vaccin Immunother 2021; 17:4005-4012. [PMID: 35016491 PMCID: PMC8828104 DOI: 10.1080/21645515.2021.1953343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The objectives of this study were to determine coronavirus disease 2019 (COVID-19) vaccination hesitancy and influencing factors in China, while broadening the applicability of the Vaccine Hesitancy Scale (VHS). A cross-sectional survey was conducted in China from 4th to 26th February 2021. Convenience sampling method was adopted to recruit participants. A total of 2,361 residents filled out the questionnaire. Confirmatory factor analysis was used on the validation set to confirm the latent structure that resulted from the exploratory factor analysis, which was conducted on the construction set. Multiple linear regression model analyses were used to identify significant associations between the identified the revised version of VHS subscales and hypothesized explanatory variables. Two subscales were identified within the VHS through data analysis, including "lack of confidence in the need for vaccines" and "aversion to the risk of side effects." The results indicated that the hesitancy of the participants in our sample was both driven the two mainly aspects. In addition, more than 40% of the participants expressed hesitation in half of the items in VHS. This study characterized COVID-19 vaccine hesitancy in China, and identified disparities in vaccine hesitancy by socio-demographic groups and knowledge about the vaccine. Knowledge of the vaccine was statistically linked to respondents' answers to the clustered 'lack of confidence' and 'risks perception' items. Our results characterize Chinese citizens' COVID-19 vaccine concerns and will inform targeted health communications.
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Affiliation(s)
- Xin Shen
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hao Dong
- Department of General Practice, Shouyilu Street Community Health Service Center, Wuhan, Hubei, China
| | - Jing Feng
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Heng Jiang
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Australia,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Rowan Dowling
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chuanzhu Lv
- Department of Emergency, Hainan Clinical Research Center for Acute and Critical Diseases, the Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China,Emergency and Trauma College, Hainan Medical University, Haikou, Hainan, China,Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences (No. 2019RU013), Hainan Medical University, Haikou, Hainan, China,Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China,Chuanzhu Lv Department of Emergency, Hainan Clinical Research Center for Acute and Critical Diseases, The Second Affiliated Hospital of Hainan Medical University, No.3 Xueyuan Road, Longhua Zone, Haikou571199, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,CONTACT Yong Gan Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan430030, China
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Iftekhar EN, Priesemann V, Balling R, Bauer S, Beutels P, Calero Valdez A, Cuschieri S, Czypionka T, Dumpis U, Glaab E, Grill E, Hanson C, Hotulainen P, Klimek P, Kretzschmar M, Krüger T, Krutzinna J, Low N, Machado H, Martins C, McKee M, Mohr SB, Nassehi A, Perc M, Petelos E, Pickersgill M, Prainsack B, Rocklöv J, Schernhammer E, Staines A, Szczurek E, Tsiodras S, Van Gucht S, Willeit P. A look into the future of the COVID-19 pandemic in Europe: an expert consultation. THE LANCET REGIONAL HEALTH. EUROPE 2021; 8:100185. [PMID: 34345876 PMCID: PMC8321710 DOI: 10.1016/j.lanepe.2021.100185] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
How will the coronavirus disease 2019 (COVID-19) pandemic develop in the coming months and years? Based on an expert survey, we examine key aspects that are likely to influence the COVID-19 pandemic in Europe. The challenges and developments will strongly depend on the progress of national and global vaccination programs, the emergence and spread of variants of concern (VOCs), and public responses to non-pharmaceutical interventions (NPIs). In the short term, many people remain unvaccinated, VOCs continue to emerge and spread, and mobility and population mixing are expected to increase. Therefore, lifting restrictions too much and too early risk another damaging wave. This challenge remains despite the reduced opportunities for transmission given vaccination progress and reduced indoor mixing in summer 2021. In autumn 2021, increased indoor activity might accelerate the spread again, whilst a necessary reintroduction of NPIs might be too slow. The incidence may strongly rise again, possibly filling intensive care units, if vaccination levels are not high enough. A moderate, adaptive level of NPIs will thus remain necessary. These epidemiological aspects combined with economic, social, and health-related consequences provide a more holistic perspective on the future of the COVID-19 pandemic.
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Affiliation(s)
| | - Viola Priesemann
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
| | - Rudi Balling
- University of Luxembourg, Luxembourg, Luxembourg
| | - Simon Bauer
- Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
| | | | | | | | - Thomas Czypionka
- Institute for Advanced Studies, Vienna, Austria, and London School of Economics, London, UK
| | - Uga Dumpis
- Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia
| | - Enrico Glaab
- University of Luxembourg, Luxembourg, Luxembourg
| | - Eva Grill
- Ludwig-Maximilians-University München, München, Germany
| | - Claudia Hanson
- Karolinska Institute, Stockholm, Sweden, and London School of Hygiene & Tropical Medicine, London, UK
| | - Pirta Hotulainen
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Peter Klimek
- Medical University of Vienna, Vienna, Austria, and Complexity Science Hub Vienna, Vienna, Austria
| | | | - Tyll Krüger
- Wroclaw University of Science and Technology, Wroclaw, Poland
| | | | | | - Helena Machado
- Institute for Social Sciences, University of Minho, Braga, Portugal
| | - Carlos Martins
- Department of Community Medicine, Health Information and Decision Sciences of the Faculty of Medicine, University of Porto, Porto, Portugal
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Armin Nassehi
- Ludwig-Maximilians-University München, München, Germany
| | - Matjaž Perc
- University of Maribor, Maribor, Slovenia, and Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Elena Petelos
- University of Crete, Crete, Greece, and Maastricht University, Maastricht, The Netherlands
| | | | - Barbara Prainsack
- Department of Political Science, University of Vienna, Vienna, Austria
| | - Joacim Rocklöv
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | | | | | | | | | | | - Peter Willeit
- Medical University of Innsbruck, Innsbruck, Austria, and University of Cambridge, Cambridge, UK
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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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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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Giubilini A, Douglas T, Savulescu J. The moral obligation to be vaccinated: utilitarianism, contractualism, and collective easy rescue. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2018; 21:547-560. [PMID: 29429063 PMCID: PMC6267229 DOI: 10.1007/s11019-018-9829-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
We argue that individuals who have access to vaccines and for whom vaccination is not medically contraindicated have a moral obligation to contribute to the realisation of herd immunity by being vaccinated. Contrary to what some have claimed, we argue that this individual moral obligation exists in spite of the fact that each individual vaccination does not significantly affect vaccination coverage rates and therefore does not significantly contribute to herd immunity. Establishing the existence of a moral obligation to be vaccinated (both for adults and for children) despite the negligible contribution each vaccination can make to the realisation of herd immunity is important because such moral obligation would strengthen the justification for coercive vaccination policies. We show that two types of arguments-namely a utilitarian argument based on Parfit's Principle of Group Beneficence and a contractualist argument-can ground an individual moral obligation to be vaccinated, in spite of the imperceptible contribution that any single vaccination makes to vaccine coverage rates. We add a further argument for a moral obligation to be vaccinated that does not require embracing problematic comprehensive moral theories such as utilitarianism or contractualism. The argument is based on a "duty of easy rescue" applied to collectives, which grounds a collective moral obligation to realise herd immunity, and on a principle of fairness in the distribution of the burdens that must be borne to realise herd immunity.
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Affiliation(s)
- Alberto Giubilini
- Oxford Martin School and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK.
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Littlegate House, St Ebbes St, Oxford, OX1 1PT, UK.
| | - Thomas Douglas
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Littlegate House, St Ebbes St, Oxford, OX1 1PT, UK
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Littlegate House, St Ebbes St, Oxford, OX1 1PT, UK
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Brown RCH. Resisting Moralisation in Health Promotion. ETHICAL THEORY AND MORAL PRACTICE : AN INTERNATIONAL FORUM 2018; 21:997-1011. [PMID: 30613183 PMCID: PMC6304181 DOI: 10.1007/s10677-018-9941-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/22/2018] [Indexed: 05/05/2023]
Abstract
Health promotion efforts are commonly directed towards encouraging people to discard 'unhealthy' and adopt 'healthy' behaviours in order to tackle chronic disease. Typical targets for behaviour change interventions include diet, physical activity, smoking and alcohol consumption, sometimes described as 'lifestyle behaviours.' In this paper, I discuss how efforts to raise awareness of the impact of lifestyles on health, in seeking to communicate the (perceived) need for people to change their behaviour, can contribute to a climate of 'healthism' and promote the moralisation of people's lifestyles. I begin by summarising recent trends in health promotion and introducing the notion of healthism, as described by Robert Crawford in the 1980s. One aspect of healthism is moralisation, which I outline (alongside the related term moralism) and suggest is facilitated by efforts to promote health via information provision and educational strategies. I propose that perceived responsibility plays a role in mediating the tendency to moralise about health and behaviour. Since I argue that states ought to avoid direct and indirect moralisation of people's health-related behaviour, this suggests states must be cautious with regard to the use of responsibility-indicating interventions (including informational and educational campaigns) to promote health.
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Affiliation(s)
- Rebecca C. H. Brown
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Suite 8 Littlegate House, 16-17 St Ebbe’s Street, Oxford, OX1 1PT UK
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Nuismer SL, Althouse BM, May R, Bull JJ, Stromberg SP, Antia R. Eradicating infectious disease using weakly transmissible vaccines. Proc Biol Sci 2017; 283:rspb.2016.1903. [PMID: 27798311 DOI: 10.1098/rspb.2016.1903] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/04/2016] [Indexed: 01/23/2023] Open
Abstract
Viral vaccines have had remarkable positive impacts on human health as well as the health of domestic animal populations. Despite impressive vaccine successes, however, many infectious diseases cannot yet be efficiently controlled or eradicated through vaccination, often because it is impossible to vaccinate a sufficient proportion of the population. Recent advances in molecular biology suggest that the centuries-old method of individual-based vaccine delivery may be on the cusp of a major revolution. Specifically, genetic engineering brings to life the possibility of a live, transmissible vaccine. Unfortunately, releasing a highly transmissible vaccine poses substantial evolutionary risks, including reversion to high virulence as has been documented for the oral polio vaccine. An alternative, and far safer approach, is to rely on genetically engineered and weakly transmissible vaccines that have reduced scope for evolutionary reversion. Here, we use mathematical models to evaluate the potential efficacy of such weakly transmissible vaccines. Our results demonstrate that vaccines with even a modest ability to transmit can significantly lower the incidence of infectious disease and facilitate eradication efforts. Consequently, weakly transmissible vaccines could provide an important tool for controlling infectious disease in wild and domestic animal populations and for reducing the risks of emerging infectious disease in humans.
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Affiliation(s)
- Scott L Nuismer
- Department of Biological Sciences, University of Idaho, Moscow, ID 83844, USA .,Department of Mathematics, University of Idaho, Moscow, ID 83844, USA
| | - Benjamin M Althouse
- Institute for Disease Modeling, Bellevue, WA 98005, USA.,Santa Fe Institute, Santa Fe, NM 87501, USA.,New Mexico State University, Las Cruces, NM 88003, USA
| | - Ryan May
- Department of Mathematics, University of Idaho, Moscow, ID 83844, USA
| | - James J Bull
- Integrative Biology, University of Texas, Austin, TX 78712, USA
| | - Sean P Stromberg
- Bioinformatics, Omniome Inc., 10575 Roselle Street, San Diego, CA 92121, USA
| | - Rustom Antia
- Department of Biology, Emory University, Altanta, GA 30322, USA
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Luyten J, Beutels P. The Social Value Of Vaccination Programs: Beyond Cost-Effectiveness. Health Aff (Millwood) 2017; 35:212-8. [PMID: 26858372 DOI: 10.1377/hlthaff.2015.1088] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In the current global environment of increased strain on health care budgets, all medical interventions have to compete for funding. Cost-effectiveness analysis has become a standard method to use in estimating how much value an intervention offers relative to its costs, and it has become an influential element in decision making. However, the application of cost-effectiveness analysis to vaccination programs fails to capture the full contribution such a program offers to the community. Recent literature has highlighted how cost-effectiveness analysis can neglect the broader economic impact of vaccines. In this article we also argue that socioethical contributions such as effects on health equity, sustaining the public good of herd immunity, and social integration of minority groups are neglected in cost-effectiveness analysis. Evaluations of vaccination programs require broad and multidimensional perspectives that can account for their social, ethical, and economic impact as well as their cost-effectiveness.
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Affiliation(s)
- Jeroen Luyten
- Jeroen Luyten is a fellow in the Department of Social Policy at the London School of Economics, in the United Kingdom
| | - Philippe Beutels
- Philippe Beutels is a professor at the Centre for Health Economics Research and Modeling Infectious Diseases at the University of Antwerp, in Belgium
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14
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Abstract
Human papillomavirus (HPV) is one of the most common sexually transmitted infections. It is a leading cause of cervical cancer in women but the virus is increasingly being linked to several other cancers in men and women alike. Since the introduction of safe and effective but also expensive vaccines, many developed countries have implemented selective vaccination programs for girls. Some however argue that these programs should be expanded to include boys, since (1) HPV constitutes non-negligible health risks for boys as well and (2) protected boys will indirectly also protect girls. In this paper we approach this discussion from an ethical perspective. First, on which moral grounds can one justify not reimbursing vaccination for the male sex? We develop an ethical framework to evaluate selective vaccination programs and conclude that, in the case of HPV, efficiency needs to be balanced against non-stigmatization, non-discrimination and justice. Second, if vaccination programs were to be expanded to boys as well, do the latter then also have a moral duty to become immunized? Two arguments in favor of such a moral duty are well known in vaccination ethics: the duty not to harm others and to contribute to the public good of public health. However, we argue that these are not particularly convincing in the context of HPV. In contrast, we believe a third, more powerful but also more controversial argument is possible. In our view, the sexual mode of transmission of HPV constitutes an additional reason to believe that boys in fact may have a moral obligation to accept vaccination.
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Affiliation(s)
- Jeroen Luyten
- Centre for Health Economics Research and Modelling Infectious Diseases, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium,
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Giles EL, Robalino S, Sniehotta FF, Adams J, McColl E. Acceptability of financial incentives for encouraging uptake of healthy behaviours: A critical review using systematic methods. Prev Med 2015; 73:145-58. [PMID: 25600881 DOI: 10.1016/j.ypmed.2014.12.029] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 11/28/2014] [Accepted: 12/26/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Financial incentives are effective in encouraging healthy behaviours, yet concerns about acceptability remain. We conducted a systematic review exploring acceptability of financial incentives for encouraging healthy behaviours. METHODS Database, reference, and citation searches were conducted from the earliest available date to October 2014, to identify empirical studies and scholarly writing that: had an English language title, were published in a peer-reviewed journal, and explored acceptability of financial incentives for healthy behaviours in members of the public, potential recipients, potential practitioners or policy makers. Data was analysed using thematic analysis. RESULTS Eighty one papers were included: 59 pieces of scholarly writing and 22 empirical studies, primarily exploring acceptability to the public. Five themes were identified: fair exchange, design and delivery, effectiveness and cost-effectiveness, recipients, and impact on individuals and wider society. Although there was consensus that if financial incentives are effective and cost effective they are likely to be considered acceptable, a number of other factors also influenced acceptability. CONCLUSIONS Financial incentives tend to be acceptable to the public when they are effective and cost-effective. Programmes that benefit recipients and wider society; are considered fair; and are delivered to individuals deemed appropriate are likely to be considered more acceptable.
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Affiliation(s)
- Emma L Giles
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, Tyne and Wear NE2 4AX, UK.
| | - Shannon Robalino
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, Tyne and Wear NE2 4AX, UK.
| | - Falko F Sniehotta
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, Tyne and Wear NE2 4AX, UK.
| | - Jean Adams
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, Tyne and Wear NE2 4AX, UK.
| | - Elaine McColl
- Newcastle Clinical Trials Unit, Institute of Health and Society, Newcastle University, 4th Floor William Leech Building, The Medical School, Framlington Place, Newcastle upon Tyne, Tyne and Wear NE2 4HH, UK.
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Giles EL, Sniehotta FF, McColl E, Adams J. Acceptability of financial incentives and penalties for encouraging uptake of healthy behaviours: focus groups. BMC Public Health 2015; 15:58. [PMID: 25636330 PMCID: PMC4318173 DOI: 10.1186/s12889-015-1409-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 01/13/2015] [Indexed: 11/21/2022] Open
Abstract
Background There is evidence that financial incentive interventions, which include both financial rewards and also penalties, are effective in encouraging healthy behaviours. However, concerns about the acceptability of such interventions remain. We report on focus groups with a cross-section of adults from North East England exploring their acceptance of financial incentive interventions for encouraging healthy behaviours amongst adults. Such information should help guide the design and development of acceptable, and effective, financial incentive interventions. Methods Eight focus groups with a total of 74 adults were conducted between November 2013 and January 2014 in Newcastle upon Tyne, UK. Focus groups lasted approximately 60 minutes and explored factors that made financial incentives acceptable and unacceptable to participants, together with discussions on preferred formats for financial incentives. Verbatim transcripts were thematically coded and analysed in Nvivo 10. Results Participants largely distrusted health promoting financial incentives, with a concern that individuals may abuse such schemes. There was, however, evidence that health promoting financial incentives may be more acceptable if they are fair to all recipients and members of the public; if they are closely monitored and evaluated; if they are shown to be effective and cost-effective; and if clear health education is provided alongside health promoting financial incentives. There was also a preference for positive rewards rather than negative penalties, and for shopping vouchers rather than cash incentives. Conclusions This qualitative empirical research has highlighted clear suggestions on how to design health promoting financial incentives to maximise acceptability to the general public. It will also be important to determine the acceptability of health promoting financial incentives in a range of stakeholders, and in particular, those who fund such schemes, and policy-makers who are likely to be involved with the design, implementation and evaluation of health promoting financial incentive schemes. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1409-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emma L Giles
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, Tyne and Wear, NE2 4AX, UK.
| | - Falko F Sniehotta
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, Tyne and Wear, NE2 4AX, UK.
| | - Elaine McColl
- Newcastle Clinical Trials Unit, 4th Floor William Leech Building, The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.
| | - Jean Adams
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, Tyne and Wear, NE2 4AX, UK. .,Centre for Diet & Activity Research, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
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Luyten J, Ogunjimi B, Beutels P. Varicella-zoster virus vaccination under the exogenous boosting hypothesis: two ethical perspectives. Vaccine 2014; 32:7175-8. [PMID: 25454883 DOI: 10.1016/j.vaccine.2014.10.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/06/2014] [Accepted: 10/07/2014] [Indexed: 01/23/2023]
Abstract
The varicella-zoster virus (VZV) causes two diseases: varicella ('chickenpox') and herpes zoster ('shingles'). VZV vaccination of children reduces exposure to chickenpox in the population and it has been hypothesized that this could increase the prevalence of shingles. This 'exogenous boosting' effect of VZV raises an important equity concern: introducing a vaccination program could advance the health of one population group (children) at the expense of another (adults and elderly). We discuss the program's justifiability from two ethical perspectives, classic utilitarianism and contractualism. Whereas the former framework might offer a foundation for the case against introducing this vaccination, the latter offers a basis to justify it.
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Affiliation(s)
- Jeroen Luyten
- Department of Social Policy, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom; Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Benson Ogunjimi
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Philippe Beutels
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia
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Luyten J, Desmet P, Dorgali V, Hens N, Beutels P. Kicking against the pricks: vaccine sceptics have a different social orientation. Eur J Public Health 2013; 24:310-4. [PMID: 23813706 DOI: 10.1093/eurpub/ckt080] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In any country, part of the population is sceptical about the utility of vaccination. To develop successful vaccination programmes, it is important to study and understand the defining characteristics of vaccine sceptics. Research till now mainly focused either on the underlying motives of vaccine refusal, or on socio-demographic differences between vaccine sceptics and non-sceptics. It remained till now unexplored whether both groups differ in terms of basic psychological dispositions. METHODS We held a population survey in a representative sample of the population in Flanders, Belgium (N = 1050), in which we investigated whether respondents' attitude to vaccination was associated with their basic disposition toward other community members or society in general, as measured by the Triandis and Gelfand social orientation scale. RESULTS We found that sceptics and non-sceptics have a different social orientation, even when several variables are controlled for. More specifically, vaccine sceptics scored significantly lower on both horizontal individualism and horizontal collectivism, indicating a lower disposition to see others as equals. CONCLUSION These findings need confirmation in the context of different countries. Such insights can be valuable to optimize the design of effective communication strategies on vaccination programmes.
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Affiliation(s)
- Jeroen Luyten
- 1 Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, 2610 Wilrijk, Belgium
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Bilcke J, van Hoek AJ, Beutels P. Childhood varicella-zoster virus vaccination in Belgium: cost-effective only in the long run or without exogenous boosting? Hum Vaccin Immunother 2013; 9:812-22. [PMID: 23321955 DOI: 10.4161/hv.23334] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIM To assess the effectiveness and cost-effectiveness of a universal childhood varicella-zoster vaccination programme in Belgium (1) using the most recent Belgian data on varicella-zoster burden, (2) exploring different options for the timing of the second dose, (3) obtaining results with and without exogenous natural boosting, and (4) investigating the possible additional benefit of zoster booster vaccination for adults at age 50 or 60 y. METHODS An extensively studied and improved dynamic model is used to estimate primary and breakthrough chickenpox and zoster cases over time. For a range of vaccination options, we compared the direct costs (health care payer perspective) and health outcomes (including Quality-Adjusted Life-Years (QALYs) lost) associated with chickenpox and herpes zoster. Estimates of social contact patterns, health care use, costs and QALY losses are almost exclusively based on Belgian databases and surveys. RESULTS AND CONCLUSIONS If exogenous natural boosting exists, a net loss in QALYs is expected for several decades after implementing a universal chickenpox vaccination programme, due to an increase in zoster mainly in persons aged 50-80 y. This result holds also for scenarios that minimise or counteract the expected increase in zoster incidence (e.g. additional booster vaccinations in adults). However, if the boosting hypothesis is not true or if costs and QALYs are cumulated over at least 33 to more than 100 y after vaccination (depending on the assumptions made), different options for universal 2-dose vaccination against chickenpox in Belgium would be cost-effective at a vaccine price of €43/dose or lower.
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Affiliation(s)
- Joke Bilcke
- Center for Health Economic Research and Modeling Infectious Diseases (CHERMID); Vaccine and Infectious Disease Institute (Vaxinfectio); University of Antwerp; Wilrijk, Belgium
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