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Kelsall J. COVID-19 vaccine refusal as unfair free-riding. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2024; 27:107-119. [PMID: 38189907 PMCID: PMC10904454 DOI: 10.1007/s11019-023-10188-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 01/09/2024]
Abstract
Contributions to COVID-19 vaccination programmes promise valuable collective goods. They can support public and individual health by creating herd immunity and taking the pressure off overwhelmed public health services; support freedom of movement by enabling governments to remove restrictive lockdown policies; and improve economic and social well-being by allowing businesses, schools, and other essential public services to re-open. The vaccinated can contribute to the production of these goods. The unvaccinated, who benefit from, but who do not contribute to these goods can be morally criticised as free-riders. In this paper defends the claim that in the case of COVID-19, the unvaccinated are unfair free-riders. I defend the claim against two objections. First, that they are not unfair free-riders because they lack the subjective attitudes and intentions of free-riders; second, that although the unvaccinated may be free-riders, their free-riding is not unfair.
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Affiliation(s)
- Joshua Kelsall
- University of Warwick, PAIS Building, Coventry, CV47AL, UK.
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2
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Hirani JC, Wüst M. Reminder design and childhood vaccination coverage. JOURNAL OF HEALTH ECONOMICS 2024; 93:102832. [PMID: 37976788 DOI: 10.1016/j.jhealeco.2023.102832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/11/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
Abstract
A major policy concern across public vaccination programs is non-compliance. Exploiting Danish population data and three national reforms in regression discontinuity designs, we document the effects of reminders for childhood vaccination coverage. Retrospective reminders are primarily effective for families with small children and when sent out close to the recommended vaccination age. Digital and postal reminders are equally effective. Prospective reminders increase timely vaccinations in later childhood and help reaching high coverage for new vaccines in increasingly complex vaccination programs. While reminders prompt additional preventive care for focal children, we find no spillovers to other health behaviors or relatives.
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Affiliation(s)
| | - Miriam Wüst
- The Danish Center for Social Science Research - VIVE, Denmark; University of Copenhagen, Denmark; CEBI, Denmark.
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3
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Chen R, Guay M, Gilbert NL, Dubé E, Witteman HO, Hakim H. Determinants of parental vaccine hesitancy in Canada: results from the 2017 Childhood National Immunization Coverage Survey. BMC Public Health 2023; 23:2327. [PMID: 38001412 PMCID: PMC10668395 DOI: 10.1186/s12889-023-17079-4] [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: 05/15/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND In 2019, the World Health Organization (WHO) designated vaccine hesitancy as one of the ten leading threats to global health. Vaccine hesitancy exists when vaccination services are available and accessible, but vaccine uptake is lower than anticipated. It is often attributed to lack of trust in vaccine safety and effectiveness, or low level of concern about the risk of many vaccine-preventable diseases. This study aimed to examine the sociodemographic factors associated with parental vaccine hesitancy and vaccine refusal in Canada using data from the 2017 Childhood National Immunization Coverage Survey (CNICS). METHOD The 2017 CNICS was a cross-sectional and nationally representative survey to estimate national vaccine uptake and to collect information about parents' Knowledge, Attitudes and Beliefs (KAB) regarding vaccination. Using the KAB questions, parental vaccine hesitancy (i.e., parental hesitation, delay or refusal of at least one recommended vaccination) and refusal (i.e., unvaccinated children) by sociodemographic factors was estimated using weighted prevalence proportions. A multinomial logistic regression model was fitted to examine associations between parental vaccine hesitancy or refusal and sociodemographic factors among parents of two-year-old children in Canada. Adjusted odds ratios (aOR) of being vaccine-hesitant or vaccine-refusing versus being non-vaccine-hesitant were generated. RESULTS Both unadjusted and adjusted logistic regressions models showed that parents with lower household income (aOR 1.7, 95% CI 1.2-2.5), and those with a higher number of children in the household (aOR 2.2, 95% CI 1.4-3.5) had higher vaccine hesitancy. Conversely, lower vaccine hesitancy was observed among non-immigrant parents (aOR 0.4, 95% CI 0.3-0.6). In addition, lower household income (aOR 4.0, 95% CI 1.3-12.9), and higher number of children in the household (aOR 6.9, 95% CI 2.1-22.9) were significantly associated with parental vaccine refusal. Regional variations were also observed. CONCLUSION Several sociodemographic determinants are associated with parental vaccine hesitancy and refusal. The findings of the study could help public health officials and policymakers to develop and implement targeted interventions to improve childhood vaccination programs.
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Affiliation(s)
- Ruoke Chen
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, ON, Canada.
| | - Mireille Guay
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Nicolas L Gilbert
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, ON, Canada
- University of Montreal School of Public Health, Quebec, Canada
| | - Eve Dubé
- Institut National de Santé Publique du Québec, Quebec, Canada
- Department of Anthropology, Laval University, Quebec, Canada
| | | | - Hina Hakim
- Faculty of Medicine, Laval University, Quebec, Canada
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Campeau K. Vaccine Lines and Line Jumpers: Mapping a New Metaphor from an Interview-Based Study about COVID Vaccination. THE JOURNAL OF MEDICAL HUMANITIES 2023; 44:369-394. [PMID: 36227405 PMCID: PMC9557998 DOI: 10.1007/s10912-022-09749-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 06/16/2023]
Abstract
This article considers how the metaphor of the vaccine line and the subjectivity of the line jumper came to frame COVID vaccination experiences. Drawing on analysis of interviews (n = 24) with self-identified vaccine line jumpers, this article reports on three narratives that arose across interviews: (1) vaccine line jumping is a necessary strategy of health-advocacy, (2) vaccines are personal healthcare tools earned through individual merit, and (3) vaccine refusal is a problem of belief rather than access. Findings advance research about the personalization of vaccination and public health while contributing insights about the constrained subjectivities that people adopt in individualistic health landscapes.
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Affiliation(s)
- Kari Campeau
- English Department, University of Colorado Denver, 1051 Ninth Street Park, Denver, CO, 80204, USA.
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5
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Fasce A, Schmid P, Holford DL, Bates L, Gurevych I, Lewandowsky S. A taxonomy of anti-vaccination arguments from a systematic literature review and text modelling. Nat Hum Behav 2023; 7:1462-1480. [PMID: 37460761 DOI: 10.1038/s41562-023-01644-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/25/2023] [Indexed: 09/23/2023]
Abstract
The proliferation of anti-vaccination arguments is a threat to the success of many immunization programmes. Effective rebuttal of contrarian arguments requires an approach that goes beyond addressing flaws in the arguments, by also considering the attitude roots-that is, the underlying psychological attributes driving a person's belief-of opposition to vaccines. Here, through a pre-registered systematic literature review of 152 scientific articles and thematic analysis of anti-vaccination arguments, we developed a hierarchical taxonomy that relates common arguments and themes to 11 attitude roots that explain why an individual might express opposition to vaccination. We further validated our taxonomy on coronavirus disease 2019 anti-vaccination misinformation, through a combination of human coding and machine learning using natural language processing algorithms. Overall, the taxonomy serves as a theoretical framework to link expressed opposition of vaccines to their underlying psychological processes. This enables future work to develop targeted rebuttals and other interventions that address the underlying motives of anti-vaccination arguments.
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Affiliation(s)
- Angelo Fasce
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - Philipp Schmid
- Institute for Planetary Health Behaviour, University of Erfurt, Erfurt, Germany
- Department of Implementation Research, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Dawn L Holford
- School of Psychological Science, University of Bristol, Bristol, UK
- Department of Psychology, University of Essex, Colchester, UK
| | - Luke Bates
- Ubiquitous Knowledge Processing Lab/Department of Computer Science and Hessian Center for AI (hessian.AI), Technical University of Darmstadt, Darmstadt, Germany
| | - Iryna Gurevych
- Ubiquitous Knowledge Processing Lab/Department of Computer Science and Hessian Center for AI (hessian.AI), Technical University of Darmstadt, Darmstadt, Germany
| | - Stephan Lewandowsky
- School of Psychological Science, University of Bristol, Bristol, UK
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
- Department of Psychology, University of Potsdam, Potsdam, Germany
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6
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Pulgaron ER, D’Agostino EM, Johnson SB, Ko LK, Drain PK, Duran MC, Keener Mast D, Kay S, Layer MA, Kenworthy T, Dozier A. Reflections From School Communities in Underserved Populations on Childhood COVID-19 Vaccination. Pediatrics 2023; 152:e2022060352M. [PMID: 37394501 PMCID: PMC10312275 DOI: 10.1542/peds.2022-060352m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVES Outbreaks in vaccine-preventable diseases among children have increased, primarily among under- or unvaccinated subgroups. The influence and interaction of a child's school community on parental health care decisions, such as vaccination, has not been explored. Our study examined childhood coronavirus disease 2019 (COVID-19) vaccine hesitancy within the context of school communities. METHODS This study combines data from 4 independent research studies funded by the National Institutes of Health Rapid Acceleration of Diagnostics Underserved Populations Return to School Initiative. We examined focus group data to better understand the apprehension surrounding parental and child COVID-19 vaccination among underserved school populations. RESULTS Across all study sites, 7 main themes emerged with regard to COVID-19-related vaccination concerns for children: (1) potential side effects, (2) vaccine development, (3) misinformation (subthemes: content of vaccine and negative intent of the vaccine), (4) vaccine effectiveness, (5) timing of vaccine administration/availability for children, (6) fear of needles, and (7) mistrust. CONCLUSIONS School settings offered unique access to youth and family perspectives in underserved communities. Our studies highlighted several factors contributing to COVID-19 vaccine hesitancy in school communities, which align with existing literature on vaccine hesitancy. These concerns centered primarily on potential harm of vaccines, as well as misinformation, mistrust, and timing of vaccines. Related recommendations for increasing vaccination rates are provided. Developing specific strategies that address parent and child concerns will be critical to reducing health inequities related to COVID-19 vaccination.
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Affiliation(s)
- Elizabeth R. Pulgaron
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - Emily M. D’Agostino
- Departments of Orthopedic Surgery
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Sara B. Johnson
- Division of General Pediatrics, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Linda K. Ko
- Department of Health Systems and Population Health
| | - Paul K. Drain
- Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington
| | | | | | | | | | - Tara Kenworthy
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - Ann Dozier
- Public Health Sciences, University of Rochester, Rochester, New York
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7
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Guaracha-Basañez GA, Contreras-Yáñez I, Álvarez-Hernández E, Reyes-Cordero G, Flores-Alvarado DE, González-Chávez SA, Galarza-Delgado DÁ, Martínez-Leyva PR, Moctezuma-Ríos JF, García-García C, Medrano-Ramírez G, Gastelum-Strozzi A, Pacheco-Tena C, Peláez-Ballestas I, Pascual-Ramos V. Factors associated to COVID-19 vaccine acceptance in Mexican patients with rheumatic diseases: A cross-sectional and multicenter study. Hum Vaccin Immunother 2022; 18:2049131. [PMID: 35389817 PMCID: PMC9196644 DOI: 10.1080/21645515.2022.2049131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/25/2022] [Indexed: 11/23/2022] Open
Abstract
COVID-19 vaccination is recommended in patients with rheumatic diseases (RDs) to prevent hospitalized COVID-19 and worse outcomes. However, patients' willingness to receive a SARS-CoV-2 vaccine and the associated factors vary across populations, vaccines, and time. The objective was to identify factors associated with COVID-19 vaccine acceptance (VA) in Mexican outpatients with RDs. This multicenter study was performed between March 1 and September 30, 2021, and four national centers contributed with patients. Participants filled out a questionnaire, which included 32 items related to patients' perception of the patient-doctor relationship, the COVID-19 vaccine component, the pandemic severity, the RD-related disability, comorbid conditions control, immunosuppressive treatment impact on the immune system, and moral/civil position of COVID-19 vaccine. Sociodemographic, disease-related, and treatment-related variables and previous influenza record vaccination were also obtained. Multiple logistic regression analyses identified factors associated with VA, which was defined based on a questionnaire validated in our population. There were 1439 patients whose data were analyzed, and the most frequent diagnoses were Rheumatoid Arthritis in 577 patients (40.1%) and Systemic Lupus Erythematosus in 427 (29.7%). Patients were primarily middle-aged women (1235 [85.8%]), with (mean±SD) 12.1 (±4.4) years of formal education. Years of education, corticosteroid use, patient perceptions about the vaccine and the pandemic severity, patient civil/moral position regarding COVID-19 vaccine, and previous influenza vaccination were associated with VA. In Mexican patients with RDs, COVID-19 VA is associated with individual social-demographic and disease-related factors, patient´s perceptions, and previous record vaccination. This information is crucial for tailoring effective vaccine messaging in Mexican patients with RDs.
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Affiliation(s)
- Guillermo Arturo Guaracha-Basañez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City, Mexico
| | - Irazú Contreras-Yáñez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City, Mexico
| | | | | | - Diana Elsa Flores-Alvarado
- Rheumatology Department, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - Dionicio Ángel Galarza-Delgado
- Rheumatology Department, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Perla Rocío Martínez-Leyva
- Rheumatology Department, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - Conrado García-García
- Department of Rheumatology, Hospital General de México “Dr. Eduardo Liceaga”, México City, México
| | - Gabriel Medrano-Ramírez
- Department of Rheumatology, Hospital General de México “Dr. Eduardo Liceaga”, México City, México
| | | | - César Pacheco-Tena
- Facultad de Medicina y Universidad Autónoma de Chihuahua, Chihuahua, Mexico
| | - Ingris Peláez-Ballestas
- Department of Rheumatology, Hospital General de México “Dr. Eduardo Liceaga”, México City, México
| | - Virginia Pascual-Ramos
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City, Mexico
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Abstract
Vaccine hesitancy is a growing complex and multifaceted phenomenon. It encompasses a wide spectrum of context-dependent attitudes and beliefs. Multiple factors influence parental decision-making including knowledge, sources of information, risk perception, trust, and individual experiences among others. This review focuses on describing the most common reasons that contribute to vaccine hesitancy among parents. Social media and the Internet have been described as major elements that can negatively influence parental decision-making regarding vaccines. The next focus is describing effective interventions that clinical providers can apply. Nonconfrontational and open discussions along with trusting and strong relationships between parents and providers seem to create a solid foundation toward vaccine acceptance. In addition, motivational interviewing is a helpful tool that has proven to be effective during these discussions. Ultimately, an individualized approach tailored to a specific community will likely be most effective in addressing vaccine hesitancy.
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Affiliation(s)
- Andrea Lafnitzegger
- Pediatrics, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Tampa, FL 33606, USA
| | - Claudia Gaviria-Agudelo
- Pediatric Infectious Diseases, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, Tampa, FL 33606, USA.
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9
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Van Hoecke AL, Sanders JG. An Online Experiment of NHS Information Framing on Mothers’ Vaccination Intention of Children against COVID-19. Vaccines (Basel) 2022; 10:vaccines10050720. [PMID: 35632477 PMCID: PMC9143012 DOI: 10.3390/vaccines10050720] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 12/14/2022] Open
Abstract
Children under the age of 5, will likely all be offered vaccination against SARS-CoV-2 soon. Parental concerns over vaccination of children are long standing and could impede the success of a vaccination campaign. In the UK, a trusted source to inform vaccination choices is the NHS website. Here we used a randomized controlled experiment of framing effects in NHS information content for COVID-19 and flu with 550 mothers under the age of 5. We compared both vaccination offers following two commonly used frames in vaccination informational campaigns: alerting to the risks of no vaccination for the child itself vs. those in their community. We find that vaccination intention was twice as high when risks to the child are emphasized, relative to risks to the community. Exploratory analyses suggest that these effects may differ between white and non-white mothers. Whilst communication directed at adult vaccination against COVID-19 generally focuses on risks of infecting others, communication about vaccination of children may benefit from emphasizing risks to the children themselves. This pattern is in line with flu vaccination research from pre-COVID-19 times.
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10
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Liao Q, Cowling BJ, Xiao J, Yuan J, Dong M, Ni MY, Fielding R, Lam WWT. Priming with social benefit information of vaccination to increase acceptance of COVID-19 vaccines. Vaccine 2022; 40:1074-1081. [PMID: 35090777 PMCID: PMC8769881 DOI: 10.1016/j.vaccine.2022.01.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 01/10/2022] [Accepted: 01/15/2022] [Indexed: 01/24/2023]
Abstract
Vaccine hesitancy can be heightened due to increasing negative reports about vaccines. Emphasizing the social benefits of vaccination may shift individual attention from individual to social benefit of vaccination and hence promote prosocial vaccination. In six rounds of a population-based survey conducted over one major community epidemic of coronavirus disease 2019 (COVID-19) in Hong Kong from June to November 2020, we manipulated the question asking about acceptance of a COVID-19 vaccine with or without emphasizing the social benefit of vaccination against COVID-19 (prosocial priming) and monitored the changes of vaccine confidence by news media sentiment on vaccines. Population-weighted percentages of accepting COVID-19 vaccines by priming condition and vaccine confidence were compared across survey rounds. Logit regression models assessed the main effect of prosocial priming and the modification effects of vaccine confidence and perceived personal risk from COVID-19 on acceptance of COVID-19 vaccines. We found that prosocial priming significantly increased acceptance of COVID-19 vaccines across all survey rounds except for Round 3 when incidence of COVID-19 reached a peak. Vaccine confidence significantly declined in Round 6 when news media sentiment on vaccines became predominantly negative. The effect of prosocial priming on promoting vaccine acceptance was significantly greater in participants with low vaccine confidence and those perceiving the severity of COVID-19 to be mild/very mild. Our study suggests that packaging vaccination against COVID-19 as a prosocial behaviour can help overcome low vaccine confidence and promote prosocial vaccination particularly when disease incidence temporarily declines and the public perceive low severity of COVID-19.
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11
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Capasso M, Caso D, Conner M. Anticipating pride or regret? Effects of anticipated affect focused persuasive messages on intention to get vaccinated against COVID-19. Soc Sci Med 2021; 289:114416. [PMID: 34562773 PMCID: PMC8452346 DOI: 10.1016/j.socscimed.2021.114416] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/03/2021] [Accepted: 09/17/2021] [Indexed: 11/30/2022]
Abstract
Understanding the factors that increase intention to receive COVID-19 vaccines is essential to maximise the vaccination campaign effectiveness. The present experimental study evaluated the effect of exposure to messages targeting cognitive attitude plus anticipated positive (pride) or negative (regret) affective reactions on intention to get vaccinated. Participants included 484 Italian adults randomly allocated to one of four conditions: 1) cognitive attitude message; 2) cognitive attitude plus positive affect message; 3) cognitive attitude plus negative affect message; 4) control condition (no message). Results showed that participants in the second condition reported greater intention to get vaccinated against COVID-19 compared with those in the control condition. Parallel mediation analysis indicated that the effect of the second condition on intention was fully mediated by cognitive attitude and anticipated positive affect. These findings suggest that future campaigns aimed at promoting COVID-19 vaccination intention could usefully target both cognitive attitude and anticipated positive affect.
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Affiliation(s)
- Miriam Capasso
- Department of Humanities, University of Naples Federico II, Italy.
| | - Daniela Caso
- Department of Humanities, University of Naples Federico II, Italy
| | - Mark Conner
- School of Psychology, University of Leeds, UK
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12
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Kaufman J, Tuckerman J, Bonner C, Durrheim DN, Costa D, Trevena L, Thomas S, Danchin M. Parent-level barriers to uptake of childhood vaccination: a global overview of systematic reviews. BMJ Glob Health 2021; 6:e006860. [PMID: 34580071 PMCID: PMC8477248 DOI: 10.1136/bmjgh-2021-006860] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/09/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Understanding barriers to childhood vaccination is crucial to inform effective interventions for maximising uptake. Published systematic reviews include different primary studies, producing varying lists of barriers. To make sense of this diverse body of literature, a comprehensive level of summary and synthesis is necessary. This overview of systematic reviews maps all potential parent-level barriers to childhood vaccination identified in systematic reviews. It synthesises these into a conceptual framework to inform development of a vaccine barriers assessment tool. METHODS We applied Joanna Briggs methodology, searching the Epistemonikos review database and reference lists of included reviews to June 2020. Systematic reviews of qualitative or quantitative data on parent-level barriers to routine vaccination in preschool-aged children were included. Reviews addressing influenza, reporting non-modifiable determinants or reporting barriers not relevant to parents were excluded. Where possible, we extracted review details, barrier descriptions and the number, setting and design of primary studies. Two authors independently screened search results and inductively coded barrier descriptions. RESULTS We screened 464 papers, identifying 30 relevant reviews with minimal overlap. Fourteen reviews included qualitative and quantitative primary studies, seven included quantitative and seven included qualitative studies only. Two did not report included study designs. Two-thirds of reviews (n=20; 67%) only included primary studies from high-income countries. We extracted 573 barrier descriptions and inductively coded these into 64 unique barriers in six overarching categories: (1) Access, (2) Clinic or Health System Barriers, (3) Concerns and Beliefs, (4) Health Perceptions and Experiences, (5) Knowledge and Information and (6) Social or Family Influence. CONCLUSIONS A global overview of systematic reviews of parent-level barriers to childhood vaccine uptake identified 64 barriers to inform development of a new comprehensive survey instrument. This instrument will assess both access and acceptance barriers to more accurately diagnose the reasons for under-vaccination in children in different settings.
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Affiliation(s)
- Jessica Kaufman
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Tuckerman
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Carissa Bonner
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - David N Durrheim
- Health Protection, Hunter New England Health, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Daniel Costa
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - Lyndal Trevena
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - Susan Thomas
- Health Protection, Hunter New England Health, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Margie Danchin
- Vaccine Uptake Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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13
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Gavaruzzi T, Caserotti M, Leo I, Tasso A, Speri L, Ferro A, Fretti E, Sannino A, Rubaltelli E, Lotto L. The Role of Emotional Competences in Parents' Vaccine Hesitancy. Vaccines (Basel) 2021; 9:vaccines9030298. [PMID: 33810071 PMCID: PMC8005154 DOI: 10.3390/vaccines9030298] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 11/20/2022] Open
Abstract
The role of parents’ emotional competencies on vaccine hesitancy and decision making has been seldom examined. Two studies investigated the relationship between parents’ attitudes towards childhood vaccines and self-reported behavior (Study 1) and between parents’ emotional competence and attitudes towards vaccines (Study 2). In Study 1, predictors of temporal, partial, or complete vaccine refusal (having voluntarily postponed/forgone some/all vaccines) were examined in 2778 parents. In Study 2, psychological predictors of the attitude towards vaccines were examined in 593 parents, using the Profile of Emotional Competence and the valence of mental images spontaneously associated with the term “vaccine”. In Study 1, attitudes were aggregated in three independent factors (concerns about vaccine safety; diseases prevented by vaccines; and naturalistic views) that independently predicted vaccine refusal. In Study 2, a significant mediational analysis showed a positive indirect effect of intrapersonal emotional competences on attitudes towards vaccines, through mental images associated with the word “vaccine”. Parents’ intrapersonal emotional competences affected all dimensions of attitudes towards vaccines, suggesting that being able to manage, identify, and recognize one’s own emotions is central to vaccine acceptance. These findings suggest that intervention strategies, rather than stressing the pro-social benefits of vaccinating, should focus on aspects related to one’s own emotions.
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Affiliation(s)
- Teresa Gavaruzzi
- Department of Developmental Psychology and Socialization, University of Padova, 35131 Padova, Italy; (M.C.); (I.L.); (E.R.); (L.L.)
- Correspondence: ; Tel.: +39-049-8271284
| | - Marta Caserotti
- Department of Developmental Psychology and Socialization, University of Padova, 35131 Padova, Italy; (M.C.); (I.L.); (E.R.); (L.L.)
| | - Irene Leo
- Department of Developmental Psychology and Socialization, University of Padova, 35131 Padova, Italy; (M.C.); (I.L.); (E.R.); (L.L.)
| | - Alessandra Tasso
- Department of Humanities, University of Ferrara, 44121 Ferrara, Italy;
| | - Leonardo Speri
- Department of Prevention, AULSS 9 Scaligera, 37122 Verona, Italy; (L.S.); (E.F.); (A.S.)
| | - Antonio Ferro
- Department of Prevention, APSS Trento, 38123 Trento, Italy;
| | - Elena Fretti
- Department of Prevention, AULSS 9 Scaligera, 37122 Verona, Italy; (L.S.); (E.F.); (A.S.)
| | - Anna Sannino
- Department of Prevention, AULSS 9 Scaligera, 37122 Verona, Italy; (L.S.); (E.F.); (A.S.)
| | - Enrico Rubaltelli
- Department of Developmental Psychology and Socialization, University of Padova, 35131 Padova, Italy; (M.C.); (I.L.); (E.R.); (L.L.)
| | - Lorella Lotto
- Department of Developmental Psychology and Socialization, University of Padova, 35131 Padova, Italy; (M.C.); (I.L.); (E.R.); (L.L.)
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Griffith BC, Ulrich AK, Becker AB, Nederhoff D, Koch B, Awan FA, Basta NE. Does education about local vaccination rates and the importance of herd immunity change US parents' concern about measles? Vaccine 2020; 38:8040-8048. [PMID: 33158593 PMCID: PMC7740073 DOI: 10.1016/j.vaccine.2020.09.076] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 11/28/2022]
Abstract
It is unclear how broadly aware parents are of the concept of herd immunity and whether parents consider community benefits of vaccination when making decisions about their child's vaccinations. We aimed to determine whether educating parents about community-level benefits of measles, mumps, and rubella (MMR) vaccination and local vaccination rates would impact concern about their child's risk of measles and risk of a measles outbreak. We conducted an electronic survey among Minnesota parents of children aged 6-18 years in August 2016. We assessed baseline knowledge of herd immunity, asked participants to estimate MMR vaccination coverage in their county, and asked participants to estimate the minimum coverage needed to prevent measles outbreaks. We then delivered a short, educational intervention via the survey to inform participants about the benefits of herd immunity, the actual MMR vaccination coverage in their county, and that at least 95% MMR vaccination coverage is needed to prevent measles outbreaks. Pre- and post-intervention, participants were asked to report how concerned they were that their child might get measles. We used logistic regression models to assess factors associated with awareness of herd immunity, change in concern about one's child's measles risk, and overall concern for a measles outbreak. Among 493 participants, 67.8% were aware of herd immunity at baseline. Post-intervention, 40.2% (n = 198) of parents learned that MMR vaccination rates in their county were higher than they expected. All participants found out that their county MMR rates were lower than the measles herd immunity threshold of 95%. Overall, 27.0% (n = 133) of participants reported an increase in concern that their child might get measles after learning about local vaccination coverage and the coverage needed to achieve herd immunity. We found that our short, educational intervention aimed to increase awareness about herd immunity and local vaccination led to an increase in concern about disease risk among less than a third of parents.
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Affiliation(s)
- Bridget C Griffith
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, United States.
| | - Angela K Ulrich
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, United States
| | - Andy B Becker
- University of Minnesota School of Public Health, Division of Biostatistics, United States
| | - Dawn Nederhoff
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, United States
| | - Brandon Koch
- School of Community Health Sciences, University of Nevada, Reno, United States
| | - Fareed A Awan
- Biomedical Ethics Unit, Faculty of Medicine, McGill University, Canada
| | - Nicole E Basta
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Canada
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15
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Hakim H, Bettinger JA, Chambers CT, Driedger SM, Dubé E, Gavaruzzi T, Giguere AMC, Kavanagh É, Leask J, MacDonald SE, Orji R, Parent E, Paquette JS, Roberge J, Sander B, Scherer AM, Tremblay-Breault M, Wilson K, Reinharz D, Witteman HO. A Web Application About Herd Immunity Using Personalized Avatars: Development Study. J Med Internet Res 2020; 22:e20113. [PMID: 33124994 PMCID: PMC7665952 DOI: 10.2196/20113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/03/2020] [Accepted: 07/26/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Herd immunity or community immunity refers to the reduced risk of infection among susceptible individuals in a population through the presence and proximity of immune individuals. Recent studies suggest that improving the understanding of community immunity may increase intentions to get vaccinated. OBJECTIVE This study aims to design a web application about community immunity and optimize it based on users' cognitive and emotional responses. METHODS Our multidisciplinary team developed a web application about community immunity to communicate epidemiological evidence in a personalized way. In our application, people build their own community by creating an avatar representing themselves and 8 other avatars representing people around them, for example, their family or coworkers. The application integrates these avatars in a 2-min visualization showing how different parameters (eg, vaccine coverage, and contact within communities) influence community immunity. We predefined communication goals, created prototype visualizations, and tested four iterative versions of our visualization in a university-based human-computer interaction laboratory and community-based settings (a cafeteria, two shopping malls, and a public library). Data included psychophysiological measures (eye tracking, galvanic skin response, facial emotion recognition, and electroencephalogram) to assess participants' cognitive and affective responses to the visualization and verbal feedback to assess their interpretations of the visualization's content and messaging. RESULTS Among 110 participants across all four cycles, 68 (61.8%) were women and 38 (34.5%) were men (4/110, 3.6%; not reported), with a mean age of 38 (SD 17) years. More than half (65/110, 59.0%) of participants reported having a university-level education. Iterative changes across the cycles included adding the ability for users to create their own avatars, specific signals about who was represented by the different avatars, using color and movement to indicate protection or lack of protection from infectious disease, and changes to terminology to ensure clarity for people with varying educational backgrounds. Overall, we observed 3 generalizable findings. First, visualization does indeed appear to be a promising medium for conveying what community immunity is and how it works. Second, by involving multiple users in an iterative design process, it is possible to create a short and simple visualization that clearly conveys a complex topic. Finally, evaluating users' emotional responses during the design process, in addition to their cognitive responses, offers insights that help inform the final design of an intervention. CONCLUSIONS Visualization with personalized avatars may help people understand their individual roles in population health. Our app showed promise as a method of communicating the relationship between individual behavior and community health. The next steps will include assessing the effects of the application on risk perception, knowledge, and vaccination intentions in a randomized controlled trial. This study offers a potential road map for designing health communication materials for complex topics such as community immunity.
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Affiliation(s)
- Hina Hakim
- Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Christine T Chambers
- Department of Psychology and Neuroscience and Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada, Winnipeg, MB, Canada
| | - Eve Dubé
- Institut national de santé publique du Québec, Institut national de santé publique du Québec, Quebec City, QC, Canada
| | - Teresa Gavaruzzi
- Department of Developmental Psychology and Socialization, University of Padova, Italy, Padova, Italy
| | - Anik M C Giguere
- Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada
| | - Éric Kavanagh
- École de design, Édifice La Fabrique, Laval University, Quebec City, QC, Canada
| | - Julie Leask
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, Australia
| | | | - Rita Orji
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada
| | - Elizabeth Parent
- Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada
| | | | - Jacynthe Roberge
- École de design, Édifice La Fabrique, Laval University, Quebec City, QC, Canada
| | - Beate Sander
- University Health Network, Toronto General Hospital, Eaton Building, Toronto, ON, Canada
| | - Aaron M Scherer
- Department of Internal Medicine, University of Iowa, Iowa, IA, United States
| | | | - Kumanan Wilson
- Department of Medicine, Bruyere Research Institute and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Daniel Reinharz
- Department of Social and Preventive Medicine, Laval University, Quebec City, QC, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada
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Weitz L, Bellach L, Faltum A, Berger A, Maurer W. Vaccine hesitancy. Wien Klin Wochenschr 2020; 132:243-252. [PMID: 32322962 PMCID: PMC7223449 DOI: 10.1007/s00508-020-01655-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/20/2020] [Indexed: 11/28/2022]
Abstract
SummaryIn summer 2019 an extracurricular activity was started at the Medical University of Vienna (MUW) with the title: “Esoterism in Medicine”, where different chapters were evaluated by students. Here we present the subheading “Vaccine Hesitancy”. Three students formulated arguments from sceptic, hesitant or anti-vaccine groups and discussed the scientific literature to rebut it. Frequent objections were partly taken from the homepage of the German Robert-Koch-Institute, the home of the “Ständige Impfkommission”. Other objections were taken from blogs and social media. The students’ rebuttal was based on current scientific literature (preferentially pubmed), but also from other scientific sources like authorities.
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Affiliation(s)
- Lisa Weitz
- Medical University of Vienna, Vienna, Austria
| | | | | | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care, and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090 Austria
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18
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Switzer C, Babiuk L, Loeb M. Determining optimal community protection strategies for the influenza vaccine. Expert Rev Vaccines 2019; 18:755-764. [PMID: 31288585 DOI: 10.1080/14760584.2019.1642110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Seasonal influenza poses a major risk to the health of the population. Optimal strategies for influenza vaccination can help to reduce this risk. Areas covered: Systematic evaluations of the burden of influenza are first reviewed. Key meta-analysis, randomized trials, and observational studies are critically reviewed to provide the best estimates of the efficacy of influenza vaccine. The concept of herd effect is first introduced and this is followed by the rationale and the evidence to support herd effect that can be provided with strategic use of influenza vaccination in populations. Challenges including the effect of repeated influenza vaccination and vaccine hesitancy are reviewed. The citations were selected by the authors based on PubMed searches of the literature. Expert opinion: Efforts to develop new vaccines, including a universal vaccine, offer the best prospects for improved herd effect. Increasing uptake in new populations can increase likelihood of a herd effect.
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Affiliation(s)
- Charlotte Switzer
- a Department of Health Research Evidence, and Impact, McMaster University , Hamilton , Ontario , Canada
| | - Lorne Babiuk
- b Department of Agricultural Life and Environmental Sciences, University of Alberta , Edmonton , Alberta , Canada
| | - Mark Loeb
- a Department of Health Research Evidence, and Impact, McMaster University , Hamilton , Ontario , Canada
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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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20
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McKillop CN, Leonard T, Pruitt SL, Tiro JA. Do traditional economic theories of free riding behavior explain spatial clustering of HPV vaccine uptake? SSM Popul Health 2019; 8:100421. [PMID: 31206005 PMCID: PMC6558301 DOI: 10.1016/j.ssmph.2019.100421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/30/2019] [Accepted: 06/01/2019] [Indexed: 10/31/2022] Open
Abstract
Rationale Geographic clusters of low vaccination uptake reduce the population-level efficacy of vaccination programs. However, little is known about the mechanisms that drive geographic patterns in vaccination rates. Traditional economic theory considers vaccination as a classic public good and suggests that free riding-individuals taking advantage of public goods by relying on others' immunization behavior without contributing toward them-is a primary cause of low vaccination rates. However, behavioral economics suggests that free riding does not fully explain observed individual behavior, and the presence of both high and low clusters of vaccination rates suggest that this theory alone does not fully explain geographic patterns of vaccination. Objective We assessed geographic clustering of HPV vaccination uptake and examined the evidence for or against free riding in HPV vaccination decisions. Methods We analyzed HPV vaccination decisions of low-income adolescent females (N = 601) residing in urban neighborhoods in Dallas, Texas, USA during 2011-2012. Spatial econometric models were estimated to assess the relationship between neighborhood vaccination rates and individual vaccination decisions. Results We found a positive and significant relationship between individual HPV vaccination choices and the average neighborhood vaccination rate at the time parents were making vaccine decisions for their adolescent daughters while controlling for neighborhood sorting and other confounders. Conclusion Individuals were more likely to complete the HPV vaccination series when others in their neighborhood had already completed the series. We do not find evidence for free riding in HPV vaccination decisions.
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Affiliation(s)
- Caitlin N McKillop
- Economics Department, State University of New York at Cortland, 28 Graham St, Old Main 136A, Cortland, NY, 13045, United States
| | - Tammy Leonard
- Economics Department, University of Dallas, 1845 E Northgate Drive, Irving, TX, 75062, United States
| | - Sandi L Pruitt
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center and Harold C. Simmons Cancer Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, United States
| | - Jasmin A Tiro
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center and Harold C. Simmons Cancer Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, United States
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21
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Philip RK, Attwell K, Breuer T, Di Pasquale A, Lopalco PL. Life-course immunization as a gateway to health. Expert Rev Vaccines 2019; 17:851-864. [PMID: 30350731 DOI: 10.1080/14760584.2018.1527690] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Extending the benefits of vaccination against infectious diseases from childhood throughout the entire life-span is becoming an increasingly urgent priority in view of the world's aging population, emergence and reemergence of infectious diseases, and the necessity to invest more on prevention versus cure in global healthcare. Areas covered: This perspective discusses how life-course immunization could benefit human health at all stages of life. To achieve this, the current vaccination paradigm should be changed and all stakeholders have a role to play. Expert commentary: To enhance immunization confidence in the population, it is essential that stakeholders eliminate complacency toward infectious diseases, improve vaccination convenience, remove barriers among different healthcare specialties, and address prevention as a single entity. They must also consider societal and cultural mindsets by understanding and including public viewpoints. A new "4Cs' model encompassing convenience, confidence, complacency, and cultural acceptance is proposed to convert 'vaccine availability' to 'vaccination acceptance' throughout life. Life-course vaccination should become the new social norm of a healthy life-style, along with a healthy diet, adequate physical exercise, and not smoking. We are 'all in' to make life-course immunization a gateway for all people to lead longer, healthier lives.
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Affiliation(s)
- Roy K Philip
- a Division of Neonatology, Department of Paediatrics , Graduate Entry Medical School (GEMS), University of Limerick and University Maternity Hospital , Limerick , Ireland
| | - Katie Attwell
- b School of Social Science , University of Western Australia , Perth , Australia
| | | | | | - Pier Luigi Lopalco
- d Department of Translational Research on New Technologies in Medicine and Surgery , University of Pisa , Pisa , Italy
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22
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Betsch C, Schmid P, Heinemeier D, Korn L, Holtmann C, Böhm R. Beyond confidence: Development of a measure assessing the 5C psychological antecedents of vaccination. PLoS One 2018; 13:e0208601. [PMID: 30532274 PMCID: PMC6285469 DOI: 10.1371/journal.pone.0208601] [Citation(s) in RCA: 612] [Impact Index Per Article: 102.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/20/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Monitoring the reasons why a considerable number of people do not receive recommended vaccinations allows identification of important trends over time, and designing and evaluating strategies to address vaccine hesitancy and increase vaccine uptake. Existing validated measures assessing vaccine hesitancy focus primarily on confidence in vaccines and the system that delivers them. However, empirical and theoretical work has stated that complacency (not perceiving diseases as high risk), constraints (structural and psychological barriers), calculation (engagement in extensive information searching), and aspects pertaining to collective responsibility (willingness to protect others) also play a role in explaining vaccination behavior. The objective was therefore to develop a validated measure of these 5C psychological antecedents of vaccination. METHODS AND FINDINGS Three cross-sectional studies were conducted. Study 1 uses factor analysis to develop an initial scale and assesses the sub-scales' convergent, discriminant, and concurrent validity (N = 1,445, two German convenience-samples). In Study 2, a sample representative regarding age and gender for the German population (N = 1,003) completed the measure for vaccination in general and for specific vaccinations to assess the potential need for a vaccine-specific wording of items. Study 3 compared the novel scale's performance with six existing measures of vaccine hesitancy (N = 350, US convenience-sample). As an outcome, a long (15-item) and short (5-item) 5C scale were developed as reliable and valid indicators of confidence, complacency, constraints, calculation, and collective responsibility. The 5C sub-scales correlated with relevant psychological concepts, such as attitude (confidence), perceived personal health status and invulnerability (complacency), self-control (constraints), preference for deliberation (calculation), and communal orientation (collective responsibility), among others. The new scale provided similar results when formulated in a general vs. vaccine-specific way (Study 2). In a comparison of seven measures the 5C scale was constantly among the scales that explained the highest amounts of variance in analyses predicting single vaccinations (between 20% and 40%; Study 3). The present studies are limited to the concurrent validity of the scales. CONCLUSIONS The 5C scale provides a novel tool to monitor psychological antecedents of vaccination and facilitates diagnosis, intervention design and evaluation. Its short version is suitable for field settings and regular global monitoring of relevant antecedents of vaccination.
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Affiliation(s)
- Cornelia Betsch
- CEREB - Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, Erfurt, Germany
- Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Philipp Schmid
- CEREB - Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, Erfurt, Germany
- Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Dorothee Heinemeier
- CEREB - Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, Erfurt, Germany
- Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Lars Korn
- CEREB - Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, Erfurt, Germany
- Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Cindy Holtmann
- CEREB - Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, Erfurt, Germany
| | - Robert Böhm
- School of Business and Economics, RWTH Aachen University, Aachen, Germany
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Hakim H, Provencher T, Chambers CT, Driedger SM, Dube E, Gavaruzzi T, Giguere AMC, Ivers NM, MacDonald S, Paquette JS, Wilson K, Reinharz D, Witteman HO. Interventions to help people understand community immunity: A systematic review. Vaccine 2018; 37:235-247. [PMID: 30528593 DOI: 10.1016/j.vaccine.2018.11.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/05/2018] [Accepted: 11/01/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Herd immunity, or community immunity, occurs when susceptible people in a population are indirectly protected from infection thanks to the pervasiveness of immunity within the population. In this study, we aimed to systematically review interventions designed to communicate what community immunity is and how community immunity works to members of the general public. METHODS We searched PubMed, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials and Web of Science for peer-reviewed articles describing interventions with or without evaluations. We then conducted web searches with Google to identify interventions lacking associated publications. We extracted data about the target population of the interventions, the interventions themselves (e.g., did they describe what community immunity is, and how it works), any effects of evaluated interventions, and synthesized data narratively. RESULTS We identified 32 interventions: 11 interventions described in peer-reviewed articles and 21 interventions without associated articles. Of the 32 interventions, 5 described what community immunity is, 6 described the mechanisms of how community immunity occurs and 21 described both. Fourteen of the 32 addressed infectious diseases in general while the other 13 addressed one or more specific diseases. Twelve of the 32 interventions used videos, 7 used interactive simulations and 6 used questionnaires. Ten of the 11 peer-reviewed articles described studies evaluating at least one effect of the interventions. Within these 10, 4/4 reported increased knowledge, 3/5 reported shifts of attitudes in favour of vaccination, 2/5 reported increased intentions to vaccinate. Of 3 studies evaluating interventions specifically about community immunity, 2 reported increased intentions to vaccinate. CONCLUSIONS A compelling benefit of vaccination exists at the population level in the form of community immunity. Identifying ways to optimally communicate about this benefit may be important, because some evidence suggests that effective communication about community immunity can increase vaccination intentions.
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Affiliation(s)
- Hina Hakim
- Department of Family and Emergency Medicine, Laval University, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Quebec City, QC G1V 0A6, Canada.
| | | | - Christine T Chambers
- Department of Pediatrics and Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Eve Dube
- Institut national de santé publique du Québec, Quebec City, QC, Canada.
| | - Teresa Gavaruzzi
- Department of Developmental Psychology and Socialization, University of Padova, Italy.
| | - Anik M C Giguere
- Department of Family and Emergency Medicine, Laval University, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Quebec City, QC G1V 0A6, Canada.
| | - Noah M Ivers
- Department of Family and Community Medicine, Women's College Hospital - University of Toronto, Toronto, ON, Canada.
| | | | - Jean-Sebastien Paquette
- Department of Family and Emergency Medicine, Laval University, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Quebec City, QC G1V 0A6, Canada.
| | - Kumanan Wilson
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Daniel Reinharz
- Department of Social and Preventive Medicine, Laval University, Quebec City, QC, Canada.
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Laval University, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Quebec City, QC G1V 0A6, Canada.
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Williamson L, Glaab H. Addressing vaccine hesitancy requires an ethically consistent health strategy. BMC Med Ethics 2018; 19:84. [PMID: 30355355 PMCID: PMC6201581 DOI: 10.1186/s12910-018-0322-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/04/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Vaccine hesitancy is a growing threat to public health. The reasons are complex but linked inextricably to a lack of trust in vaccines, expertise and traditional sources of authority. Efforts to increase immunization uptake in children in many countries that have seen a fall in vaccination rates are two-fold: addressing hesitancy by improving healthcare professional-parent exchange and information provision in the clinic; and, secondly, public health strategies that can override parental concerns and values with coercive measures such as mandatory and presumptive vaccination. MAIN TEXT It is argued that such conflicting, parallel approaches seriously risk undermining trust that is crucial for sustaining herd immunity. Although public health strategies can be ethically justified in limiting freedoms, a parent-centered approach seldom acknowledges how it is impacted by contemporaneous coercive measures. In addition, the clinical encounter is not well suited to helping parents consider the public dimensions of vaccination, despite these being important for trust formation and informed decision-making. Efforts to address vaccine hesitancy require more consistent engagement of parental and citizen views. Along with evidence-based information, debates need to be informed by ethical support that equips parents and professionals to respond to the private and public dimensions of vaccination in a more even-handed, transparent manner. CONCLUSION Efforts to address vaccine hesitancy need to avoid simple reliance on either parental values or coercive public policies. To do this effectively requires increasing citizen engagement on vaccination to help inform a parent-centered approach and legitimize public policy measures. In addition, cultivating a more ethically consistent strategy means moving beyond the current silos of health ethics - clinical and public health ethics.
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Affiliation(s)
- Laura Williamson
- Biobehavioral Health Department, Pennsylvania State University, University Park, USA.
| | - Hannah Glaab
- Biobehavioral Health Department, Pennsylvania State University, University Park, USA
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25
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Logan J, Nederhoff D, Koch B, Griffith B, Wolfson J, Awan FA, Basta NE. 'What have you HEARD about the HERD?' Does education about local influenza vaccination coverage and herd immunity affect willingness to vaccinate? Vaccine 2018; 36:4118-4125. [PMID: 29789242 PMCID: PMC6008254 DOI: 10.1016/j.vaccine.2018.05.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 05/03/2018] [Accepted: 05/07/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Vaccination protects individuals directly and communities indirectly by reducing transmission. We aimed to determine whether information about herd immunity and local vaccination coverage could change an individual's vaccination plans and concern about influenza. METHODS We surveyed Minnesota residents ≥18 years during the 2016 Minnesota State Fair. Participants were asked to identify the definition of herd immunity, to report their history of and plans to receive influenza vaccine, to report their concern about influenza, and to estimate the reported influenza vaccination coverage in their county. After providing educational information about herd immunity and local vaccination rates, we reassessed vaccination plans and concerns. We used logistic regression to estimate predicted percentages for those willing to be vaccinated, for concern about influenza, and for changes in these outcomes after the intervention. We then compared those individuals with and without prior knowledge of herd immunity, accounting for other characteristics. RESULTS Among 554 participants, the median age was 57 years; most were female (65.9%), white (91.0%), and non-Hispanic/Latino (93.9%). Overall, 37.2% of participants did not know about herd immunity and 75.6% thought that the influenza vaccination coverage in their county was higher than it was reported. Those not knowledgeable about herd immunity were significantly less likely than those knowledgeable about the concept to report plans to be vaccinated at baseline (67.8% versus 78.9%; p = 0.004). After learning about herd immunity and influenza vaccination coverage, the proportion of those not knowledgeable about herd immunity who were willing to be vaccinated increased significantly by 7.3 percentage points (p = 0.001). Educating participants eliminated the significant difference in the proportion planning to be vaccinated between these two groups (80.1% of those knowledgeable and 75.1% of those who were not initially knowledgeable became willing; p = 0.148). CONCLUSIONS Education about herd immunity and local vaccination coverage could be a useful tool for increasing willingness to vaccinate, generating benefits both to individuals and communities.
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Affiliation(s)
- Jacqueline Logan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Dawn Nederhoff
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Brandon Koch
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Bridget Griffith
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Julian Wolfson
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Fareed A Awan
- Department of Philosophy, College of Liberal Arts, University of Minnesota, Minneapolis, MN, United States
| | - Nicole E Basta
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States.
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Jarmolowicz DP, Reed DD, Francisco AJ, Bruce JM, Lemley SM, Bruce AS. Modeling effects of risk and social distance on vaccination choice. J Exp Anal Behav 2018; 110:39-53. [DOI: 10.1002/jeab.438] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 04/20/2018] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | | | | | - Amanda S. Bruce
- University of Kansas Medical Center and Children's Mercy Hospital
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Individual decisions to vaccinate one's child or oneself: A discrete choice experiment rejecting free-riding motives. Soc Sci Med 2018; 207:106-116. [PMID: 29738898 DOI: 10.1016/j.socscimed.2018.04.038] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 04/18/2018] [Accepted: 04/24/2018] [Indexed: 02/03/2023]
Abstract
It is essential for public health to understand what drives people's hesitance towards vaccination. Theoretical models of vaccination decisions are ubiquitous, often incorporating herd immunity, perceptions of vaccine-related side-effects (VRSE) and of vaccine-preventable burden of disease, but with little to no empirical exploration. Herd immunity is a (usually) positive externality where vaccinated individuals influence others' risks by their reduced capability to transmit an infectious disease to them. It is often assumed that (rational) individuals incorporate this externality in their strategic vaccination decision, from which free-riding behavior arises. We performed a Bayesian D-efficient discrete choice experiment in February-March 2017 to study vaccination behavior in 1919 Belgian respondents. Choice sets with vaccine profiles were constructed using six attributes: vaccine effectiveness, VRSE, accessibility (in terms of convenience and reimbursement), vaccine-preventable burden of disease, local (respondents' network of contacts) vaccination coverage, and population (the population at large) vaccination coverage. VRSE and accessibility are the most influential attributes, followed by vaccine effectiveness and burden of disease. Both population and local coverage are less important than the other attributes, but show a significant direct linear relationship with vaccine utility. This supports the existence of peer influence (more incentivized as more and more vaccinate), rather than free-riding on herd immunity. These findings were independent of whether respondents made vaccine choices for themselves or for their child. Around 40% of the respondents indicated accepting vaccination with little or no questioning. These 'acceptors' were less sensitive to changes in the vaccine-preventable burden of disease for their child's vaccination choices (but not for themselves). Public health institutions are critical in stimulating vaccine uptake by making vaccines conveniently available at an affordable price and by communicating pro-actively on perceived VRSEs. The free-riding assumption as a driver of individual vaccine decisions, seems inappropriate, but this observation needs confirming in other populations.
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Maisonneuve AR, Witteman HO, Brehaut J, Dubé È, Wilson K. Educating children and adolescents about vaccines: a review of current literature. Expert Rev Vaccines 2018; 17:311-321. [PMID: 29569498 DOI: 10.1080/14760584.2018.1456921] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Until recently, research on vaccine hesitancy has focused primarily on parent populations. Although adolescent knowledge and views are gaining momentum within the literature, particularly with regards to the human papillomavirus and influenza, children remain a virtually unstudied population with regards to vaccine hesitancy. AREAS COVERED This review focuses on the lack of literature in this area and argues for more vaccine hesitancy research involving child and adolescent populations. It also outlines special issues to consider when framing health promotion messages for children and adolescents. Finally, we explore the use of new and existing technologies as delivery mechanisms for education on vaccines and immunizations in populations of children and adolescents. EXPERT COMMENTARY Children undergo cognitive development and experiences with vaccines (e.g. pain or education) have the potential to create future attitudes toward vaccines. This can influence future vaccine behaviour, including their participation in decision-making around adolescent vaccines, their decisions to vaccinate themselves when they are adults, and their decisions to vaccinate their own children. Interventions aimed at children, such as education, can create positive attitudes toward vaccines. These can also potentially influence parental attitudes toward vaccines as children convey this knowledge to them. Both of these impacts require further study.
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Affiliation(s)
| | - Holly O Witteman
- b Department of Family and Emergency Medicine , Université Laval , Québec , QC , Canada
| | - Jamie Brehaut
- c Ottawa Hospital Research Institute , Ottawa , ON , Canada
| | - Ève Dubé
- d Institut national de santé publique du Québec , Québec , QC , Canada
| | - Kumanan Wilson
- c Ottawa Hospital Research Institute , Ottawa , ON , Canada
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Sherman SM, Nailer E. Attitudes towards and knowledge about Human Papillomavirus (HPV) and the HPV vaccination in parents of teenage boys in the UK. PLoS One 2018; 13:e0195801. [PMID: 29641563 PMCID: PMC5895045 DOI: 10.1371/journal.pone.0195801] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/29/2018] [Indexed: 01/27/2023] Open
Abstract
The incidence of cancers attributable to Human Papillomavirus (HPV) that affect males is on the rise. Currently in the UK teenage boys are not vaccinated against HPV while teenage girls are. The rationale for not vaccinating boys is that vaccinating girls should provide herd immunity to boys, however this does not protect men who have sex with men or men who have sex with unvaccinated women. The issue of whether to vaccinate boys or not is a controversial one with considerable lobbying taking place to change the existing policy. On one side of the debate are financial considerations while on the other side health equality is important. One avenue that has not been presented is the parental perspective. The current study uses a self-report questionnaire to explore what parents of teenage boys know about HPV and the vaccine and whether they want the vaccine for their sons. Only half of the parents had heard of HPV prior to completing the survey. Of those who had heard of HPV, knowledge about the health sequelae of HPV for men was poor relative to their knowledge about its impact on female health. Parents who would be willing to vaccinate their sons had higher levels of knowledge about HPV than those parents who would be unwilling or unsure. Irrespective of whether they had previously heard of HPV or not, once provided with a brief description of HPV, the majority of parents thought that boys should be offered the vaccination. There is a pressing need for public education about the potential impact of HPV on male health in order to facilitate uptake of the vaccine in the event of the vaccination programme being extended to men or to facilitate informed decision making about seeking the vaccine privately in the event that it isn't.
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Affiliation(s)
| | - Emma Nailer
- School of Psychology, Keele University, Keele, Staffs, United Kingdom
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30
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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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Enkel SL, Attwell K, Snelling TL, Christian HE. 'Hesitant compliers': Qualitative analysis of concerned fully-vaccinating parents. Vaccine 2017; 36:6459-6463. [PMID: 29031695 DOI: 10.1016/j.vaccine.2017.09.088] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 09/20/2017] [Accepted: 09/28/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Some parents are hesitant about vaccines and yet still vaccinate their children. Vaccine behaviours are not fixed and parents who are concerned but nonetheless adherent to standard schedules could switch to an unconventional schedule, delaying or cherry-picking vaccines. There is a need to better understand vaccine hesitancy in specific contexts, acknowledging cultural and geographical variation, to ensure interventions targeting hesitancy are well directed and received. METHODS To identify the behaviours, knowledge and attitudes of 'hesitant compliers' in Perth, Western Australia, nine one-on-one in-depth interviews were conducted with vaccinating parents of children (<5 years) who were identified as being hesitant. Interview transcripts were analysed qualitatively and themes developed inductively, following a constructivist paradigm. RESULTS Parents saw vaccination as important for themselves and their community, despite their limited knowledge of vaccine preventable diseases. Parents reported concerns about potential side effects, and worried about the safety of the measles-mumps-rubella (MMR) and seasonal influenza vaccines. Concerned about the role of anti-vaccination information in the community, some sought to isolate themselves from parents who did not vaccinate, although others were concerned that this could entrench non-vaccinators' behaviours. Parents' views were all underlaid by two pivotal 'vaccine-related events' that had occurred in the community: the severe injury of a baby from seasonal influenza vaccination in 2010, and the death of a baby from whooping cough in 2015. CONCLUSIONS Parents interpreted pivotal vaccine-related events in the community as requiring them to take personal responsibility for vaccine decisions. Their reports of continued vaccine fears (evident in international studies in recent decades) demonstrate that vaccine scares have long lasting effects. With vaccine rates high and stable, current strategies appear to be have little impact on addressing parental vaccine concerns. Further research is required to determine the prevalence of hesitancy amongst vaccinating parents and identify critical points for intervention.
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Affiliation(s)
- Stephanie L Enkel
- School of Population and Global Health, The University of Western Australia, Australia.
| | - Katie Attwell
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Australia; School of Social Science, The University of Western Australia, Australia
| | - Thomas L Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Australia; Menzies School of Health Research and Charles Darwin University, Darwin, Australia; Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia
| | - Hayley E Christian
- School of Population and Global Health, The University of Western Australia, Australia; Telethon Kids Institute, The University of Western Australia, Australia
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Attwell K, Smith DT. Parenting as politics: social identity theory and vaccine hesitant communities. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2017. [DOI: 10.1108/ijhg-03-2017-0008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to develop a theoretical framework for understanding the identity politics associated with parental hesitancy and refusal of vaccines for their children (“vaccine hesitancy or refusal” or “VHR”). Understanding these identity politics helps policymakers to craft appropriate communication interventions that do not make the problem worse.
Design/methodology/approach
Social identity theory is a way of understanding how group identities develop around the lifestyle practices that often include refusal to vaccinate, and how this group identity is accentuated by conflict with the pro-vaccinating societal mainstream. This paper critically appraises existing studies of VHR to explore this groupness across many different contexts.
Findings
Groupness is evident across many different contexts. There are also key group characteristics: preference for natural birth and breastfeeding, nature as a concept and use of complementary and alternative medicine.
Research limitations/implications
The paper is speculative and theoretical, using existing sources. Future studies will need to demonstrate empirically with new data. However, this theoretical approach sets up a new research agenda.
Social implications
These findings can help governments and policymakers minimise social conflict that risks further polarising vaccine conversations and wedging parents on the fence.
Originality/value
This paper argues that the decision to vaccinate or not is an inherently social one, not a matter of pure individual rationality. This is a novel approach to engaging with what is often characterised and studied as an individual decision.
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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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From Immunologically Archaic to Neoteric Glycovaccines. Vaccines (Basel) 2017; 5:vaccines5010004. [PMID: 28134792 PMCID: PMC5371740 DOI: 10.3390/vaccines5010004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 11/14/2016] [Accepted: 01/22/2017] [Indexed: 12/13/2022] Open
Abstract
Polysaccharides (PS) are present in the outermost surface of bacteria and readily come in contact with immune cells. They interact with specific antibodies, which in turn confer protection from infections. Vaccines with PS from pneumococci, meningococci, Haemophilus influenzae type b, and Salmonella typhi may be protective, although with the important constraint of failing to generate permanent immunological memory. This limitation has in part been circumvented by conjugating glycovaccines to proteins that stimulate T helper cells and facilitate the establishment of immunological memory. Currently, protection evoked by conjugated PS vaccines lasts for a few years. The same approach failed with PS from staphylococci, Streptococcus agalactiae, and Klebsiella. All those germs cause severe infections in humans and often develop resistance to antibiotic therapy. Thereby, prevention is of increasing importance to better control outbreaks. As only 23 of more than 90 pneumococcal serotypes and 4 of 13 clinically relevant Neisseria meningitidis serogroups are covered by available vaccines there is still tremendous clinical need for PS vaccines. This review focuses on glycovaccines and the immunological mechanisms for their success or failure. We discuss recent advances that may facilitate generation of high affinity anti-PS antibodies and confer specific immunity and long-lasting protection.
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Corben P, Leask J. To close the childhood immunization gap, we need a richer understanding of parents' decision-making. Hum Vaccin Immunother 2016; 12:3168-3176. [PMID: 27564975 PMCID: PMC5215493 DOI: 10.1080/21645515.2016.1221553] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/22/2016] [Accepted: 08/03/2016] [Indexed: 12/22/2022] Open
Abstract
Vaccination is widely acknowledged as one of the most successful public health interventions globally and in most high-income countries childhood vaccination coverage rates are moderately high. Yet in many instances, immunisation rates remain below aspirational targets and have shown only modest progress toward those targets in recent years, despite concerted efforts to improve uptake. In part, coverage rates reflect individual parents' vaccination attitudes and decisions and, because vaccination decision-making is complex and context-specific, it remains challenging at individual and community levels to assist parents to make positive decisions. Consequently, in the search for opportunities to improve immunisation coverage, there has been a renewed research focus on parents' decision-making. This review provides an overview of the literature surrounding parents' vaccination decision-making, offering suggestions for where efforts to increase vaccination coverage should be targeted and identifying areas for further research.
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Affiliation(s)
- Paul Corben
- North Coast Public Health, Mid North Coast Local Health District, Port Macquarie, New South Wales, Australia
| | - Julie Leask
- School of Public Health, University of Sydney, University of Sydney, NSW, Australia
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Hamama-Raz Y, Ginossar-David E, Ben-Ezra M. Parental regret regarding children's vaccines-The correlation between anticipated regret, altruism, coping strategies and attitudes toward vaccines. Isr J Health Policy Res 2016; 5:55. [PMID: 27826413 PMCID: PMC5100327 DOI: 10.1186/s13584-016-0116-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 10/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parental hesitancy for recommended childhood vaccines is a growing public health concern influenced by various factors. This study aimed to explore regret regarding parental decisions to vaccinate their children via possible correlations between anticipated regret, altruism, coping strategies, and parents' attitudes toward the vaccination of their children. METHODS The study was conducted during 2014 in Israel. Data were collected via snowballing methodology (i.e., Internet forums, Facebook and e- mails). 314 parents of children ages 0-6 years participated in the study. Questionnaires were distributed and completed on-line including attitudes toward vaccines, altruism, coping strategies, regret and anticipated regret. RESULTS Pearson analysis revealed a moderate negative association between attitudes toward vaccinations and regret. In addition, weak but significant positive associations emerged between anticipated regret and regret as well as between gender and regret. Performing hierarchical regression analysis revealed contribution of 35.9 % to the explained variance of regret suggesting that coping strategy of instrumental support, attitudes toward vaccinations and anticipated regret are linked significantly to regret. CONCLUSION Parental attitudes toward vaccines and anticipated regret have a salient role when deciding whether or not to vaccinate children and contribute to the prediction of regret regarding vaccination. In order to increase parental consent to vaccination of their children, it is important to minimize possible regret through the strength of the recommendation and/or knowledge base about risk/benefit (perceived, heuristic) of vaccines that might influence parental attitudes and lessen their anticipated regret. TRIAL REGISTRATION N/A. This is not a clinical trial and thus does not require registration. Ethics approval was received from Ariel University School of Social Work Ethics committee (18/02/14). This was an attitude survey. The Ariel University School of Social Work Ethics committee approved performance of this attitude survey (18/02/14).
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Exploring and Promoting Prosocial Vaccination: A Cross-Cultural Experiment on Vaccination of Health Care Personnel. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6870984. [PMID: 27725940 PMCID: PMC5048021 DOI: 10.1155/2016/6870984] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/18/2016] [Indexed: 11/30/2022]
Abstract
Influenza vaccination for health care personnel (HCP) is recommended particularly because it indirectly protects patients from contracting the disease. Vaccinating can therefore be interpreted as a prosocial act. However, HCP vaccination rates are often far too low to prevent nosocomial infections. Effective interventions are needed to increase HCP's influenza vaccine uptake. Here we devise a novel tool to experimentally test interventions that aim at increasing prosocially motivated vaccine uptake under controlled conditions. We conducted a large-scale and cross-cultural experiment with participants from countries with either a collectivistic (South Korea) or an individualistic (USA) cultural background. Results showed that prosocially motivated vaccination was more likely in South Korea compared to the US, mediated by a greater perception of vaccination as a social act. However, changing the default of vaccination, such that participants had to opt out rather than to opt in, increased vaccine uptake in the US and therefore compensated for the lower level of prosocial vaccination. In sum, the present study provides both a novel method to investigate HCP influenza vaccination behavior and interventions to increase their vaccine uptake.
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Polonijo AN, Carpiano RM, Reiter PL, Brewer NT. Socioeconomic and Racial-ethnic Disparities in Prosocial Health Attitudes: The Case of Human Papillomavirus (HPV) Vaccination for Adolescent Males. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2016; 57:390-406. [PMID: 27601412 PMCID: PMC6314033 DOI: 10.1177/0022146516660344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Research on prosocial attitudes, social networks, social capital, and social stratification suggest that lower-socioeconomic status (SES), Hispanic, and nonwhite individuals will be more likely than their higher-SES and non-Hispanic white counterparts to engage in health behaviors that serve a social good. Analyzing data from the University of North Carolina Human Papillomavirus (HPV) Immunization in Sons Study, we test whether SES and race-ethnicity are associated with willingness to vaccinate via prosocial attitudes toward HPV vaccination among adolescent males (n = 401) and parents (n = 518). Analyses revealed that (a) parents with lower education and (b) black and Hispanic parents and adolescent males reported higher prosocial vaccination attitudes, but only some attitudes were associated with higher willingness to vaccinate. We discuss these findings in terms of how prosocial attitudes may motivate certain health behaviors and serve as countervailing mechanisms in the (re)production of health disparities and promising targets of future public health interventions.
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Li M, Taylor EG, Atkins KE, Chapman GB, Galvani AP. Stimulating Influenza Vaccination via Prosocial Motives. PLoS One 2016; 11:e0159780. [PMID: 27459237 PMCID: PMC4961402 DOI: 10.1371/journal.pone.0159780] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 07/06/2016] [Indexed: 11/23/2022] Open
Abstract
Objective Americans do not vaccinate nearly enough against Influenza (flu) infection, despite severe health and economic burden of influenza. Younger people are disproportionately responsible for transmission, but do not suffer severely from the flu. Thus, to achieve herd immunity, prosocial motivation needs to be a partial driver of vaccination decisions. Past research has not established the causal role of prosociality in flu vaccination, and the current research evaluates such causal relationship by experimentally eliciting prosociality through messages about flu victims. Methods In an experimental study, we described potential flu victims who would suffer from the decision of others to not vaccinate to 3952 Internet participants across eight countries. We measured sympathy, general prosociality, and vaccination intentions. The study included two identifiable victim conditions (one with an elderly victim and another with a young victim), an unidentified victim condition, and a no message condition. Results We found that any of the three messages increased flu vaccination intentions. Moreover, this effect was mediated by enhanced prosocial motives, and was stronger among people who were historical non-vaccinators. In addition, younger victim elicited greater sympathy, and describing identifiable victims increased general sympathy and prosocial motives. Conclusions These findings provide direct experimental evidence on the causal role of prosocial motives in flu vaccination, by showing that people can be prompted to vaccinate for the sake of benefiting others.
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Affiliation(s)
- Meng Li
- Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, Colorado, United States of America
- * E-mail:
| | - Eric G. Taylor
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Katherine E. Atkins
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, United States of America
- Department of Infectious Disease Epidemiology, London School of Tropical Medicine and Hygiene, London, United Kingdom
| | - Gretchen B. Chapman
- Department of Psychology, Rutgers University, New Brunswick, New Jersey, United States of America
| | - Alison P. Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, United States of America
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Sobo EJ. What is herd immunity, and how does it relate to pediatric vaccination uptake? US parent perspectives. Soc Sci Med 2016; 165:187-195. [PMID: 27497915 DOI: 10.1016/j.socscimed.2016.06.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 11/17/2022]
Abstract
In light of current concern over pediatric immunization rates, 53 US parents with at least one child kindergarten age or younger were surveyed and interviewed regarding vaccine decision making. Data were collected in 2014 in San Diego, California. Herd immunity was not a salient issue: only six (11.3%) referenced the term or concept spontaneously; others had to be prompted. Parents familiar with herd immunity (70%) variously saw it as not just unnecessary but unproven, illogical, unrealistic, and unreliable. For instance, parents questioned its attainability because many adults do not immunize themselves. Some understood the concept negatively, as an instance of "herd mentality." Further, having knowledge of herd immunity that public health experts would deem 'correct' did not lead to full vaccination. Implications of findings for understanding how the public makes use of scientific information, the potential role of public health messaging regarding altruism and 'free-riding,' and assumptions that vaccine-cautious parents would willfully take advantage of herd immunity are explored in relation to parent role expectations and American individualism.
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Affiliation(s)
- Elisa J Sobo
- Department of Anthropology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-6040, USA.
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Dubé E, Gagnon D, Ouakki M, Bettinger JA, Guay M, Halperin S, Wilson K, Graham J, Witteman HO, MacDonald S, Fisher W, Monnais L, Tran D, Gagneur A, Guichon J, Saini V, Heffernan JM, Meyer S, Driedger SM, Greenberg J, MacDougall H. Understanding Vaccine Hesitancy in Canada: Results of a Consultation Study by the Canadian Immunization Research Network. PLoS One 2016; 11:e0156118. [PMID: 27257809 PMCID: PMC4892544 DOI: 10.1371/journal.pone.0156118] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/08/2016] [Indexed: 11/18/2022] Open
Abstract
"Vaccine hesitancy" is a concept now frequently used in vaccination discourse. The increased popularity of this concept in both academic and public health circles is challenging previously held perspectives that individual vaccination attitudes and behaviours are a simple dichotomy of accept or reject. A consultation study was designed to assess the opinions of experts and health professionals concerning the definition, scope, and causes of vaccine hesitancy in Canada. We sent online surveys to two panels (1- vaccination experts and 2- front-line vaccine providers). Two questionnaires were completed by each panel, with data from the first questionnaire informing the development of questions for the second. Our participants defined vaccine hesitancy as an attitude (doubts, concerns) as well as a behaviour (refusing some / many vaccines, delaying vaccination). Our findings also indicate that both vaccine experts and front-line vaccine providers have the perception that vaccine rates have been declining and consider vaccine hesitancy an important issue to address in Canada. Diffusion of negative information online and lack of knowledge about vaccines were identified as the key causes of vaccine hesitancy by the participants. A common understanding of vaccine hesitancy among researchers, public health experts, policymakers and health care providers will better guide interventions that can more effectively address vaccine hesitancy within Canada.
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Affiliation(s)
- Eve Dubé
- Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada
- Maladies infectieuses, Institut national de santé publique du Québec, Québec, Québec, Canada
- Maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec–Université Laval, Québec, Québec, Canada
| | - Dominique Gagnon
- Maladies infectieuses, Institut national de santé publique du Québec, Québec, Québec, Canada
| | - Manale Ouakki
- Maladies infectieuses, Institut national de santé publique du Québec, Québec, Québec, Canada
| | - Julie A. Bettinger
- Vaccine Evaluation Center, BC Children’s Hospital, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Maryse Guay
- Maladies infectieuses, Institut national de santé publique du Québec, Québec, Québec, Canada
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Scott Halperin
- Department of Microbiology & Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Janice Graham
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Holly O. Witteman
- Département de médecine familiale et de médecine d’urgence, Université Laval, Québec, Québec, Canada
- Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec–Université Laval, Québec, Québec, Canada
| | - Shannon MacDonald
- Nursing Faculty, University of Alberta, Edmonton, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - William Fisher
- Department of Psychology, University of Western Ontario, London, Ontario, Canada
| | - Laurence Monnais
- Département d'Histoire, Université de Montréal, Montréal, Québec, Canada
| | - Dat Tran
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Arnaud Gagneur
- Département de pédiatrie, Service de néonatologie, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Juliet Guichon
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Vineet Saini
- Department of Production Animal Health, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
| | - Jane M. Heffernan
- Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
| | - Samantha Meyer
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - S. Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joshua Greenberg
- School of Journalism and Communication, Carleton University, Ottawa, Ontario, Canada
| | - Heather MacDougall
- Department of History, University of Waterloo, Waterloo, Ontario, Canada
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Salazar KR, Seib KG, Underwood NL, Gargano LM, Sales JM, Morfaw C, Murray D, Diclemente RJ, Hughes JM. Recommendations for Structure and Content for a School-Based Adolescent Immunization Curriculum. Health Promot Pract 2016; 17:512-20. [PMID: 27009129 DOI: 10.1177/1524839915627458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite high utilization of childhood vaccinations, adolescent immunization coverage rates lag behind recommended coverage levels. The four vaccines recommended for adolescents ages 11 to 18 years are tetanus, diphtheria, and pertussis vaccine; human papillomavirus vaccine; meningococcal conjugate vaccine; and an annual influenza vaccine. The Healthy People 2020 goal is 80% coverage for each recommended immunization, but coverage rates in Georgia among adolescents fall below those goals for all but the tetanus, diphtheria, and pertussis vaccine. We developed a multicomponent intervention that included a school-based, teacher-delivered educational curriculum to increase adolescent vaccination coverage rates in Richmond County, Georgia. We facilitated focus group discussions with middle- and high school science teachers who delivered the immunization curriculum in two consecutive school years. The objective of the focus group was to understand teachers' perspectives about the curriculum impact and to synthesize recommendations for optimal dissemination of the curriculum content, structure, and packaging. Teachers provided recommendations for curriculum fit within existing classes, timing of delivery, and dosage of delivery and recommended creating a flexible tool kit, such as a downloadable online package. Teachers also recommended increasing emphasis on disease transmission and symptoms to keep students engaged. These findings can be applied to the development of an online, cost-effective tool kit geared toward teaching adolescents about the immune system and adolescent vaccinations.
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Affiliation(s)
| | | | | | - Lisa M Gargano
- Emory University, Atlanta, GA, USA New York City Department of Health and Mental Hygiene, New York City, NY, USA
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Abstract
INTRODUCTION "Vaccine hesitancy" is a concept frequently used in the discourse around vaccine acceptance. This study aims to contribute to the ongoing reflections on tools and indicators of vaccine hesitancy by providing results of a knowledge, attitudes and beliefs (KAB) survey conducted among parents. METHODS Data were collected in 2014 through a computer-assisted telephone interview survey administered to a sample of parents of children aged between 2 months and 17 years of age. RESULTS The majority of the 589 parents included in the analyses agreed on the importance of vaccination to protect their children's health and to prevent the spread of diseases in the community. The majority of the parents (81%) reported that their child had received all doses of recommended vaccines and 40% of parents indicated having hesitated to have their child vaccinated. Fear of adverse events and low perceived vulnerability of the child or severity of the disease were the most frequent reasons mentioned by these vaccine-hesitant parents. In multivariate analyses, KAB items remaining significantly associated both with an incomplete vaccination status of the child and parents' vaccine hesitancy were: not thinking that it is important to have the child vaccinated to prevent the spreading of diseases in the community; not trusting the received vaccination information and having felt pressure to have the child vaccinated. DISCUSSION Further researches will be needed to better understand when, how and why these beliefs are formed in order to prevent the onset of vaccine hesitancy.
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Affiliation(s)
- Eve Dubé
- Institut National de Santé Publique du Québec, Québec, Canada; Centre de Recherche du CHU de Québec, Université Laval, Québec, Canada
| | | | - Zhou Zhou
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Canada
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Lee J. Cochlear Implantation, Enhancements, Transhumanism and Posthumanism: Some Human Questions. SCIENCE AND ENGINEERING ETHICS 2016; 22:67-92. [PMID: 25962718 DOI: 10.1007/s11948-015-9640-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 03/09/2015] [Indexed: 05/28/2023]
Abstract
Biomedical engineering technologies such as brain-machine interfaces and neuroprosthetics are advancements which assist human beings in varied ways. There are exciting yet speculative visions of how the neurosciences and bioengineering may influence human nature. However, these could be preparing a possible pathway towards an enhanced and even posthuman future. This article seeks to investigate several ethical themes and wider questions of enhancement, transhumanism and posthumanism. Four themes of interest are: autonomy, identity, futures, and community. Three larger questions can be asked: will everyone be enhanced? Will we be "human" if we are not, one day, transhuman? Should we be enhanced or not? The article proceeds by concentrating on a widespread and sometimes controversial application: the cochlear implant, an auditory prosthesis implanted into Deaf patients. Cochlear implantation and its reception in both the deaf and hearing communities have a distinctive moral discourse, which can offer surprising insights. The paper begins with several points about the enhancement of human beings, transhumanism's reach beyond the human, and posthuman aspirations. Next it focuses on cochlear implants on two sides. Firstly, a shorter consideration of what technologies may do to humans in a transhumanist world. Secondly, a deeper analysis of cochlear implantation's unique socio-political movement, its ethical explanations and cultural experiences linked with pediatric cochlear implantation-and how those wary of being thrust towards posthumanism could marshal such ideas by analogy. As transhumanism approaches, the issues and questions merit continuing intense analysis.
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Affiliation(s)
- Joseph Lee
- Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
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Dubé E, Vivion M, Sauvageau C, Gagneur A, Gagnon R, Guay M. "Nature Does Things Well, Why Should We Interfere?": Vaccine Hesitancy Among Mothers. QUALITATIVE HEALTH RESEARCH 2016; 26:411-25. [PMID: 25711847 DOI: 10.1177/1049732315573207] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Parents' decision to use vaccination services is complex and multi-factorial. Of particular interest are "vaccine-hesitant" parents who are in the middle of the continuum between vaccine acceptance and refusal. The objective of this qualitative longitudinal study was to better understand why mothers choose to vaccinate-or not-their newborns. Fifty-six pregnant mothers living in different areas of Quebec (Canada) were interviewed. These interviews gathered information on mothers' views about health and vaccination. Almost half of the mothers were categorized as vaccine-hesitant. A second interview was conducted with these mothers 3 to 11 months after birth to look at their actual decision and behavior concerning vaccination. Our results show the heterogeneity of factors influencing vaccine decision making. Although the majority of vaccine-hesitant mothers finally chose to follow the recommended vaccine schedule for their child, they were still ambivalent and they continued to question their decision.
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Affiliation(s)
- Eve Dubé
- Centre de recherche du CHU de Québec, Québec City, Québec, Canada
| | - Maryline Vivion
- Institut national de santé publique du Québec, Québec City, Québec, Canada
| | - Chantal Sauvageau
- Institut national de santé publique du Québec, Québec City, Québec, Canada
| | | | - Raymonde Gagnon
- Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Maryse Guay
- Université de Sherbrooke, Sherbrooke, Québec, Canada
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Shaw J, Long SS. Public Discourse on Measles, A Shot in the Arm for Vaccination. J Pediatr 2015; 167:477-80. [PMID: 26003999 DOI: 10.1016/j.jpeds.2015.04.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/15/2015] [Accepted: 04/22/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Jana Shaw
- Division of Infectious Diseases, Department of Pediatrics, State University of New York Upstate Medical University, Golisano Children's Hospital, Syracuse, NY.
| | - Sarah S Long
- Division of Infectious Diseases, Department of Pediatrics, Drexel University College of Medicine, St Christopher's Hospital for Children, Philadelphia, PA
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47
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Newman PA, Lacombe-Duncan A. Human papillomavirus vaccination for men: advancing policy and practice. Future Virol 2014. [DOI: 10.2217/fvl.14.91] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT The quadrivalent HPV vaccine (HPV4) is safe and highly efficacious, and can significantly reduce the burden of HPV-related genital warts and cancers among men, in addition to promoting herd immunity. Nevertheless, HPV4 coverage among boys remains low in most settings. Research to date has focused predominantly on HPV vaccination of girls to prevent cervical cancer. Most countries with publicly funded healthcare where HPV4 is licensed cover the costs of HPV vaccination programs for girls only. We critically review the evidence for extending publicly funded HPV vaccination programs to boys in addition to girls. After an overview of research on HPV prevalence and associated cancers among men, we review cost–effectiveness studies, benefits of universal versus targeted vaccination approaches and multifaceted health equity concerns, along with directions in vaccine delivery programs and intervention research to promote HPV vaccine uptake for boys. Comprehensive evaluation of the systematic exclusion of boys from publicly financed HPV vaccination programs is warranted given tremendous public health implications of new infections and subsequent cancers that could have otherwise been averted.
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Affiliation(s)
- Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, ON, M5S 1V4, Canada
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48
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Dubé E, Vivion M, MacDonald NE. Vaccine hesitancy, vaccine refusal and the anti-vaccine movement: influence, impact and implications. Expert Rev Vaccines 2014; 14:99-117. [PMID: 25373435 DOI: 10.1586/14760584.2015.964212] [Citation(s) in RCA: 479] [Impact Index Per Article: 47.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Despite being recognized as one of the most successful public health measures, vaccination is perceived as unsafe and unnecessary by a growing number of parents. Anti-vaccination movements have been implicated in lowered vaccine acceptance rates and in the increase in vaccine-preventable disease outbreaks and epidemics. In this review, we will look at determinants of parental decision-making about vaccination and provide an overview of the history of anti-vaccination movements and its clinical impact.
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Affiliation(s)
- Eve Dubé
- Institut national de santé publique du Québec, Québec, QC, Canada
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49
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Hendrix KS, Finnell SME, Zimet GD, Sturm LA, Lane KA, Downs SM. Vaccine message framing and parents' intent to immunize their infants for MMR. Pediatrics 2014; 134:e675-83. [PMID: 25136038 PMCID: PMC4143998 DOI: 10.1542/peds.2013-4077] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Emphasizing societal benefits of vaccines has been linked to increased vaccination intentions in adults. It is unclear if this pattern holds for parents deciding whether to vaccinate their children. The objective was to determine whether emphasizing the benefits of measles-mumps-rubella (MMR) vaccination directly to the vaccine recipient or to society differentially impacts parents' vaccine intentions for their infants. METHODS In a national online survey, parents (N = 802) of infants <12 months old were randomly assigned to receive 1 of 4 MMR vaccine messages: (1) the Centers for Disease Control and Prevention Vaccine Information Statement (VIS), (2) VIS and information emphasizing the MMR vaccine's benefits to the child, (3) VIS and information emphasizing societal benefits, or (4) VIS and information emphasizing benefits both to the child and society. Parents reported their likelihood of vaccinating their infants for MMR on a response scale of 0 (extremely unlikely) to 100 (extremely likely). RESULTS Compared with the VIS-only group (mean intention = 86.3), parents reported increased vaccine intentions for their infants when receiving additional information emphasizing the MMR vaccine's benefits either directly to the child (mean intention = 91.6, P = .01) or to both the child and society (mean intention = 90.8, P = .03). Emphasizing the MMR vaccine's benefits only to society did not increase intentions (mean intention = 86.4, P = .97). CONCLUSIONS We did not see increases in parents' MMR vaccine intentions for their infants when societal benefits were emphasized without mention of benefits directly to the child. This finding suggests that providers should emphasize benefits directly to the child. Mentioning societal benefits seems to neither add value to, nor interfere with, information highlighting benefits directly to the child.
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Affiliation(s)
- Kristin S Hendrix
- Departments of Pediatrics, and Regenstrief Institute, Inc, Indianapolis, Indiana; and
| | - S Maria E Finnell
- Departments of Pediatrics, and Regenstrief Institute, Inc, Indianapolis, Indiana; and Ryan White Center for Pediatric Infectious Disease, Riley Hospital for Children, Indianapolis, Indiana
| | | | | | - Kathleen A Lane
- Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Stephen M Downs
- Departments of Pediatrics, and Regenstrief Institute, Inc, Indianapolis, Indiana; and
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50
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Parents’ Refusal to Vaccinate their Children: An Increasing Social Phenomenon Which Threatens Public Health. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.sbspro.2014.08.165] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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