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Chau M, Kaufman J, Holland P, Danchin M, Tuckerman J. Co-designing an intervention to improve the childhood catch-up vaccination process for migrant parents in Australia. Vaccine 2024; 42:126104. [PMID: 39030082 DOI: 10.1016/j.vaccine.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 04/21/2024] [Accepted: 07/02/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Catch-up vaccination is a personalised process through which children with missing recommended vaccinations or incomplete vaccination records are brought up to date with the Australian vaccination schedule. Navigating childhood catch-up vaccination can be difficult for migrant parents with inadequate health system knowledge and competing priorities during settlement. This study aimed to understand the experiences of migrant parents with childhood catch-up vaccination and co-design an intervention to improve the process. METHODS We recruited migrant parents who had attended the City of Melbourne Immunisation Service in Melbourne, Australia to participate in a qualitative co-design study between June and August 2022. Expression of interest emails were sent by the service, and we recruited eligible participants. In Phase One, we conducted group interviews with parents to understand their experiences and preferences for an intervention, these were analysed using inductive and framework analysis. In Phase Two, we designed prototype interventions based on parents' preferences and suggestions. In Phase Three, parents shared their feedback on each prototype. RESULTS Fourteen migrant parents participated in the study. Most parents did not discover the need for catch-up vaccination until childcare or kindergarten enrolment. The lack of information received about vaccination requirements and difficulty navigating the health system made the process challenging and time-consuming. Based on these Phase One themes, we designed a printout, mobile application, and website prototype. All three were well-received in Phase Three. Overall, parents' top three considerations for any intervention were 1) digital and online accessibility, 2) inclusion of step-by-step processes outlining catch-up vaccination; and 3) inclusion of a checklist. CONCLUSIONS Migrant parents lack information about childhood catch-up vaccination in Australia. A relatively simple intervention could help parents more easily navigate the process, thereby saving time and stress. The next steps are to seek funding to pilot such an intervention to assess practicality and usefulness.
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Affiliation(s)
- Maxine Chau
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia.
| | - Jessica Kaufman
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia
| | | | - Margie Danchin
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of General Medicine, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Jane Tuckerman
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia
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Degeling C, Leask J, Attwell K, Wood N, Braunack‐Mayer A, Wiley K, Ward P, Carter SM. Public values to guide childhood vaccination mandates: A report on four Australian community juries. Health Expect 2024; 27:e13936. [PMID: 39102740 PMCID: PMC10753634 DOI: 10.1111/hex.13936] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 08/07/2024] Open
Abstract
OBJECTIVE Governments use vaccination mandates, of different degrees of coerciveness, to encourage or require childhood vaccination. We elicited the views of well-informed community members on the public acceptability of using childhood vaccination mandates in Australia. METHODS Four community juries were conducted in Canberra, Launceston, Cairns and Melbourne, Australia between 2021 and 2022. We recruited 51 participants from diverse backgrounds, genders and ages through random digit dialling and social media. Two juries were held in metropolitan areas, and two in regional/rural settings. Outcome measures included jury verdicts and reasons in response to structured questions. RESULTS All juries were concerned about collective protection and individual rights but prioritised the former over the latter. A majority in all juries supported mandates but juries disagreed with respect to the appropriate mandate types. All juries endorsed using the least restrictive or coercive means to encourage vaccination (providing incentives or education, e.g.) before imposing penalties such as financial losses and school exclusions. The overriding view was that it is fairer to place a direct burden on parents rather than children and that mandates should be designed to avoid inequitable impacts on less advantaged groups in society. Many jurors found conscientious objection acceptable as a controlled option for resolute refusers, provided that overall vaccination coverage remains high. CONCLUSION This paper gives policymakers access to the reasons that Australians have for supporting or opposing different mandates under conditions of high knowledge, understanding and deliberation regarding policy options. Sustaining high rates of vaccination requires high levels of co-operation between governments, public health actors and the public. Our findings highlight the importance of considering public values in the design and implementation of vaccination mandates. PATIENT AND PUBLIC INVOLVEMENT We sought input from individuals who did and did not vaccinate during the study design. The views and perspectives of nonvaccinating parents were presented in the evidence to juries. We deliberately excluded nonvaccinating individuals from participating, as the divisive and often hostile nature of the topic, and their minority status, made it difficult to ensure they would feel safe as members of the jury without overrepresenting their perspective in the sample. Two related projects engaged directly with these parents.
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Affiliation(s)
- Chris Degeling
- The Faculty of Arts, Social Sciences and Humanities, Australian Centre for Health Engagement, Evidence and ValuesUniversity of WollongongWollongongNew South WalesAustralia
| | - Julie Leask
- Faculty of Medicine and Health, School of Public HealthThe University of SydneySydneyNew South WalesAustralia
| | - Katie Attwell
- School of Social SciencesThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Nicholas Wood
- National Centre for Immunisation Research and SurveillanceWestmeadNew South WalesAustralia
| | - Annette Braunack‐Mayer
- The Faculty of Arts, Social Sciences and Humanities, Australian Centre for Health Engagement, Evidence and ValuesUniversity of WollongongWollongongNew South WalesAustralia
| | - Kerrie Wiley
- Faculty of Medicine and Health, School of Public HealthThe University of SydneySydneyNew South WalesAustralia
| | - Paul Ward
- Research Centre for Public Health, Equity and Human FlourishingTorrens University AustraliaAdelaideSouth AustraliaAustralia
| | - Stacy M. Carter
- The Faculty of Arts, Social Sciences and Humanities, Australian Centre for Health Engagement, Evidence and ValuesUniversity of WollongongWollongongNew South WalesAustralia
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Attwell K, Hannah A. Convergence on Coercion: Functional and Political Pressures as Drivers of Global Childhood Vaccine Mandates. Int J Health Policy Manag 2022; 11:2660-2671. [PMID: 35397484 PMCID: PMC9818102 DOI: 10.34172/ijhpm.2022.6518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 02/05/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Vaccine hesitancy is a global problem with diverse local policy responses, from voluntaristic to coercive. Between 2015 and 2017, California, Australia, France, and Italy increased the coerciveness of their childhood vaccine regimes. Despite this apparent convergence, there is little evidence of imposition, policy learning, or diffusion - the drivers that are usually discussed in scholarly literature on policy convergence. The fact that the four governments were oriented across the political spectrum, with quite different political and institutional systems, further indicates an empirical puzzle. METHODS To better understand the drivers of enhanced vaccine mandates, a crucial issue during the coronavirus disease 2019 (COVID-19) global rollout, this article engages with four case studies assembled from qualitative analysis of semi-structured in-country interviews and document analysis between November 2018 and November 2020. Key informants had specific expert knowledge or played a role in the introduction or implementation of the new policies. Interview transcripts were coded inductively and deductively, augmented with extensive analysis of legal, policy, academic and media documents. RESULTS The case analysis identifies two key and interacting elements in government decisions to tighten vaccine mandates: functional and political pressures. Policy-makers in Italy and France were primarily driven by functional challenges, with their vaccination governance systems under threat from reduced population compliance. California and Australia did not face systemic threats to the functioning of their systems, but activists utilised local opportunities to heighten political pressure on decision makers. CONCLUSION In four recent cases of high-income jurisdictions making childhood vaccination policies more coercive, vaccine hesitancy alone could not explain why the policies arose in these jurisdictions and not others, while path dependency alone could not explain why some jurisdictions with mandates made them more coercive. Explanation lies in restrictive mandates being attractive for governments, whether they face systemic functional problems in vaccine governance, or political pressures generated by media and activists. Mandates can be framed as targeting whole populations or localised groups of refusers, and implemented without onerous costs or policy complexity.
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Affiliation(s)
- Katie Attwell
- Political Science and International Relations, School of Social Sciences, University of Western Australia, Perth, WA, Australia
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Healthcare professional and professional stakeholders' perspectives on vaccine mandates in Switzerland: A mixed-methods study. Vaccine 2022; 40:7397-7405. [PMID: 35164988 PMCID: PMC8832463 DOI: 10.1016/j.vaccine.2021.12.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/13/2021] [Accepted: 12/30/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND There currently are no mandatory vaccines in Switzerland. However, Swiss federal legislation allows for vaccination mandates in settings where the risk of transmission to vulnerable groups is high, such as healthcare professionals (HCPs) working with vulnerable patients. Since HCPs are trusted information sources, a priority population for COVID-19 vaccination, and potentially subjected to mandates, we investigated HCP perspectives on mandates. METHODS A national online survey was administered to HCPs (October 2020-March 2021), including vaccine mandates questions concerning patients (measles) and HCPs (influenza). We qualitatively investigated HCP mandate perspectives through: (1) 34 interviews with HCPs, HCP professional society representatives, and health authorities; (2) a focus group discussion (FGD) with complementary medicine (CM) and biomedical physicians, and Swiss Federal Vaccination Commission members. RESULTS 1933 participants (496 physicians, 226 pharmacists, 607 nurses, 604 midwives) responded to the survey. Quantitative results show all professional groups preferred shared parent-HCP measles vaccine decisions (65%, 54%, 50%, 48%, respectively; p for trend < 0.001). Midwives (87%) and nurses (70%) preferred individual influenza vaccination decisions for HCPs, while physicians (49%) and pharmacists (44%) preferred shared employee-employer decisions (p for trend < 0.001). Physicians (p < .001) and pharmacists (p < .01) with CM training favored individual influenza vaccination decisions. Qualitative results show general HCP opposition to vaccine mandates, mainly because participants argued how other approaches, such as HCP training and better information, could encourage uptake. Arguments against COVID-19 mandates included insufficiently documented long-term safety/efficacy data. From participants' perspectives, mandated vaccination should be used as a last resort. Some participants expressed fear that with mandates, notably for influenza and COVID-19, some HCPs might leave their jobs. HCPs were unsure what vaccine mandates would concretely look like in practice, particularly regarding sanctions for non-compliance and enforcement. CONCLUSION In Switzerland, HCPs generally were opposed to vaccination mandates. Clarity and guidance are needed from health authorities to better inform discussions around vaccine mandates.
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COVID-19 vaccine Mandates: An Australian attitudinal study. Vaccine 2022; 40:7360-7369. [PMID: 34872796 PMCID: PMC8629747 DOI: 10.1016/j.vaccine.2021.11.056] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND The rollout of vaccines against COVID-19 is prompting governments and the private sector to adopt mandates. However, there has been little conceptual analysis of the types of mandates available, nor empirical analysis of how the public thinks about different mandates and why. Our conceptual study examines available instruments, how they have been implemented pre-COVID, and their use for COVID-19 globally. Then, our qualitative study reports the acceptability of such measures in Western Australia, which has experienced very limited community transmission, posing an interesting scenario for vaccine acceptance and acceptability of measures to enforce it. METHOD Our conceptual study developed categories of mandates from extant work, news reports, and legislative interventions globally. Then, our empirical study asked 44 West Australians about their attitudes towards potential mandatory policies, with data analysed using NVivo 12. RESULTS Our novel studies contribute richness and depth to emerging literature on the types and varying acceptability of vaccine requirements. Participants demonstrated tensions and confusion about whether instruments were incentives or punishments, and many supported strong consequences for non-vaccination even if they ostensibly opposed mandates. Those attached to restrictions for disease prevention were most popular. There were similar degrees of support for mandates imposed by employers or businesses, with participants showing little concern for potential issues of accountability linked to public health decisions delegated to the private sector. Participants mostly supported tightly regulated medical exemptions granted by specialists, with little interest in religious or personal belief exemptions. CONCLUSION Our participants are used to being governed by vaccine mandates, and now by rigorous lockdown and travel restrictions that have ensured limited local COVID-19 disease and transmission. These factors appear influential in their general openness to COVID-19 vaccine mandates, especially when linked explicitly to the prevention of disease in high-risk settings.
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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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Attwell K, Rizzi M, Paul KT. Consolidating a research agenda for vaccine mandates. Vaccine 2022; 40:7353-7359. [PMID: 36396514 PMCID: PMC9662755 DOI: 10.1016/j.vaccine.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022]
Abstract
A workshop on mandatory vaccination was pitched to the World Public Health Congress in 2019 and the resultant special issue was pitched to Vaccine in 2020. During this project, the COVID-19 pandemic pushed vaccine policy to the forefront of global public health policy, and the imposition of vaccine mandates prompted a new wave of scholarship in the field. This introductory article employs the heuristic of Lasswell's (1956) policy cycle to synthesise the findings of the articles in the special issue. It considers the temporal lifetime of mandates and highlights findings regarding: the emergence of mandates as a policy option, public support and policy instrument design, what matters in the implementation of mandates, and what we can learn from evaluating them. The second half of the paper categorizes the included papers in terms of what aspects of mandates they study and the methods they employ to do so, in order to formulate a guide for future researchers of vaccine mandates. Scholars study either speculative or existing mandates - research can address several stages of the policy cycle or just one of them, ranging from attitudinal research to implementation studies and impact studies. Historical and contextual studies that take deep dives into a particular mandate are a much needed resource for studying emerging mandates, too, and scoping and framework- building work will undoubtedly be valuable in understanding and appreciating the wealth of knowledge production in this growing field. This special issue can serve as a roadmap for a consolidation of this interdisciplinary research agenda, and provide a helpful resource for decisionmakers at this historical juncture.
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Affiliation(s)
- Katie Attwell
- School of Social Science, The University of Western Australia, Perth, Australia.
| | - Marco Rizzi
- UWA Law School, The University of Western Australia, Perth, Australia
| | - Katharina T Paul
- Department of Political Science, Faculty of Social Sciences, The University of Vienna, Vienna, Austria
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Caliskan Y, Hippen BE, Axelrod DA, Schnitzler M, Maher K, Alhamad T, Lam NN, Anwar S, Kute V, Lentine KL. International Practices on COVID-19 Vaccine Mandates for Transplant Candidates. KIDNEY360 2022; 3:1754-1762. [PMID: 36514724 PMCID: PMC9717656 DOI: 10.34067/kid.0004062022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/15/2022] [Indexed: 01/12/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic created unprecedented challenges for solid organ transplant centers worldwide. We sought to assess an international perspective on COVID-19 vaccine mandates and rationales for or against mandate policies. Methods We administered an electronic survey to staff at transplant centers outside the United States (October 14, 2021-January 28, 2022) assessing the reasons cited by transplant centers for or against implementing a COVID-19 vaccine mandate. Each responding center was represented once in the analysis. Results Respondents (N=90) represented 27 countries on five continents. Half (51%) of responding transplant center representatives reported implementing a COVID-19 vaccine mandate, 38% did not, and 12% were unsure. Staff at centers implementing a vaccine mandate cited efficacy of pretransplant vaccination versus post-transplant vaccination, importance for public health, and minimizing exposure of other patients as rationale for the mandate. Of centers with a mandate, the majority (81%) of the centers mandate vaccination regardless of prior SARS-CoV-2 infection status and regardless of prevaccination spike-protein antibody titer or other markers of prior infection. Only 27% of centers with a vaccine mandate for transplant candidates also extended a vaccine requirement to living donor candidates. Centers not implementing a vaccine mandate cited concerns for undue pressure on transplant candidates, insufficient evidence to support vaccine mandates, equity, and legal considerations. Conclusions The approach to pretransplant COVID-19 vaccination mandate policies at international transplant centers is heterogeneous. International transplant centers with a vaccine mandate were more willing to extend vaccine requirements to candidates' support persons, cohabitants, and living donors. Broader stakeholder engagement to overcome vaccine hesitancy across the world is needed to increase the acceptance of pretransplant COVID-19 vaccination to protect the health of transplant patients.
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Affiliation(s)
- Yasar Caliskan
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri
| | - Benjamin E. Hippen
- Global Medical Office, Fresenius Medical Care, Charlotte, North Carolina
| | | | - Mark Schnitzler
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri
| | - Kennan Maher
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri
| | - Tarek Alhamad
- Washington University School of Medicine at St. Louis, St. Louis, Missouri
| | - Ngan N. Lam
- Division of Nephrology, Cumming School of Medicine, University of Calgary, Canada
| | - Siddiq Anwar
- Sheikh Shakhbout Medical Hospital, Abu Dhabi, United Arab Emirates
| | - Vivek Kute
- Dr. H.L. Trivedi Institute of Transplantation Sciences, Ahmedabad, India
| | - Krista L. Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri
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Wiley KE, Leask J, Attwell K, Helps C, Barclay L, Ward PR, Carter SM. Stigmatized for standing up for my child: A qualitative study of non-vaccinating parents in Australia. SSM Popul Health 2021; 16:100926. [PMID: 34604497 PMCID: PMC8473775 DOI: 10.1016/j.ssmph.2021.100926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Vaccine refusal is highly polarizing in Australia, producing a challenging social landscape for non-vaccinating parents. We sought to understand the lived experience of non-vaccinating parents in contemporary Australia. METHODS We recruited a national sample of non-vaccinating parents of children <18 yrs, advertising on national radio, in playgrounds in low vaccination areas, and using snowballing. Grounded Theory methodology guided data collection (via semi-structured interviews). Inductive analysis identified stigmatization as a central concept; stigma theory was adopted as an analytical lens. RESULTS Twenty-one parents from regional and urban locations in five states were interviewed. Parent's described experiences point to systematic stigmatization which can be characterized using Link & Phelan's five-step process. Parents experienced (1) labelling and (2) stereotyping, with many not identifying with the "anti-vaxxers" portrayed in the media and describing frustration at being labelled as such, believing they were defending their child from harm. Participants described (3) social "othering", leading to relationship loss and social isolation, and (4) status loss and discrimination, feeling "brushed off" as incompetent parents and discriminated against by medical professionals and other parents. Finally, (5) legislative changes exerted power over their circumstances, rendering them unable to provide their children with the same financial and educational opportunities as vaccinated children, often increasing their steadfastness in refusing vaccination. CONCLUSION Non-vaccinating Australian parents feel stigmatized for defending their child from perceived risk of harm, reporting a range of social and psychological effects, as well as financial effects from policies which disadvantaged their children through differential financial treatment, and diminished early childhood educational opportunities. While it might be argued that social stigma and exclusionary policies directed a small minority for the greater good are justified, other more nuanced approaches based on better understandings of vaccine rejection could achieve comparable public health outcomes without the detrimental effect on unvaccinated families.
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Affiliation(s)
- Kerrie E. Wiley
- Sydney School of Public Health, Faculty of Health and Medicine, University of Sydney, Australia
| | - Julie Leask
- Sydney School of Public Health, Faculty of Health and Medicine, University of Sydney, Australia
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Australia
| | - Katie Attwell
- School of Social Sciences, Faculty of Arts, Business, Law and Education, University of Western Australia, Australia
| | - Catherine Helps
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Australia
| | - Lesley Barclay
- University Centre for Rural Health, Sydney School of Public Health, University of Sydney, Australia
| | - Paul R. Ward
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Stacy M. Carter
- Australian Centre for Health Engagement, Evidence and Values (ACHEEV), University of Wollongong, Australia
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Court J, Carter SM, Attwell K, Leask J, Wiley K. Labels matter: Use and non-use of 'anti-vax' framing in Australian media discourse 2008-2018. Soc Sci Med 2021; 291:114502. [PMID: 34715625 DOI: 10.1016/j.socscimed.2021.114502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/20/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
Childhood vaccine refusal is a globally contentious topic, with some jurisdictions addressing it with punitive policies. Media discourse influences how solutions are framed by implying blame - a process known as framing. We examined Australian media discourse on vaccine rejection over a period in which mandatory childhood vaccination policies were discussed and introduced, focusing on the common Australian pejorative term 'anti-vaxxer'. We mapped frequency of use from January 2008 to December 2018. We then searched Factiva for print media articles on childhood vaccination and parents published in that period, searching separately for articles using and not using 'anti-vaxxer' and variants. We constructed a set of 85 articles that did, and 85 articles date-matched that did not use the term to make comparisons and conducted a frame analysis of each set. 'Anti-vaxxer' was absent in Australian media discourse 2008-2010, rising to a peak of 247 articles using the term at the height of legislative change in 2017. Parents were framed as: 1) deviant "others"; 2) ignorant and in need of informing; 3) vulnerable and in need of protection from anti-vaccination activists; 4) thoughtful, critical, informed, and in need of agency and respect; 5) entitled, privileged and selfish; and finally, 6) lacking access to vaccination, rather than being unwilling. Articles using 'anti-vax' terms were more likely to negatively characterise non-vaccinating parents, while articles not including this language were more likely to frame them as thoughtful or lacking access. This study clearly demonstrates strategic use of pejoratives in the Australian mass media around a time of pressure for legislative change and conflation of anti-vaccination activists with non-vaccinating parents. We suggest fundamental changes to how non-vaccination is framed and dealt with in the media to curb polarization and fostering more respectful dialogue, and better social and public health outcomes.
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Affiliation(s)
- Jay Court
- Susan Wakil School of Nursing and Midwifery, University of Sydney, Australia
| | - Stacy M Carter
- Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Australia
| | - Katie Attwell
- Faculty of Arts, Business, Law and Education, School of Social Sciences, University of Western, Australia
| | - Julie Leask
- Susan Wakil School of Nursing and Midwifery, University of Sydney, Australia; School of Public Health, University of Sydney, Australia
| | - Kerrie Wiley
- School of Public Health, University of Sydney, Australia.
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Danchin M, Buttery J. COVID-19 vaccine hesitancy: a unique set of challenges. Intern Med J 2021; 51:1987-1989. [PMID: 34713544 PMCID: PMC8652967 DOI: 10.1111/imj.15599] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 11/29/2022]
Abstract
The global SARS-CoV-2 pandemic has seen a revolution in both vaccine development and approval processes enabling life-saving vaccines to be implemented at record speed. The resultant vaccines, implemented in Australia under provisional licensure, have used vaccine technologies not used before in Australia. Australia and New Zealand, for much of the pandemic, have been spared the high rates of COVID-19 disease seen elsewhere. Implementing COVID-19 vaccination programs at an entire adult population level has been a complex, evolving series of programs, with recommendations and strategies responding to community confidence, concerns and rare but potentially severe post-licensure adverse events. Understanding our diverse community and their concerns, incentivising immunisation, and responding openly to emergent concerns are key components to maintaining community and health care provider confidence in this critical ongoing COVID-19 vaccine program. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Margie Danchin
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, Victoria, 3052.,Department of Paediatrics, University of Melbourne, 50 Flemington Road, Parkville, Victoria, 3052.,Department of General Medicine, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3052
| | - Jim Buttery
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, Victoria, 3052.,Department of Paediatrics, University of Melbourne, 50 Flemington Road, Parkville, Victoria, 3052.,Department of General Medicine, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3052.,Centre for Health Analytics, Melbourne Children's Campus, 50 Flemington Road, Parkville, Victoria, 3052
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12
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Attwell K, Harper T, Rizzi M, Taylor J, Casigliani V, Quattrone F, Lopalco P. Inaction, under-reaction action and incapacity: communication breakdown in Italy's vaccination governance. POLICY SCIENCES 2021; 54:457-475. [PMID: 34149101 PMCID: PMC8203395 DOI: 10.1007/s11077-021-09427-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/29/2021] [Indexed: 06/12/2023]
Abstract
This article explores why governments do not respond to public compliance problems in a timely manner with appropriate instruments, and the consequences of their failure to do so. Utilising a case study of Italian vaccination policy, the article considers counterfactuals and the challenges of governing health policy in an age of disinformation. It counterposes two methods of governing vaccination compliance: discipline, which uses public institutions to inculcate the population with favourable attitudes and practices, and modulation, which uses access to public institutions as a form of control. The Italian government ineffectively employed discipline for a number of years. Epistemological and organisational constraints stymied its efforts to tackle a significant childhood vaccination compliance problem. With a loss of control over the information environment, vaccinations were not served well by exogenous crises, the sensationalism of the news cycle and online misinformation. Hampered by austerity, lack of capacity and epistemic shortcomings, the Italian government did not protect the public legitimacy of the vaccination programme. Instead of employing communications to reassure a hesitant population, they focused on systemic and delivery issues, until it was too late to do anything except make vaccinations mandatory (using modulation). The apparent short-term success of this measure in generating population compliance does not foreclose the need for ongoing governance of vaccine confidence through effective discipline. This is evident for the COVID-19 vaccination campaign, with many Italians still indicating that they would not accept a vaccine despite the devastation that the disease has wrought throughout their country.
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Affiliation(s)
- Katie Attwell
- School of Social Sciences, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Northern Entrance, Perth Children’s Hospital, 15 Hospital Avenue, Nedlands, WA 6009 Australia
| | - Tauel Harper
- School of Social Sciences, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Marco Rizzi
- Law School, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Jeannette Taylor
- School of Social Sciences, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Virginia Casigliani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Filippo Quattrone
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - PierLuigi Lopalco
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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13
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Removing conscientious objection: The impact of 'No Jab No Pay' and 'No Jab No Play' vaccine policies in Australia. Prev Med 2021; 145:106406. [PMID: 33388333 DOI: 10.1016/j.ypmed.2020.106406] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 02/07/2023]
Abstract
Vaccine refusal and hesitancy pose a significant public health threat to communities. Public health authorities have been developing a range of strategies to improve childhood vaccination coverage. This study examines the effect of removing conscientious objection on immunisation coverage for one, two and five year olds in Australia. Conscientious objection was removed from immunisation requirement exemptions for receipt of family assistance payments (national No Jab No Pay) and enrolment in childcare (state No Jab No Play). The impact of these national and state-level policies is evaluated using quarterly coverage data from the Australian Immunisation Register linked with regional data from the Australian Bureau of Statistics at the statistical area level between 2014 and 2018. Results suggest that there have been overall improvements in coverage associated with No Jab No Pay, and states that implemented additional No Jab No Play and tightened documentation requirement policies tended to show more significant increases. However, policy responses were heterogeneous. The improvement in coverage was largest in areas with greater socioeconomic disadvantage, lower median income, more benefit dependency, and higher pre-policy baseline coverage. Overall, while immunisation coverage has increased post removal of conscientious objection, the policies have disproportionally affected lower income families whereas socioeconomically advantaged areas with lower baseline coverage were less responsive. More effective strategies require investigation of differential policy effects on vaccine hesitancy, refusal and access barriers, and diagnosis of causes for unresponsiveness and under-vaccination in areas with persistently low coverage, to better address areas with persistent non-compliance with accordant interventions.
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Abstract
Vaccination decisions and policies present tensions between individual rights and the moral duty to contribute to harm prevention. This article focuses on ethical issues around vaccination behaviour and policies. It will not cover ethical issues around vaccination research. SOURCES OF DATA Literature on ethics of vaccination decisions and policies. AREAS OF AGREEMENT Individuals have a moral responsibility to vaccinate, at least against certain infectious diseases in certain circumstances. AREAS OF CONTROVERSY Some argue that non-coercive measures are ethically preferable unless there are situations of emergency. Others hold that coercive measures are ethically justified even in absence of emergencies. GROWING POINTS Conscientious objection to vaccination is becoming a major area of discussion. AREAS TIMELY FOR DEVELOPING RESEARCH The relationship between individual, collective and institutional responsibilities to contribute to the public good of herd immunity will be a major point of discussion, particularly with regard to the COVID-19 vaccine.
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Affiliation(s)
- Alberto Giubilini
- Oxford Uehiro Centre for Practical Ethics and Wellcome Centre for Ethics and Humanities, University of Oxford, 16-17 St Ebbes St, Oxford OX1 1PT, UK
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15
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Bayliss J, Nissen M, Prakash D, Richmond P, Oh KB, Nolan T. Control of vaccine preventable diseases in Australian infants: reviewing a decade of experience with DTPa-HBV-IPV/Hib vaccine. Hum Vaccin Immunother 2021; 17:176-190. [PMID: 32573398 PMCID: PMC7872029 DOI: 10.1080/21645515.2020.1764826] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/29/2020] [Indexed: 02/07/2023] Open
Abstract
The combined vaccine against diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis, and Haemophilus influenzae b (DTPa-HBV-IPV/Hib, Infanrix Hexa, GSK) has been used for childhood immunization in Australia according to a two-, four-, six-month schedule since 2009. We reviewed data available in the Australian National Notifiable Diseases Surveillance System, annual vaccination coverage reports, the Database of Adverse Event Notifications, and peer-reviewed literature to assess vaccine coverage rates, incidence of all six vaccine preventable diseases, and the safety profile of DTPa-HBV-IPV/Hib vaccine in Australian infants over a period of ten years of exclusive use. Between 2009 and 2018 vaccine coverage for infants aged 12 months increased from 91.7% to 94.0% and from 84.9% to 92.6% for all and for Indigenous infants, respectively. Over the same time period, there were no reports of poliomyelitis, diphtheria or tetanus in infants <12 months of age. The incidence of hepatitis B among Australian infants <12 months of age remains 10 to 20-fold lower than the national average. Control of Haemophilus influenzae b (Hib) and pertussis disease has continued to be challenging. Timely administration of the primary series, as well as increasing coverage rates, particularly among Indigenous children, has contributed to improvements in Hib and pertussis disease control. The incorporation of additional strategies such as adjustment of the first vaccination encounter to six weeks of age, parental cocooning, and most recently maternal vaccination has further reduced the burden of pertussis, particularly during the first six months of life. The frequency of the ten most common adverse events related to the DTPa-HBV-IPV/Hib vaccine demonstrates an acceptable safety profile. Data collected over ten years of consistent, exclusive use of the DTPa-HBV-IPV/Hib vaccine in Australia highlights combination vaccination as a cornerstone in maintaining infant health.
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Affiliation(s)
| | - Michael Nissen
- Scientific Affairs & Public Health, GSK, Singapore, Singapore
| | | | - Peter Richmond
- Division of Paediatrics and Centre for Child Health Research, University of Western Australia, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth Children’s Hospital, Perth, Australia
| | - Kyu-Bin Oh
- Medical Affairs, GSK, Singapore, Singapore
| | - Terry Nolan
- Vaccine and Immunisation Research Group (Virgo), University of Melbourne, School of Population and Global Health and Murdoch Children’s Research Institute, Melbourne, Australia
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16
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Navin MC, Danchin M. Vaccine mandates in the US and Australia: balancing benefits and burdens for children and physicians. Vaccine 2020; 38:8075-8077. [PMID: 33183856 DOI: 10.1016/j.vaccine.2020.10.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/13/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Mark C Navin
- Department of Philosophy, Oakland University, Rochester, MI, United States; Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, United States.
| | - Margie Danchin
- Department of Paediatrics, University of Melbourne, Australia; Murdoch Children's Research Institute, Australia; Department of General Medicine, Royal Childrens Hospital, Australia
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17
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Attwell K, Seth R, Beard F, Hendry A, Lawrence D. Financial Interventions to Increase Vaccine Coverage. Pediatrics 2020; 146:peds.2020-0724. [PMID: 33199467 DOI: 10.1542/peds.2020-0724] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Recent vaccine mandates in Australia, as in other high income settings, have sought to change the behavior of parents, including those who would otherwise access nonmedical exemptions. Since 2014, Australian state governments have introduced and progressively tightened policies restricting the access of unvaccinated children to early education and child care. In 2016, the Federal Government removed financial entitlements and subsidies from nonvaccinating families. We sought to ascertain the impact of these policies on vaccine coverage rates by state, and also to consider their impact on communities with high numbers of registered refusers. METHODS Interrupted time series models were fitted by using the Autoregressive Integrated Moving Average framework to test for changes in trend in vaccination rates following implementation of government policies. RESULTS Australian vaccine coverage rates were rising before the vaccine mandates and continued to do so subsequently, with no statistically significant changes to coverage rates associated with the interventions. The exception was New South Wales, where vaccine coverage rates were static before the policy intervention, but were increasing at an annual rate of 1.25% after (P < .001). The impact of the policies was indistinguishable between communities with high, medium and low numbers of registered vaccine refusers. CONCLUSIONS In our study, we show that childhood vaccine coverage continued on its positive trajectory without any conclusive evidence of impact of mandatory policies. Overseas policymakers looking to increase coverage rates would be well-advised to examine the contribution of pre-existing and parallel nonmandatory interventions employed by Australian governments to the country's enhanced coverage.
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Affiliation(s)
- Katie Attwell
- School of Social Sciences, The University of Western Australia, Perth, Australia; .,Wesfarmers School of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - Rebecca Seth
- Graduate School of Education, The University of Western Australia, Perth, Australia
| | - Frank Beard
- National Centre for Immunisation Research and Surveillance, Westmead, Australia; and.,School of Public Health, The University of Sydney, Sydney, Australia
| | - Alexandra Hendry
- National Centre for Immunisation Research and Surveillance, Westmead, Australia; and
| | - David Lawrence
- Graduate School of Education, The University of Western Australia, Perth, Australia
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18
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Toll M, Li A. Vaccine sentiments and under-vaccination: Attitudes and behaviour around Measles, Mumps, and Rubella vaccine (MMR) in an Australian cohort. Vaccine 2020; 39:751-759. [PMID: 33218781 DOI: 10.1016/j.vaccine.2020.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 09/12/2020] [Accepted: 11/06/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The study aimed to examine the consistency in factors associated with attitudes towards vaccination and MMR vaccination status. METHODS Using the nationally representative Longitudinal Study of Australian Children matched with the Australian Childhood Immunisation Register, 4,779 children were included from 2004-2005 to 2010-11. Different MMR vaccine dosages and general attitude towards vaccination were modelled individually with multinomial logit regressions, controlling for demographic, socioeconomic, and health related factors of the children and their primary carers. RESULTS The group with non-vaccination and negative attitudes was characterised by more siblings and older parents the group with under-vaccination but positive attitudes was characterised by younger parental age; and the group with under-vaccination and neutral attitudes was characterised by less socioeconomically advantaged areas. The presence of parental medical condition(s), being private or public renters, and higher parental education were associated with under-vaccination but not with attitudes towards vaccination, whilst parental religion was associated with attitudes towards vaccination but not reflected in the vaccine uptake. CONCLUSIONS Vaccine attitudes were largely consistent with MRR vaccine outcomes. However, there was variation in the associations of factors with vaccine attitudes and uptake. The results have implications for different policy designs that target subgroups with consistent or inconsistent vaccination attitudes and behaviour. Parents with intentional and unintentional under-vaccination are of policy concern and require different policy solutions.
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Affiliation(s)
- Mathew Toll
- Department of Sociology and Social Policy, School of Social and Political Science, Faculty of Arts and Social Science, The University of Sydney, Camperdown, NSW, Australia; LCT Centre for Knowledge Building, Faculty of Arts and Social Science, The University of Sydney, Camperdown, NSW, Australia.
| | - Ang Li
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia; Sydney Health Economics, Sydney Local Health District, Camperdown, NSW, Australia
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19
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Navin MC, Attwell K. Imperfect Immunization Communication on School District Websites: A Mixed-Methods Review. J Sch Nurs 2020; 38:459-466. [PMID: 33153397 DOI: 10.1177/1059840520970886] [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] [Indexed: 11/17/2022] Open
Abstract
Schools and school districts are key to U.S. vaccination policies: They communicate immunization enrollment requirements and enforce them during registration. This article presents a mixed-methods study of how Michigan's 537 districts communicate about vaccine mandates through public-facing websites. It reports the results of a qualitative analysis (n = 50) of websites from Southeast Michigan and a quantitative analysis of all (n = 537) Michigan's district websites. School district websites engage in diverse health promotion practices surrounding immunization, from encouraging vaccination to neutral messaging and to encouraging exemptions. Most provide scant immunization information and few promote the importance of immunization for individual and community health. We recommend that school nurses, district staff, and health authorities collaborate to ensure that school district communication promotes immunization and does not promote nonmedical exemptions. This can lead schools to embrace immunization as an essential activity for their own functioning rather than as an unwelcome requirement imposed by outside agents.
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Affiliation(s)
- Mark C Navin
- Department of Philosophy, Oakland University, Rochester, MI, USA.,Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Katie Attwell
- Political Science and International Relations, University of Western Australia, Crawley, Western Australia, Australia
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20
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Nolan TM. "No jab, no pay" pays off. Med J Aust 2020; 213:356-357. [PMID: 32996182 DOI: 10.5694/mja2.50796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Terence M Nolan
- Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC.,Murdoch Children's Research Institute, Melbourne, VIC
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21
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Hull BP, Beard FH, Hendry AJ, Dey A, Macartney K. "No jab, no pay": catch-up vaccination activity during its first two years. Med J Aust 2020; 213:364-369. [PMID: 32951230 PMCID: PMC7692886 DOI: 10.5694/mja2.50780] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/15/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess catch-up vaccination of older children and adolescents during the first two years of the "No jab, no pay" policy linking eligibility for federal family assistance payments with childhood vaccination status. DESIGN, SETTING, PARTICIPANTS Cross-sectional analysis of Australian Immunisation Register data on catch-up vaccination of children aged 5 to less than 7 years before (January 2013 - December 2014; baseline) and during the first two years of "No jab, no pay" (December 2015 - December 2017), and of children aged 7 to less than 10 years and young people aged 10 to less than 20 years ("No jab, no pay" period only). MAIN OUTCOMES Catch-up vaccination rates for measles-mumps-rubella vaccine second dose (MMR2), by age group, Indigenous status, and socio-economic status; catch-up vaccination of children aged 5 to less than 7 years (third dose of diphtheria-tetanus-pertussis vaccine [DTPa3], MMR1), before and after introduction of "No jab, no pay". RESULTS The proportion of incompletely vaccinated children aged 5 to less than 7 years who received catch-up DTPa3 was higher under "No jab, no pay" than during the baseline period (15.5% v 9.4%). Of 407 332 incompletely vaccinated people aged 10 to less than 20 years, 71 502 (17.6%) received catch-up MMR2 during the first two years of "No jab, no pay", increasing overall coverage for this age group from 86.6% to 89.0%. MMR2 catch-up activity in this age group was greater in the lowest socio-economic status areas than in the highest status areas (29.1% v 7.6%), and also for Indigenous than for non-Indigenous Australians (35.8% v 17.1%). MMR2 catch-up activity in 2016 and 2017 peaked mid-year. CONCLUSIONS Linking family assistance payments with childhood vaccination status and associated program improvements were followed by substantial catch-up vaccination activity, particularly in young people from families of lower socio-economic status.
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Affiliation(s)
- Brynley P Hull
- National Centre for Immunisation Research and Surveillancethe Sydney Children's Hospitals Network
| | - Frank H Beard
- National Centre for Immunisation Research and Surveillancethe Sydney Children's Hospitals Network
- The University of SydneySydneyNSW
| | - Alexandra J Hendry
- National Centre for Immunisation Research and Surveillancethe Sydney Children's Hospitals Network
| | - Aditi Dey
- National Centre for Immunisation Research and Surveillancethe Sydney Children's Hospitals Network
- The University of SydneySydneyNSW
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillancethe Sydney Children's Hospitals Network
- The University of SydneySydneyNSW
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22
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Armiento R, Hoq M, Kua E, Crawford N, Perrett KP, Elia S, Danchin M. Impact of Australian mandatory ‘No Jab, No Pay’ and ‘No Jab, No Play’ immunisation policies on immunisation services, parental attitudes to vaccination and vaccine uptake, in a tertiary paediatric hospital, the Royal Children’s Hospital, Melbourne. Vaccine 2020; 38:5231-5240. [DOI: 10.1016/j.vaccine.2020.05.094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 10/24/2022]
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Gargiulo F, Cafiero F, Guille-Escuret P, Seror V, Ward JK. Asymmetric participation of defenders and critics of vaccines to debates on French-speaking Twitter. Sci Rep 2020; 10:6599. [PMID: 32313016 PMCID: PMC7171088 DOI: 10.1038/s41598-020-62880-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 03/19/2020] [Indexed: 12/02/2022] Open
Abstract
For more than a decade, doubt about vaccines has become an increasingly important global issue. Polarization of opinions on this matter, especially through social media, has been repeatedly observed, but details about the balance of forces are left unclear. In this paper, we analyse the flow of information on vaccines on the French-speaking realm of Twitter between 2016 and 2017. Two major asymmetries appear. Rather than opposing themselves on each vaccine, defenders and critics focus on different vaccines and vaccine-related topics. Pro-vaccine accounts focus on hopes for new groundbreaking vaccines and on ongoing outbreaks of vaccine-preventable illnesses. Vaccine critics concentrate their posts on a limited number of "controversial" vaccines and adjuvants. Furthermore, vaccine-critical accounts display greater craft and energy, using a wider variety of sources, and a more coordinated set of hashtags. This double asymmetry can have serious consequences. Despite the presence of a large number of pro-vaccine accounts, some arguments raised by efficiently organized and very active vaccine-critical activists are left unanswered.
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Affiliation(s)
| | - Florian Cafiero
- CNRS, Université Paris Sorbonne, GEMASS, 75017, Paris, France
| | - Paul Guille-Escuret
- CNRS, Université Paris Sorbonne, GEMASS, 75017, Paris, France
- Aix Marseille Université, IRD, AP-HM, SSA, VITROME, 13005, Marseille, France
| | - Valérie Seror
- Aix Marseille Université, IRD, AP-HM, SSA, VITROME, 13005, Marseille, France
| | - Jeremy K Ward
- CNRS, Université Paris Sorbonne, GEMASS, 75017, Paris, France.
- Aix Marseille Université, IRD, AP-HM, SSA, VITROME, 13005, Marseille, France.
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24
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Menzies R, Heron L, Lampard J, McMillan M, Joseph T, Chan J, Storken A, Marshall H. A randomised controlled trial of SMS messaging and calendar reminders to improve vaccination timeliness in infants. Vaccine 2020; 38:3137-3142. [PMID: 32147296 DOI: 10.1016/j.vaccine.2020.02.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/11/2020] [Accepted: 02/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The effectiveness of SMS reminders in improving vaccination coverage has been assessed previously, with effectiveness varying between settings. However, there are very few studies on their effect on the timeliness of vaccination. DESIGN Unblinded, randomised controlled trial with blocked sampling. METHODS 1594 Australian infants and young children were recruited to assess the impact of (1) SMS reminders only, (2) a personalised calendar, (3) SMS reminder and personalised calendar and (4) no intervention, on receipt of vaccine within 30 days of the due date. Outcomes were measured for receipt of vaccines due at 2, 4, 6, 12 and 18 months of age. A post-hoc assessment was also conducted of the impact of a new national "No jab No Pay" policy introduced during the trial, which removed philosophical objections as an exemption for financial penalties for non-vaccination. RESULTS There was a statistically significant improvement in on-time vaccination only at the 12 month schedule point amongst infants who received SMS reminders alone (RR 1.09, 95% CI 1.01-1.18) or in combination with a personalised calendar (1.11, CI 1.03-1.20) compared to controls. This impact was limited to participants who had received one or more previous doses late. No statistically significant impacts of calendar interventions alone were seen. There was a high rate of on-time compliance amongst control participants - 95%, 86%, 80%, 74% at the 4, 6, 12 and 18 month schedule points respectively, which increased more than 10 percentage points after implementation of the "No Jab, No Pay" policy. CONCLUSIONS SMS reminders are more effective in improving timeliness where pre-existing compliance is lower, but the 18 month schedule point appeared to be less amenable to intervention. Australia and New Zealand Clinical Trial Registration No. ACTRN12614000970640.
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Affiliation(s)
- R Menzies
- Kirby Institute, University of New South Wales, Kensington, NSW, Australia.
| | - L Heron
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, NSW, Australia; Kids Research Institute, The Children's Hospital Westmead, Westmead, NSW, Australia
| | - J Lampard
- Kids Research Institute, The Children's Hospital Westmead, Westmead, NSW, Australia
| | - M McMillan
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - T Joseph
- Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - J Chan
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, NSW, Australia; National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - A Storken
- Department of Health, South Australia, Adelaide, SA, Australia
| | - H Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
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25
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Vaz OM, Ellingson MK, Weiss P, Jenness SM, Bardají A, Bednarczyk RA, Omer SB. Mandatory Vaccination in Europe. Pediatrics 2020; 145:e20190620. [PMID: 31932361 PMCID: PMC7011108 DOI: 10.1542/peds.2019-0620] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mandatory vaccination has been effective in maintaining high vaccination coverage in countries such as the United States. However, there are no peer-reviewed analyses of the association between mandates and both coverage and subsequent incidence of vaccine-preventable disease in Europe. METHODS Using data from the European Centre for Disease Prevention and Control and the World Health Organization, we evaluated the relationship between country-level mandatory vaccination policies and (1) measles and pertussis vaccine coverage and (2) the annual incidence of these diseases in 29 European countries. Multivariate negative binomial and linear regression models were used to quantify these associations. RESULTS Mandatory vaccination was associated with a 3.71 (95% confidence interval [CI]: 1.68 to 5.74) percentage point higher prevalence of measles vaccination and a 2.14 (95% CI: 0.13 to 4.15) percentage point higher prevalence of pertussis vaccination when compared with countries that did not have mandatory vaccination. Mandatory vaccination was only associated with decreased measles incidence for countries without nonmedical exemptions (adjusted incidence rate ratio = 0.14; 95% CI: 0.05 to 0.36). We did not find a significant association between mandatory vaccination and pertussis incidence. CONCLUSIONS Mandatory vaccination and the magnitude of fines were associated with higher vaccination coverage. Moreover, mandatory vaccination was associated with lower measles incidence for countries with mandatory vaccination without nonmedical exemptions. These findings can inform legislative policies aimed at increasing vaccination coverage.
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Affiliation(s)
| | | | | | | | - Azucena Bardají
- Hospital Clínic, Barcelona Institute for Global Health, Universitat de Barcelona, Barcelona, Spain
| | - Robert A Bednarczyk
- Departments of Epidemiology and
- Hubert Department of Global Health, Rollins School of Public Health
- Emory Vaccine Center, and
- Winship Cancer Institute, Emory University, Atlanta, Georgia; and
| | - Saad B Omer
- Departments of Epidemiology and
- Hubert Department of Global Health, Rollins School of Public Health
- Department of Pediatrics, School of Medicine
- Emory Vaccine Center, and
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26
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ATTWELL KATIE, C. NAVIN MARK. Childhood Vaccination Mandates: Scope, Sanctions, Severity, Selectivity, and Salience. Milbank Q 2019; 97:978-1014. [PMID: 31529546 PMCID: PMC6904257 DOI: 10.1111/1468-0009.12417] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Policy Points We offer the first systematic conceptual framework for analyzing the operation of mandatory vaccination policies. Our multicomponent framework facilitates synthesis judgments on single issues of pressing concern to policymakers, in particular, how mandatory vaccination policies motivate people to vaccinate. We consider the impact of each component of our framework on persons who remain unvaccinated for different reasons, including complacency, social disadvantage, and more or less committed forms of refusal. CONTEXT In response to outbreaks of vaccine-preventable disease and increasing rates of vaccine refusal, some political communities have recently implemented coercive childhood immunization programs, or they have made existing childhood immunization programs more coercive. Many other political communities possess coercive vaccination policies, and others are considering developing them. Scholars and policymakers generally refer to coercive immunization policies as "vaccine mandates." However, mandatory vaccination is not a unitary concept. Rather, coercive childhood immunization policies are complex, context-specific instruments. Their legally and morally significant features often differ, and they are imposed by political communities in varying circumstances and upon diverse populations. METHODS In this paper, we introduce a taxonomy for classifying real-world and theoretical mandatory childhood vaccination policies, according to their scope (which vaccines to require), sanctions and severity (which kind of penalty to impose on vaccine refusers, and how much of that penalty to impose), and selectivity (how to enforce or exempt people from vaccine mandates). FINDINGS A full understanding of the operation of a vaccine mandate policy (real or potential) requires attention to the separate components of that policy. However, we can synthesize information about a policy's scope, sanctions, severity, and selectivity to identify a further attribute-salience-which identifies the magnitude of the burdens the state imposes on those who are not vaccinated. CONCLUSION Our taxonomy provides a framework for forensic examination of current and potential mandatory vaccination policies, by focusing attention on those features of vaccine mandates that are most relevant for comparative judgments.
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Navin MC, Kozak AT, Deem MJ. Perspectives of public health nurses on the ethics of mandated vaccine education. Nurs Outlook 2019; 68:62-72. [PMID: 31375346 DOI: 10.1016/j.outlook.2019.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/06/2019] [Accepted: 06/21/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Since 2015, Michigan has required parents who request nonmedical exemptions (NMEs) from school or daycare immunization mandates to receive education from local public health staff (usually nurses). This is unlike most other US states that have implemented mandatory immunization counseling, which require physicians to document immunization education, or which provide online instruction. PURPOSE To attend to the activity and dispositions of the public health staff who provide "waiver education". METHOD This study reports results of focus group interviews with 39 of Michigan's vaccine waiver educators (37 nurses), conducted during 2016 and 2017, and analyzed in 2018. FINDINGS Four themes emerged from analysis of the transcripts of these interviews: Participants had (1) complex and nuanced observations and evaluations of parents' judgments and feelings about vaccines and vaccine education; (2) sympathetic attitudes about alternative vaccine schedules; (3) critical and supportive evaluations of institutional policies and the background political context of immunization education; and (4) consistent commitments to respect parents, affirm their values, and protect their rights. DISCUSSION These results show that public health nurses are sensitive to the burdens mandatory immunization education places on families, the motivations for parents' requests for nonmedical exemptions, and the values implicated by personal immunization decisions and government immunization policies. In light of the unique training, experiences, and public reputation of nurses, there is good reason for additional investigation into the roles that nurses can play in immunization education and in vaccine mandate policies, more generally.
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Affiliation(s)
- Mark C Navin
- Department of Philosophy, Oakland University, Rochester, MI.
| | - Andrea T Kozak
- Department of Psychology, Oakland University, Rochester, MI
| | - Michael J Deem
- School of Nursing, Duquesne University, Pittsburgh, PA; Center for Healthcare Ethics, Duquesne University, Pittsburgh, PA
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28
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Helps C, Leask J, Barclay L, Carter S. Understanding non-vaccinating parents' views to inform and improve clinical encounters: a qualitative study in an Australian community. BMJ Open 2019; 9:e026299. [PMID: 31142523 PMCID: PMC6549625 DOI: 10.1136/bmjopen-2018-026299] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To explain vaccination refusal in a sample of Australian parents. DESIGN Qualitative design, purposive sampling in a defined population. SETTING A geographically bounded community of approximately 30 000 people in regional Australia with high prevalence of vaccination refusal. PARTICIPANTS Semi structured interviews with 32 non-vaccinating parents: 9 fathers, 22 mothers and 1 pregnant woman. Purposive sampling of parents who had decided to discontinue or decline all vaccinations for their children. Recruitment via local advertising then snowballing. RESULTS Thematic analysis focused on explaining decision-making pathways of parents who refuse vaccination. Common patterns in parents' accounts included: perceived deterioration in health in Western societies; a personal experience introducing doubt about vaccine safety; concerns regarding consent; varied encounters with health professionals (dismissive, hindering and helpful); a quest for 'the real truth'; reactance to system inflexibilities and ongoing risk assessment. CONCLUSIONS We suggest responses tailored to the perspectives of non-vaccinating parents to assist professionals in understanding and maintaining empathic clinical relationships with this important patient group.
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Affiliation(s)
- Catherine Helps
- University Centre for Rural Health, University of Sydney, Lismore, New South Wales, Australia
| | - Julie Leask
- Susan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, New South Wales, Australia
| | - Lesley Barclay
- University Centre for Rural Health, University of Sydney, Lismore, New South Wales, Australia
| | - Stacy Carter
- Australian Centre for Health Engagement, Evidence and Values (ACHEEV), School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
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29
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Mandatory vaccination and no fault vaccine injury compensation schemes: An identification of country-level policies. Vaccine 2019; 37:2843-2848. [DOI: 10.1016/j.vaccine.2019.03.065] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/14/2019] [Accepted: 03/27/2019] [Indexed: 11/23/2022]
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30
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Isaacs D, Preisz A, Britton PN, Kilham HA, Robinson PD, Farrow G. Does asplenia make some immunisations obligatory? J Paediatr Child Health 2019; 55:499-501. [PMID: 31017363 DOI: 10.1111/jpc.14418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/12/2019] [Accepted: 02/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- David Isaacs
- Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Anne Preisz
- Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Philip N Britton
- Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Henry A Kilham
- Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Paul D Robinson
- Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Glendon Farrow
- Children's Hospital at Westmead, Sydney, New South Wales, Australia
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31
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Vanderslott S. Exploring the meaning of pro-vaccine activism across two countries. Soc Sci Med 2018; 222:59-66. [PMID: 30605800 DOI: 10.1016/j.socscimed.2018.12.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 12/17/2018] [Accepted: 12/23/2018] [Indexed: 10/27/2022]
Abstract
While vaccine-critical activism has been widely documented and discussed, comparatively little has been said about the concerted response of pro-vaccine activists defending the majority view. This paper explores two case studies of pro-vaccine activism in Australia and the United States (US). It shows how pro-vaccine views and behaviours can take varying forms due to different aims and methods of engagement - oppositional counteractivities in favour of vaccination in Australia, and issue-based advocacy as part of a political alliance in the US. The focus in Australia comes from a pro-science stance and includes 'skeptics' against pseudoscience directly opposing vaccine-critical groups. In the US, the focus takes the form of an issue-specific campaign that has arisen from existing pro-vaccine parent blogs and discussion groups pushing for policy change rather than public confrontation. These case studies exemplify how pro-vaccine activism can take varying forms of either reinforcing the mainstream view or countering digression from it. Drawing on qualitative research, this paper aims to examine the types of practices and strategies employed by activists to voice their support of vaccination, and discusses the means, messages, and motivations of pro-vaccine activism. It ends with an argument for why a study - of public support for in addition to studying public opposition to vaccination - can help to better understand vaccination views and behaviours. These findings have wider implications for the study of counter-activism and the polarisation of civil society groups.
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Affiliation(s)
- Samantha Vanderslott
- Oxford Vaccine Group & Oxford Martin School, University of Oxford, 34 Broad St, Oxford, OX1 2BD, UK.
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32
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Attwell K, Navin MC, Lopalco PL, Jestin C, Reiter S, Omer SB. Recent vaccine mandates in the United States, Europe and Australia: A comparative study. Vaccine 2018; 36:7377-7384. [PMID: 30337171 DOI: 10.1016/j.vaccine.2018.10.019] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND In response to recent outbreaks of vaccine-preventable diseases and concerns around vaccine refusal, several high-income countries have adopted or reformed vaccine mandate policies. While all make it more difficult for parents to refuse vaccines, the nature and scope of 'mandatory vaccination' is heterogeneous, and there has been no attempt to develop a detailed, comparative systematic account of the possible forms mandates can take. METHODS We compare the construction, introduction/amendment, and operation of six new high profile vaccine mandates in Australia, France, Germany, Italy, California, and Washington. We rank these policies in order of their relative restrictiveness and analyze other differences between them. RESULTS New mandate instruments differ in their effects on behavior, and with regard to their structure, exemptions, target populations, consequences and enforcement. We identify diverse means by which vaccine mandates can restrict behaviors, various degrees of severity, and different gradations of intensity in enforcement. CONCLUSION We suggest that politico-cultural context and vaccine policy history are centrally important factors for vaccine mandate policymakers to consider. It matters whether citizens trust their governments to limit individual freedom in the name of public health, and whether citizens have previously been subjected to vaccine mandates. Furthermore, political communities must consider the diverse mechanisms by which they may construct vaccine mandate policies; whether through emergency decrees or ordinary statutes, and how (or whether) to involve various stakeholder groups in developing and implementing new vaccine mandate policies.
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Affiliation(s)
- Katie Attwell
- Political Science and International Relations, University of Western Australia, 35 Stirling Highway, Crawley 6009, Australia.
| | - Mark C Navin
- Department of Philosophy, Oakland University, 146 Library Drive, Rochester, MI 48309-4479, USA
| | - Pier Luigi Lopalco
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Lungarno Antonio Pacinotti, 43, 56126 Pisa Pl, Italy
| | - Christine Jestin
- Sante Publique France, 12 rue du Val d'Osne, 94415 Saint-Maurice Cedex, France
| | - Sabine Reiter
- Infectious Diseases, Antimicrobial Resistance, Hygiene, Vaccination Federal Ministry of Health, Bundesministerium für Gesundheit Referat, 322 Friedrichstraße 108, 10117 Berlin, Germany
| | - Saad B Omer
- Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 20211, USA
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33
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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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34
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Homel J, Edwards B. Factors associated with delayed infant immunization in a nationally representative cohort study. Child Care Health Dev 2018; 44:583-591. [PMID: 29460321 DOI: 10.1111/cch.12560] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 01/15/2018] [Accepted: 01/29/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many children in developed countries do not receive recommended vaccines on time. However, knowledge about factors related to timeliness remains limited. Quantifying the relative impact of parental attitudes compared with socio-demographic factors for delayed immunization would inform policy responses. METHODS Participants in the nationally representative Longitudinal Study of Australian Children were matched with their vaccination histories in the Australian Childhood Immunisation Register (N = 4,121). Information about the children and their families were collected in face-to-face interviews in 2003-2004. We considered whether children had completed the primary course for each recommended antigen due by 6 months old. Children were categorized as either fully immunized, delayed, or totally non-immunized. The outcome was examined using logistic regression. Population attributable fractions were estimated for key predictors. RESULTS Delayed immunization was significantly associated with indicators of social disadvantage as well as parental disagreement with immunization. Attributable fractions for delayed immunization included lone motherhood (3.8%; 95% confidence interval CI [0.8, 6.7]), larger family size (39.5%; 95% CI [31.2, 46.8]), residential mobility (3.3%; 95% CI [0.1, 6.5]), lack of private hospital insurance (9.4%; 95% CI [0.7, 17.3]), a medical condition in the child (2.0%; 95% CI [0.2, 3.9]), and parental disagreement with immunization (2.1%; 95% CI [0.3, 3.9]). CONCLUSIONS Parental attitudes accounted for a relatively small percentage of delayed infant immunization. In contrast, many children who did not receive vaccines on time were characterized by social disadvantage, especially larger family size. Researchers and policy-makers should consider how to make timely immunization easier for busy parents.
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Affiliation(s)
- J Homel
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD, Australia
| | - B Edwards
- ANU Centre for Social Research and Methods, Australian National University, Canberra, ACT, Australia
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35
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Haire B, Komesaroff P, Leontini R, Raina MacIntyre C. Raising Rates of Childhood Vaccination: The Trade-off Between Coercion and Trust. JOURNAL OF BIOETHICAL INQUIRY 2018; 15:199-209. [PMID: 29497995 DOI: 10.1007/s11673-018-9841-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 11/02/2017] [Indexed: 05/09/2023]
Abstract
Vaccination is a highly effective public health strategy that provides protection to both individuals and communities from a range of infectious diseases. Governments monitor vaccination rates carefully, as widespread use of a vaccine within a population is required to extend protection to the general population through "herd immunity," which is important for protecting infants who are not yet fully vaccinated and others who are unable to undergo vaccination for medical or other reasons. Australia is unique in employing financial incentives to increase vaccination uptake, mainly in the form of various childcare payments and tax benefits linked to timely, age-appropriate vaccination. Despite relatively high compliance with the childhood vaccination schedule, however, the Australian government has determined that rates should be higher and has recently introduced policy that includes removing certain tax and childcare benefits for non-vaccinators and formally disallowing conscientious objection to vaccination ("No Jab No Pay"). In addition, it has raised the possibility of banning unvaccinated children from childcare centres ("No Jab No Play"). This article examines the impact of coercive approaches to childhood vaccination and raises the question of the ethical justification of health policy initiatives based on coercion. We consider the current evidence regarding childhood vaccination in Australia, the small but real risks associated with vaccination, the ethical requirement for consent for medical procedures, and the potential social harms of targeting non-vaccinators. We conclude that the evidence does not support a move to an increasingly mandatory approach that could only be delivered through paternalistic, coercive clinical practices.
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Affiliation(s)
- Bridget Haire
- Kirby Institute, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW, 2052, Australia.
| | - Paul Komesaroff
- Monash Centre for the Study of Ethics in Medicine, Monash University, Clayton, Australia
| | - Rose Leontini
- School of Public Health and Community Medicine, UNSW Sydney, Kensington, NSW, 2052, Australia
| | - C Raina MacIntyre
- School of Public Health and Community Medicine, UNSW Sydney, Kensington, NSW, 2052, Australia
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36
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Costa-Pinto JC, Willaby HW, Leask J, Hoq M, Schuster T, Ghazarian A, O'Keefe J, Danchin MH. Parental Immunisation Needs and Attitudes Survey in paediatric hospital clinics and community maternal and child health centres in Melbourne, Australia. J Paediatr Child Health 2018; 54:522-529. [PMID: 29168910 DOI: 10.1111/jpc.13790] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 09/12/2017] [Accepted: 09/25/2017] [Indexed: 11/29/2022]
Abstract
AIM Despite Australia's high vaccination rates, an estimated 3.3% of children are under-vaccinated due to vaccine refusal and the proportion of parents with concerns is unclear. Amongst Australian parents, we aimed to determine the prevalence of vaccine concerns, resources and health-care providers (HCPs) accessed and satisfaction with these resources in two different settings. We also aimed to identify relationships between the level of vaccine concern, socio-economic status and vaccine uptake. METHODS Parents of children under 5 years attending general paediatric clinics in a tertiary paediatric hospital (n = 301/398, 76%) and children under 19 months attending community maternal child health centres (n = 311/391, 81%) completed the survey. Vaccination status was obtained from the Australian Childhood Immunisation Register. RESULTS Despite high support for vaccination (98%, confidence interval (CI) 97-99), 43% of parents reported vaccine concerns (CI 40-47) including the number of vaccines given in the first 2 years (25%, CI 22 to 29), vaccine ingredients (22%, CI 19-25), allergies (18%, CI 15-21), weakening of the immune system (17%, CI 14-20) and autism (11%, CI 8-13). HCPs were the most commonly accessed and trusted information source. In all, 23% of parents reported insufficient knowledge to make good vaccination decisions (CI 20-26). There was little evidence of an association between parental vaccine acceptance or socio-economic status and vaccination status. CONCLUSIONS Despite high support for vaccines, nearly half of Australian parents have some concerns and a quarter lack vaccine decision-making confidence regarding childhood vaccines. Parents frequently access and report high trust in HCPs, who are best placed to address parental vaccine concerns through provision of clear information, using effective communication strategies. Further research in more highly hesitant populations is required to determine the relationship between the level and nature of vaccination concerns and vaccine uptake.
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Affiliation(s)
- Jessica C Costa-Pinto
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Harold W Willaby
- School of Public Health, University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
| | - Julie Leask
- School of Public Health, University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
| | - Monsurul Hoq
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Tibor Schuster
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Alice Ghazarian
- Centre for Community Child Health, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Jacinta O'Keefe
- Vaccine and Immunisation Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Margie H Danchin
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Vaccine and Immunisation Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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37
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Brewer NT, Chapman GB, Rothman AJ, Leask J, Kempe A. Increasing Vaccination: Putting Psychological Science Into Action. Psychol Sci Public Interest 2018; 18:149-207. [DOI: 10.1177/1529100618760521] [Citation(s) in RCA: 483] [Impact Index Per Article: 80.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Vaccination is one of the great achievements of the 20th century, yet persistent public-health problems include inadequate, delayed, and unstable vaccination uptake. Psychology offers three general propositions for understanding and intervening to increase uptake where vaccines are available and affordable. The first proposition is that thoughts and feelings can motivate getting vaccinated. Hundreds of studies have shown that risk beliefs and anticipated regret about infectious disease correlate reliably with getting vaccinated; low confidence in vaccine effectiveness and concern about safety correlate reliably with not getting vaccinated. We were surprised to find that few randomized trials have successfully changed what people think and feel about vaccines, and those few that succeeded were minimally effective in increasing uptake. The second proposition is that social processes can motivate getting vaccinated. Substantial research has shown that social norms are associated with vaccination, but few interventions examined whether normative messages increase vaccination uptake. Many experimental studies have relied on hypothetical scenarios to demonstrate that altruism and free riding (i.e., taking advantage of the protection provided by others) can affect intended behavior, but few randomized trials have tested strategies to change social processes to increase vaccination uptake. The third proposition is that interventions can facilitate vaccination directly by leveraging, but not trying to change, what people think and feel. These interventions are by far the most plentiful and effective in the literature. To increase vaccine uptake, these interventions build on existing favorable intentions by facilitating action (through reminders, prompts, and primes) and reducing barriers (through logistics and healthy defaults); these interventions also shape behavior (through incentives, sanctions, and requirements). Although identification of principles for changing thoughts and feelings to motivate vaccination is a work in progress, psychological principles can now inform the design of systems and policies to directly facilitate action.
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Affiliation(s)
- Noel T. Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina
| | | | | | - Julie Leask
- Faculty of Nursing and Midwifery, University of Sydney
- Faculty of Medicine, University of Sydney
| | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine
- Department of Pediatrics, University of Colorado Anschutz Medical Campus
- Department of Pediatrics, Children’s Hospital Colorado, Aurora, Colorado
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38
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“It just forces hardship”: impacts of government financial penalties on non-vaccinating parents. J Public Health Policy 2018; 39:156-169. [DOI: 10.1057/s41271-017-0116-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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39
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Vorsters A, Arbyn M, Baay M, Bosch X, de Sanjosé S, Hanley S, Karafillakis E, Lopalco PL, Pollock KG, Yarwood J, Van Damme P. Overcoming barriers in HPV vaccination and screening programs. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2017; 4:45-53. [PMID: 29179869 PMCID: PMC7268103 DOI: 10.1016/j.pvr.2017.07.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 07/19/2017] [Accepted: 07/19/2017] [Indexed: 01/17/2023]
Abstract
The Human Papillomavirus Prevention and Control Board brought together experts to discuss optimizing HPV vaccination and screening programs. Board members reviewed the safety profile of licensed HPV vaccines based on clinical and post-marketing data, reaching a consensus that current safety data is reassuring. Successful vaccination programs used well-coordinated communication campaigns, integrating (social) media to spread awareness. Communication of evidence supporting vaccine effectiveness had beneficial effects on the perception of the vaccine. However, anti-vaccination campaigns have threatened existing programs in many countries. Measurement and monitoring of HPV vaccine confidence over time could help understand the nature and scale of waning confidence, define issues and intervene appropriately using context-specific evidence-based strategies. Finally, a broad group of stakeholders, such as teachers, health care providers and the media should also be provided with accurate information and training to help support prevention efforts through enhanced understanding of the risks and benefits of vaccination. Similarly, while cervical cancer screening through population-based programs is highly effective, barriers to screening exist: awareness in countries with population-based screening programs, access for vulnerable populations, and access and affordability in low- and middle-income countries. Integration of primary and secondary prevention has the potential to accelerate the decrease in cervical cancer incidence.
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Affiliation(s)
- Alex Vorsters
- Centre for Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium.
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
| | - Marc Baay
- P95, Epidemiology and Pharmacovigilance Consulting and Services, Leuven, Belgium
| | - Xavier Bosch
- Cancer Research Epidemiology Program, Catalan Institute of Oncology, IDIBELL, Barcelona, Spain
| | - Silvia de Sanjosé
- Cancer Research Epidemiology Program, Catalan Institute of Oncology, IDIBELL, Barcelona, Spain; CIBER Epidemiologia y Salud Pública, Barcelona, Spain
| | - Sharon Hanley
- Department of Women's Health Medicine, Hokkaido University Graduate School of Medicine, Kita Ku, Sapporo, Japan
| | - Emilie Karafillakis
- Vaccine Confidence Project, London School of Hygiene & Tropical Medicine, London, UK
| | - Pier Luigi Lopalco
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | | | - Joanne Yarwood
- Immunisation, Hepatitis & Blood Safety Department, Public Health England, London, UK
| | - Pierre Van Damme
- Centre for Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
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40
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Beard FH, Leask J, McIntyre PB. No Jab, No Pay and vaccine refusal in Australia: the jury is out. Med J Aust 2017; 207:407. [PMID: 29297649 DOI: 10.5694/mja17.00566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 07/03/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Frank H Beard
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, NSW
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41
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Attwell K, Smith DT. Hearts, minds, nudges and shoves: (How) can we mobilise communities for vaccination in a marketised society? Vaccine 2017; 36:6506-6508. [PMID: 28830692 DOI: 10.1016/j.vaccine.2017.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 06/14/2017] [Accepted: 08/02/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Katie Attwell
- Sir Walter School of Public Policy and International Affairs, Murdoch University, South Street, Murdoch, WA 6150, Australia; Present address: Political Science and International Relations, School of Social Science, The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia.
| | - David T Smith
- United States Studies Centre at the University of Sydney and Department of Government and International Relations, Faculty of Arts and Social Sciences, The University of Sydney, Institute Building H03, NSW 2006, Australia.
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42
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Thomas S, Islam F, Durrheim DN, Cashman P. Addressing Barriers to Immunisation Using a Tailored Approach. J Paediatr Child Health 2017; 53:826. [PMID: 28770569 DOI: 10.1111/jpc.13613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 04/19/2017] [Accepted: 05/01/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Susan Thomas
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Fakhrul Islam
- Department of Population Health, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - David N Durrheim
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Patrick Cashman
- Department of Population Health, Hunter New England Local Health District, Newcastle, New South Wales, Australia
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