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Oliveira ISD, Cardoso LS, Ferreira IG, Alexandre-Silva GM, Jacob BDCDS, Cerni FA, Monteiro WM, Zottich U, Pucca MB. Anti-vaccination movements in the world and in Brazil. Rev Soc Bras Med Trop 2022; 55:e05922021. [PMID: 35613224 PMCID: PMC9131779 DOI: 10.1590/0037-8682-0592-2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 03/29/2022] [Indexed: 11/26/2022] Open
Abstract
Over the years, vaccinations have provided significant advances in public health, because they substantially reduce the morbimortality of vaccine-preventable diseases. Nevertheless, many people are still hesitant to be vaccinated. Brazil is a region of many anti-vaccine movements, and several outbreaks of vaccine-preventable diseases, such as yellow fever and measles, have occurred in the country during the last few years. To avoid new outbreaks, immunization coverage must be high; however, this is a great challenge to achieve due to the countless anti-vaccine movements. The World Health Organization has suggested new actions for the next decade via the Immunization Agenda 2030 to control, reduce, or eradicate vaccine-preventable diseases. Nonetheless, the vaccination coverage has decreased recently. To resolve the anti-vaccine issue, it is necessary to propose a long-term approach that involves innovative education programs on immunization and critical thinking, using different communication channels, including social media. Cooperation among biology and health scientists, ethicists, human scientists, policymakers, journalists, and civil society is essential for an in-depth understanding of the social action of vaccine refusal and planning effective education measures to increase the vaccine coverage.
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Affiliation(s)
- Isadora Sousa de Oliveira
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Departamento de Ciências BioMoleculares, Ribeirão Preto, SP, Brasil
| | | | - Isabela Gobbo Ferreira
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Departamento de Ciências BioMoleculares, Ribeirão Preto, SP, Brasil
| | | | - Beatriz de Cássia da Silva Jacob
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Departamento de Ciências BioMoleculares, Ribeirão Preto, SP, Brasil
| | - Felipe Augusto Cerni
- Universidade Federal de Roraima, Programa de Pós-Graduação em Ciências da Saúde, Boa Vista, RR, Brasil
| | - Wuelton Marcelo Monteiro
- Universidade do Estado do Amazonas, Faculdade de Ciências da Saúde, Departamento de Medicina e Enfermagem, Manaus, AM, Brasil.,Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Departamento de Ensino e Pesquisa, Manaus, AM, Brasil
| | - Umberto Zottich
- Universidade Federal de Roraima, Faculdade de Medicina, Boa Vista, RR, Brasil
| | - Manuela Berto Pucca
- Universidade Federal de Roraima, Faculdade de Medicina, Boa Vista, RR, Brasil.,Universidade Federal de Roraima, Programa de Pós-Graduação em Ciências da Saúde, Boa Vista, RR, Brasil
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2
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Vaccine Hesitancy in Saudi Arabia: A Cross-Sectional Study. Trop Med Infect Dis 2022; 7:tropicalmed7040060. [PMID: 35448835 PMCID: PMC9025486 DOI: 10.3390/tropicalmed7040060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/27/2022] [Accepted: 04/07/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Background: vaccine hesitancy can put the public’s health at risk from vaccine-preventable diseases. This study aimed to address vaccine hesitancy in Saudi Arabia and understand the problem’s magnitude and causes. (2) Methods: this was a descriptive observational study using quantitative and qualitative evaluation methods conducted in Saudi Arabia between December 2020 and February 2021. Public survey forms, exit interviews, and healthcare professional survey forms were used. (3) Results: our study involved 2030 public survey participants, 119 exit interviews of caregivers, and 500 healthcare professionals, demonstrating that vaccine hesitancy was relatively low. Ninety percent of the participants agreed that it was essential for everyone to receive the recommended vaccines with their children (p < 0.001), 92% believed that vaccines are safe for their children (p < 0.001), 91% of the participants agreed to give their new children all the recommended doses (p < 0.001), 86% welcomed mass/school vaccination campaigns (p < 0.001), and 81% were willing to pay for additional vaccines for themselves and their children (p < 0.001). (4) Conclusions: vaccine hesitancy is low in Saudi Arabia, and a positive attitude toward vaccination was detected among most of the participants. Vaccination decision-making is complex and includes emotional, cultural, social, spiritual, and political aspects.
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McDonald C, Leask J, Chad N, Danchin M, Fethney J, Trevena L. A Consent Support Resource with Benefits and Harms of Vaccination Does Not Increase Hesitancy in Parents-An Acceptability Study. Vaccines (Basel) 2020; 8:vaccines8030500. [PMID: 32887503 PMCID: PMC7565597 DOI: 10.3390/vaccines8030500] [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: 07/16/2020] [Revised: 08/14/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022] Open
Abstract
It is unclear whether information given about the benefits and risks of routine childhood vaccination during consent may cue parental vaccine hesitancy. Parents were surveyed before and after reading vaccine consent information at a public expo event in Sydney, Australia. We measured vaccine hesitancy with Parent Attitudes about Childhood Vaccine Short Scale (PACV-SS), informed decision-making with Informed Subscale of the Decisional Conflict Scale (DCS-IS), items from Stage of Decision Making, Positive Attitude Assessment, Vaccine Safety and Side Effect Concern, and Vaccine Communication Framework (VCF) tools. Overall, 416 parents showed no change in vaccine hesitancy (mean PACV-SS score pre = 1.97, post = 1.94; diff = −0.02 95% CI −0.10 to 0.15) but were more informed (mean DCS-IS score pre = 29.05, post = 7.41; diff = −21.63 95% CI −24.17 to −18.56), were more positive towards vaccination (pre = 43.8% post = 50.4%; diff = 6.5% 95% CI 3.0% to 10.0%), less concerned about vaccine safety (pre = 28.5%, post = 23.0%, diff = −5.6% 95% CI −2.3% to −8.8%) and side effects (pre = 37.0%, post = 29.0%, diff = −8.0% 95% CI −4.0% to −12.0%) with no change in stage of decision-making or intention to vaccinate. Providing information about the benefits and risks of routine childhood vaccination increases parents’ informed decision-making without increasing vaccine hesitancy.
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Affiliation(s)
- Ciara McDonald
- Faculty of Medicine and Health, School of Medicine, University of Sydney, Sydney 2006, Australia;
- ASK NHMRC Centre for Research Excellence, University of Sydney, Sydney 2006, Australia;
| | - Julie Leask
- ASK NHMRC Centre for Research Excellence, University of Sydney, Sydney 2006, Australia;
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney 2006, Australia;
| | - Nina Chad
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney 2006, Australia;
| | - Margie Danchin
- Department of General Medicine, Department of Pediatrics, The Royal Children’s Hospital, Victoria 3052 Australia;
- Vaccine Uptake Group, Murdoch Children’s Research Institute Victoria, University of Melbourne, Victoria 3052, Australia
| | - Judith Fethney
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney 2006, Australia;
| | - Lyndal Trevena
- ASK NHMRC Centre for Research Excellence, University of Sydney, Sydney 2006, Australia;
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney 2006, Australia;
- Correspondence: ; Tel.: +61-293517788
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Bhattacharyya S, Vutha A, Bauch CT. The impact of rare but severe vaccine adverse events on behaviour-disease dynamics: a network model. Sci Rep 2019; 9:7164. [PMID: 31073195 PMCID: PMC6509123 DOI: 10.1038/s41598-019-43596-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 04/25/2019] [Indexed: 12/02/2022] Open
Abstract
The propagation of rumours about rare but severe adverse vaccination or infection events through social networks can strongly impact vaccination uptake. Here we model a coupled behaviour-disease system where individual risk perception regarding vaccines and infection are shaped by their personal experiences and the experiences of others. Information about vaccines and infection either propagates through the network or becomes available through globally available sources. Dynamics are studied on a range of network types. Individuals choose to vaccinate according to their personal perception of risk and information about infection prevalence. We study events ranging from common and mild, to severe and rare. We find that vaccine and infection adverse events have asymmetric impacts. Vaccine (but not infection) adverse events may significantly prolong the tail of an outbreak. Similarly, introducing a small risk of a vaccine adverse event may cause a steep decline in vaccine coverage, especially on scale-free networks. Global dissemination of information about infection prevalence boosts vaccine coverage more than local dissemination. Taken together, these findings highlight the dangers associated with vaccine rumour propagation through scale-free networks such as those exhibited by online social media, as well as the benefits of disseminating public health information through mass media.
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Affiliation(s)
- Samit Bhattacharyya
- Department of Mathematics, School of Natural Sciences, Shiv Nadar University, Greater Noida, India.
| | - Amit Vutha
- ICTS, Tata Institute for Fundamental Research, Bangalore, India.
| | - Chris T Bauch
- Department of Applied Mathematics, University of Waterloo, Waterloo, Canada.
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5
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Dubé E, Gagnon D, MacDonald N, Bocquier A, Peretti-Watel P, Verger P. Underlying factors impacting vaccine hesitancy in high income countries: a review of qualitative studies. Expert Rev Vaccines 2018; 17:989-1004. [DOI: 10.1080/14760584.2018.1541406] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Eve Dubé
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada
- Axe maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Dominique Gagnon
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada
| | - Noni MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Aurélie Bocquier
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Patrick Peretti-Watel
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Pierre Verger
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
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Williamson L, Glaab H. Addressing vaccine hesitancy requires an ethically consistent health strategy. BMC Med Ethics 2018; 19:84. [PMID: 30355355 PMCID: PMC6201581 DOI: 10.1186/s12910-018-0322-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/04/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Vaccine hesitancy is a growing threat to public health. The reasons are complex but linked inextricably to a lack of trust in vaccines, expertise and traditional sources of authority. Efforts to increase immunization uptake in children in many countries that have seen a fall in vaccination rates are two-fold: addressing hesitancy by improving healthcare professional-parent exchange and information provision in the clinic; and, secondly, public health strategies that can override parental concerns and values with coercive measures such as mandatory and presumptive vaccination. MAIN TEXT It is argued that such conflicting, parallel approaches seriously risk undermining trust that is crucial for sustaining herd immunity. Although public health strategies can be ethically justified in limiting freedoms, a parent-centered approach seldom acknowledges how it is impacted by contemporaneous coercive measures. In addition, the clinical encounter is not well suited to helping parents consider the public dimensions of vaccination, despite these being important for trust formation and informed decision-making. Efforts to address vaccine hesitancy require more consistent engagement of parental and citizen views. Along with evidence-based information, debates need to be informed by ethical support that equips parents and professionals to respond to the private and public dimensions of vaccination in a more even-handed, transparent manner. CONCLUSION Efforts to address vaccine hesitancy need to avoid simple reliance on either parental values or coercive public policies. To do this effectively requires increasing citizen engagement on vaccination to help inform a parent-centered approach and legitimize public policy measures. In addition, cultivating a more ethically consistent strategy means moving beyond the current silos of health ethics - clinical and public health ethics.
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Affiliation(s)
- Laura Williamson
- Biobehavioral Health Department, Pennsylvania State University, University Park, USA.
| | - Hannah Glaab
- Biobehavioral Health Department, Pennsylvania State University, University Park, USA
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Damnjanović K, Graeber J, Ilić S, Lam WY, Lep Ž, Morales S, Pulkkinen T, Vingerhoets L. Parental Decision-Making on Childhood Vaccination. Front Psychol 2018; 9:735. [PMID: 29951010 PMCID: PMC6008886 DOI: 10.3389/fpsyg.2018.00735] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 04/26/2018] [Indexed: 11/13/2022] Open
Abstract
A growing number of parents delay vaccinations or are deciding not to vaccinate their children altogether. This increases the risk of contracting vaccine-preventable diseases and disrupting herd immunity, and also impairs the trust in the capacities of health care systems to protect people. Vaccine hesitancy is related to a range of both psychological and demographic determinants, such as attitudes toward vaccinations, social norms, and trust in science. Our aim is to understand those determinants in parents, because they are a special group in this issue-they act as proxy decision makers for their children, who are unable to decide for themselves. The fact that deciding to vaccinate is a socially forced choice that concerns a child's health makes vaccine-related decisions highly important and involving for parents. This high involvement might lead to parents overemphasizing the potential side effects that they know to be vaccine-related, and by amplifying those, parents are more focused on the potential outcomes of vaccine-related decisions, which can yield specific pattern of the outcome bias. We propose two related studies to investigate factors which promote vaccine hesitancy, protective factors that determine parental vaccination decisions, and outcome bias in parental vaccination intentions. We will explore demographic and psychological factors, and test parental involvement related to vaccine hesitancy using an online battery in a correlation panel design study. The second study is an experimental study, in which we will investigate the moderating role of parents' high involvement in the specific domain of vaccination decision making. We expect that higher involvement among parents, compared to non-parents, will shape the pattern of the proneness to outcome bias. The studies will be conducted across eight countries in Europe and Asia (Finland, Germany, Hong Kong, the Netherlands, Serbia, Slovenia, Spain, and the United Kingdom), rendering findings that will aid with understanding the underlying mechanisms of vaccine hesitancy and paving the way for developing interventions custom-made for parents.
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Affiliation(s)
- Kaja Damnjanović
- Laboratory for Experimental Psychology, Department of Psychology, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
| | - Johanna Graeber
- Department of Psychology, Faculty of Philosophy, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Sandra Ilić
- Laboratory for Experimental Psychology, Department of Psychology, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
| | - Wing Y. Lam
- Faculty of Social Sciences, School of Psychology, University of Kent, Canterbury, United Kingdom
| | - Žan Lep
- Department of Psychology, Faculty of Arts, University of Ljubljana, Ljubljana, Slovenia
| | - Sara Morales
- Faculty of Psychology, University of Basque Country, Bilbao, Spain
| | - Tero Pulkkinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Loes Vingerhoets
- Department of Psychology, Faculty of Psychology and Neuroscience, University of Maastricht, Maastricht, Netherlands
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8
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Abstract
Use of highly pure antigens to improve vaccine safety has led to reduced vaccine immunogenicity and efficacy. This has led to the need to use adjuvants to improve vaccine immunogenicity. The ideal adjuvant should maximize vaccine immunogenicity without compromising tolerability or safety. Unfortunately, adjuvant research has lagged behind other vaccine areas such as antigen discovery, with the consequence that only a very limited number of adjuvants based on aluminium salts, monophosphoryl lipid A and oil emulsions are currently approved for human use. Recent strategic initiatives to support adjuvant development by the National Institutes of Health should translate into greater adjuvant choices in the future. Mechanistic studies have been valuable for better understanding of adjuvant action, but mechanisms of adjuvant toxicity are less well understood. The inflammatory or danger-signal model of adjuvant action implies that increased vaccine reactogenicity is the inevitable price for improved immunogenicity. Hence, adjuvant reactogenicity may be avoidable only if it is possible to separate inflammation from adjuvant action. The biggest remaining challenge in the adjuvant field is to decipher the potential relationship between adjuvants and rare vaccine adverse reactions, such as narcolepsy, macrophagic myofasciitis or Alzheimer's disease. While existing adjuvants based on aluminium salts have a strong safety record, there are ongoing needs for new adjuvants and more intensive research into adjuvants and their effects.
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Affiliation(s)
- Nikolai Petrovsky
- Department of Endocrinology and Diabetes, Flinders University, Adelaide, SA, 5042, Australia.
- Vaxine Pty Ltd, Adelaide, SA, Australia.
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Dubé E, Vivion M, Sauvageau C, Gagneur A, Gagnon R, Guay M. How do Midwives and Physicians Discuss Childhood Vaccination with Parents? J Clin Med 2013; 2:242-59. [PMID: 26237146 PMCID: PMC4470147 DOI: 10.3390/jcm2040242] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 10/10/2013] [Accepted: 10/11/2013] [Indexed: 11/17/2022] Open
Abstract
Even if vaccination is often described as one of the great achievements of public health, results of recent studies have shown that parental acceptance of vaccination is eroding. Health providers' knowledge and attitudes about vaccines are important determinants of their own vaccine uptake, their intention to recommend vaccines to patients and the vaccine uptake of their patients. The purpose of this article is to compare how midwives and physicians address vaccination with parents during pregnancy and in postpartum visits. Thirty semi-structured interviews were conducted with midwives and physicians practicing in the province of Quebec, Canada. Results of our analysis have shown that physicians adopt an "education-information" stance when discussing vaccination with parents in the attempt to "convince" parents to vaccinate. In contrast, midwives adopted a neutral stance and gave information on the pros and cons of vaccination to parents while leaving the final decision up to them. Findings of this study highlight the fact that physicians and midwives have different views regarding their role and responsibilities concerning vaccination. It may be that neither of these approaches is optimal in promoting vaccination uptake.
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Affiliation(s)
- Eve Dubé
- Quebec National Institute of Public Health, Quebec G1E 7G9, Canada.
- Laval University Hospital Research Center, Quebec G1V 4G5, Canada.
| | - Maryline Vivion
- Quebec National Institute of Public Health, Quebec G1E 7G9, Canada.
| | - Chantal Sauvageau
- Quebec National Institute of Public Health, Quebec G1E 7G9, Canada.
- Laval University Hospital Research Center, Quebec G1V 4G5, Canada.
| | - Arnaud Gagneur
- Department of Pediatrics, Étienne Le-Bel Research Center of Sherbrooke University Hospital, Quebec J1H 5N4, Canada.
| | | | - Maryse Guay
- Quebec National Institute of Public Health, Quebec G1E 7G9, Canada.
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Dubé E, Laberge C, Guay M, Bramadat P, Roy R, Bettinger JA. Vaccine hesitancy: an overview. Hum Vaccin Immunother 2013; 9:1763-73. [PMID: 23584253 PMCID: PMC3906279 DOI: 10.4161/hv.24657] [Citation(s) in RCA: 1142] [Impact Index Per Article: 103.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 04/04/2013] [Accepted: 04/11/2013] [Indexed: 01/27/2023] Open
Abstract
Despite being recognized as one of the most successful public health measures, vaccination is perceived as unsafe and unnecessary by a growing number of individuals. Lack of confidence in vaccines is now considered a threat to the success of vaccination programs. Vaccine hesitancy is believed to be responsible for decreasing vaccine coverage and an increasing risk of vaccine-preventable disease outbreaks and epidemics. This review provides an overview of the phenomenon of vaccine hesitancy. First, we will characterize vaccine hesitancy and suggest the possible causes of the apparent increase in vaccine hesitancy in the developed world. Then we will look at determinants of individual decision-making about vaccination.
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Affiliation(s)
- Eve Dubé
- Centre de recherche du CHU de Québec; Québec, QC Canada
- Institut national de santé publique du Québec (INSPQ); Québec, QC Canada
- Université Laval; Québec City, QC Canada
| | | | - Maryse Guay
- Institut national de santé publique du Québec (INSPQ); Québec, QC Canada
- Université de Sherbrooke; Longueuil, QC Canada
- Centre de recherche du CSSS Champlain—Charles-LeMoyne; Longueuil, QC Canada
- Direction de santé publique de la Montérégie; Québec, QC Canada
| | | | - Réal Roy
- University of Victoria; Saanich, BC Canada
| | - Julie A. Bettinger
- University of British Columbia; Vancouver, BC Canada
- Vaccine Evaluation Center; Women’s Health Research Institute; BC Women’s and Children's Hospital; Vancouver, BC Canada
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Kilham HA, Leask J. The Royal Australasian College of Physicians immunisation position statement. J Paediatr Child Health 2013; 49:427-31. [PMID: 23678977 DOI: 10.1111/jpc.12230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Henry A Kilham
- The Children's Hospital at Westmead, New South Wales, Australia.
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12
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Leask J, Kinnersley P, Jackson C, Cheater F, Bedford H, Rowles G. Communicating with parents about vaccination: a framework for health professionals. BMC Pediatr 2012; 12:154. [PMID: 22998654 PMCID: PMC3480952 DOI: 10.1186/1471-2431-12-154] [Citation(s) in RCA: 388] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 09/04/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A critical factor shaping parental attitudes to vaccination is the parent's interactions with health professionals. An effective interaction can address the concerns of vaccine supportive parents and motivate a hesitant parent towards vaccine acceptance. Poor communication can contribute to rejection of vaccinations or dissatisfaction with care. We sought to provide a framework for health professionals when communicating with parents about vaccination. METHODS Literature review to identify a spectrum of parent attitudes or 'positions' on childhood vaccination with estimates of the proportion of each group based on population studies. Development of a framework related to each parental position with determination of key indicators, goals and strategies based on communication science, motivational interviewing and valid consent principles. RESULTS Five distinct parental groups were identified: the 'unquestioning acceptor' (30-40%), the 'cautious acceptor' (25-35%); the 'hesitant' (20-30%); the 'late or selective vaccinator' (2-27%); and the 'refuser' of all vaccines (<2%). The goals of the encounter with each group will vary, depending on the parents' readiness to vaccinate. In all encounters, health professionals should build rapport, accept questions and concerns, and facilitate valid consent. For the hesitant, late or selective vaccinators, or refusers, strategies should include use of a guiding style and eliciting the parent's own motivations to vaccinate while, avoiding excessive persuasion and adversarial debates. It may be necessary to book another appointment or offer attendance at a specialised adverse events clinic. Good information resources should also be used. CONCLUSIONS Health professionals have a central role in maintaining public trust in vaccination, including addressing parents' concerns. These recommendations are tailored to specific parental positions on vaccination and provide a structured approach to assist professionals. They advocate respectful interactions that aim to guide parents towards quality decisions.
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Affiliation(s)
- Julie Leask
- School of Public Health, and Discipline of Paediatrics and Child Health University of Sydney and National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, Australia.
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13
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Isaacs D. An ethical framework for public health immunisation programs. NEW SOUTH WALES PUBLIC HEALTH BULLETIN 2012; 23:111-115. [PMID: 22738621 DOI: 10.1071/nb11045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This paper presents seven ethical principles associated with the implementation of immunisation programs. For a public health immunisation program to be ethically justifiable, its principles and operation should be based on sound ethical values: the program should benefit the individual and the community; targeted diseases should be sufficiently severe and frequent to justify the risks and expense of the program, and vulnerable groups within the population should be targeted. The principles also deal with the obligation to monitor for adverse events and for disease incidence to ensure safety and effectiveness. When immunisations are voluntary, vaccine recipients or their parents or carers should be given sufficient information to make autonomous, informed decisions and incentives to participate in public health immunisation programs should not be coercive. Public health immunisation programs depend on mutual trust, which may be threatened by circumstances such as excessive media publicity about adverse events associated with vaccines.
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Affiliation(s)
- David Isaacs
- Department of Infectious Diseases, Children's Hospital at Westmead.
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