Political Populism, Institutional Distrust and Vaccination Uptake: A Mediation Analysis

[Balancing drug regulation and health democracy: The role of patient and healthcare professional advisors at the ANSM]

The French National Agency for Health Products (ANSM) is a regulatory and public health agency. Its regulatory, health policing and public health protection activities require a perfect fit with the field and the various people involved in the use of health products. Since 2019, the ANSM has adapted its organisation, procedures and processes to encourage and improve interaction with its stakeholders, as part of its policy of openness towards civil society. To accompany this ambitious change and to support its staff, the Agency has recruited advisors corresponding to the main users of health products: prescribers (doctor's hospital and outpatient), pharmacists and patients. Working as a group or individually, they provide a "lived" user perspective on health products at each stage of the evaluation process. They may be involved in the assessment of dossiers, signals or applications received by the Agency, in the internal validation of reports or in discussions with stakeholders. They are particularly involved when the analysis requires expertise that goes beyond the technical, scientific or regulatory aspects. They may also work with ANSM staff to explain certain processes and difficulties in the field. Advisors help to ensure that regulatory and/or scientific expertise is clear and consistent with user experience. In addition to their scientific and therapeutic aspects, medicines are also economic, social and political issues. Their regulation is therefore particularly affected by the need for health democracy. This requires the active participation of health professionals, patients and, more broadly, civil society in the decision-making process. Civil society is a space occupied by a wide range of actors who exert pressure from different ideological positions to influence the regulation of health products. In this context, taking into account a plurality of viewpoints in the regulation of health products is necessary and complex, but its operation can be facilitated by the collective efforts of the actors and the adaptation of organisations, such as the integration of advisors.

Marginalisation and distrust in the context of the COVID-19 vaccination programme: experiences of communities in a northern UK city region

BACKGROUND

There are clear inequalities in COVID - 19 vaccination rates amongst marginalised groups, with lower rates for some minoritised ethnic and religious groups, younger people, those living in more deprived areas, and with lower socio-economic status. Existing research focuses on psychological and socio-economic factors that influence vaccine uptake and does not explore broader social and historical contexts. Understanding inequalities in COVID-19 vaccine uptake requires a critical examination of the drivers of, and barriers to, vaccination.

METHODS

We present findings from a co-designed qualitative research study undertaken during the COVID-19 pandemic. Focus groups and interviews were used to examine the context underpinning responses to the COVID-19 vaccination in Greater Manchester, particularly focussing on experiences of marginalisation. Thematic framework analysis was used to analyse the data.

RESULTS

We found that the public's responses to the COVID-19 vaccination programme are intertwined with a longstanding history of institutional distrust and disenfranchisement, resulting from experiences of marginalisation and social inequalities. This was exacerbated further by the disproportionate impacts of the COVID-19 pandemic on minoritised ethnic groups, younger people, and those with existing health conditions.

CONCLUSIONS

Histories of structural inequalities experienced by minoritised groups invoked feelings of suspicion and scepticism at the motivations of the agencies behind the vaccination rollout. This highlights the need for a contextualised analysis of attitudes to vaccines, considering pre-existing inequalities, which may be especially relevant for conceptualising public responses to the vaccination programme. Finally, our study shows the important ways in which public (dis)trust can impact public health policies. We recommend this should be incorporated into responses to future public health crises.

Barriers to vaccine acceptance in the adult population of mainland Finland, 2021

There has been a lack of information on vaccine acceptance for Finnish adults. We conducted a secondary analysis of cross-sectional data collected through the Finnish Medicines Agency Medicine Barometer 2021 survey (response rate: 20.6%). We described and explained vaccine acceptance by investigating the associations between socio-demographic factors and statements using logistic regression and conducted a factor analysis. The majority of respondents (n = 2081) considered vaccines to be safe (93%), effective (97%), and important (95%). However, 20% and 14% felt they did not have enough information about vaccines and vaccine-preventable diseases (VPDs), respectively. Respondents aged 18-39 were 2.8 times more likely to disagree that they had enough information about VPDs compared to respondents aged 60-79 (p < 0.001), while respondents with poorer self-perceived health were 1.8 times more likely to declare not having enough information about vaccines (p < 0.001). We generated three-factor dimensions from the eight statements. They were related to 'Confidence and attitudes towards vaccines', 'Access to information on vaccines and VPDs', and 'Debate on vaccine issues', which may reflect the underlying thinking patterns. Access to and understanding of information about vaccines and VPDs need to be improved for Finnish adults to increase vaccine acceptance and uptake, thus preventing the spread of VPDs.

Health emergencies, science contrarianism and populism: A scoping review

Populism has emerged as a central explanation employed by both media outlets and scholars for the mishandling of the COVID-19 crisis. Nonetheless, the relationship between public health and populism extends before and beyond the pandemic. This paper offers a comprehensive overview of existing evidence and theoretical conceptualisations on the intersection of populism, health emergencies, and contrarian scientific positions, drawing from a diverse range of disciplines. I conducted a scoping review of 283 original studies, analysing their analytical framework, geographic focuses, and methodological approaches. Employing quantitative text analysis, I summarised the research field into 18 common topics, organised into five coherent categories: citizen's perspective, political elites, political communication, pandemic consequences, and non-COVID-related issues. While the scholarly interest in this area has surged since the onset of the pandemic, it has predominantly concentrated on specific cases, such as Brazil and the US, often conflating different policy types. The evidence summary elucidates that populism assumes varying roles within distinct contexts, and there is no linear relationship between political populism and specific approaches to health crises and science. I further compare definitions of populism within the context of health and scientific positions. I propose that future research should employ a policy typology for health emergency responses, assessing political positions based on policy arenas. This paper contributes to the understanding of the complex interplay between political populism, contrarian scientific perspectives, and public health.

'You just emotionally break': understanding COVID-19 narratives through public health humanities

News reports that feature the experiences of healthcare workers have shaped public conversations about the pandemic from its earliest days. For many, stories of the pandemic have been an introduction to the way public health emergencies intersect with cultural, social, structural, political and spiritual determinants. Such stories often feature clinicians and other providers as characters in pandemic tales of heroism, tragedy and, increasingly, frustration. Examining three common categories of provider-focused news narratives-the clinician as a uniquely vulnerable front-line worker, clinician frustration with vaccine and masking resistance, and the clinician as a hero-the authors argue that the framework of public health humanities offers useful tools to understand and potentially shift public conversation of the pandemic. Close reading of these stories illuminates frames that relate to the role of providers, responsibility for the spread of the virus and how the US health system functions in a global context. Public conversations of the pandemic are shaped by and shape news stories and have important implications for policy. Acknowledging that contemporary health humanities in all its iterations considers how non-clinical factors, such as culture, embodiment and power, impact our understanding of health, illness and healthcare delivery, the authors locate their argument amid critiques that focus on social and structural factors. They argue that it is still possible to shift our understanding of and telling of those stories towards a more population-focused frame.

How Did We Get Here: The Best Vaccines Ever Facing the Highest Public Hesitancy?

mRNA vaccine technology is the most interesting final product of decades of research. This new platform for public health is simple to transfer to low-income countries and can be used against diverse agents, including cancer. It is environmentally clean, relatively low-cost, and does not use animals for its production. Most importantly, mRNA vaccines have been highly efficacious in avoiding serious disease and death from COVID-19. Yet, at the highest point of the pandemic, many voices, including some from prominent positions, opposed their use. Similarly, the Human Papillomavirus (HPV) vaccines, which are highly effective, very safe, and probably confer long life protection against its HPV types, faced strong parents' hesitancy. Vaccine hesitancy has been the subject of extensive research, focusing primarily on factors associated with the public, the political environment, and messaging strategies. However, the issue of unfair worldwide access to the COVID-19 vaccines has recently sparked significant debate about the vaccine industry's role. Recent data demonstrated that the system's perceived unfairness with the masses is behind the growing populist anti-vaccine movements worldwide. The association between populism and antivaccine attitudes has been reported at country and individual levels. The anti-science attitudes behind vaccine hesitancy emerge when the scientist is not found credible due to the suspicion that they had monetary investments in pharmaceutical companies. Here, I argue that the obscurity of the vaccine market, but also its unfairness, are important factors contributing to vaccine hesitancy. The purpose of this commentary is to stimulate a review of current market regulations and to improve its transparency and fairness, particularly in the context of public health emergencies. By doing so, a new pandemic would find us better prepared. The general population and much of the healthcare community often ignore the years of dedicated work and substantial public funding that enabled the discovery and design of vaccines. Conversely, pharmaceutical companies often over-emphasize their investments in research and development. A decade ago, Marcia Angell provided a detailed breakdown of pharmaceutical expenses, revealing that marketing and administration costs were 2.5 times higher than research and development expenses; recently, Olivier Wouters confirmed the high expenditures of the pharmaceutical industry in lobbying and political campaign contributions. In this commentary, I will present the cases of HPV and COVID-19 vaccines as examples of when vaccines, instead of being public health goods, became market goods, creating large inequities and health costs. This failure is a structural cause behind more ideological vaccine hesitancy, less studied so far.

Political Ideology and Trust in Government to Ensure Vaccine Safety: Using a U.S. Survey to Explore the Role of Political Trust

Since early 2020, the rapid expansion of COVID-19 has raised concerns about vaccine safety and the government's handling of it. Particularly notable and concerning has been a growing number of people who oppose vaccines, as this opposition poses a threat to public health. Those for and against vaccination have become polarized along a political divide. Within this context, this study focuses on the role of political trust, exploring whether political ideology is associated with the perception that the government can ensure the safety of vaccines and whether there is a moderator that can alleviate the concerns of those who oppose the government's handling of vaccine safety on ideological grounds. This study relies on the 2021 U.S. General Social Survey (GSS) and employs an ordered probit method because the dependent variable is an ordered category. The ordered probit model includes a weight provided by the U.S. GSS to account for the population. The sample size was 473 because of the inclusion of all the variables relevant to this study. The results obtained are as follows: First, conservatives associate negatively with support for the government's handling of vaccine safety. Second, more importantly, conservatives exhibit a higher trust level toward the government to ensure vaccine safety if their level of political trust increases. The results point to important implications. Political ideology matters in how individuals view the government's handling of vaccine safety. Political trust plays a key role in helping individuals alter their views toward the government's handling of vaccine safety. This points to a need for the government to take political trust seriously and work hard to improve the public's trust in the government.

A Case of Pharmaceutical Messianism Amidst the COVID-19 Pandemic: An Infodemiological Study of Ivermectin in the Philippines

Pharmaceutical messianism is a manifestation of medical populism. It arises during extraordinary crises, is built on the familiar, endorsed by heterodox authorities, and involves a highly accessible panacea. Amid the politics and public desperation in the Philippines during the COVID-19 pandemic, pharmaceutical messianism can be observed in the form of Ivermectin, a panacea offered to prevent and treat COVID-19. Thus, it may be worthwhile to determine the changes and patterns of public interest toward Ivermectin. This infodemiological study utilized and described Search Volume Index and related queries for Ivermectin from Google Trends vis-à-vis reported societal events in the Philippines to determine changes in public interest in Ivermectin use. It revealed that a tremendous increase in public interest in Ivermectin has emerged during surges of COVID-19 cases, endorsement by politicians and heterodox health authorities, and public distribution of Ivermectin. It also showed that public interest increased as the number of component characteristics of pharmaceutical messianism increased. Search-related queries and topics also showed that the public might be using the internet to inform themselves regarding the use of Ivermectin for humans, including its use for COVID-19. These findings suggest that people may study the endorsed panacea and weigh it against conventional and orthodox treatment during rising COVID-19 cases. Thus, easily understandable, highly searchable, reliable, and trustworthy online information is ever-crucial in this age of information and disinformation.

Perceived partial social integration, levels of distress and resilience, and COVID-19 vaccine rejection of Jewish and Arab citizens of Israel

Introduction

The present study examines the role of perceived partial social integration (PPSI) in determining the rejection of the COVID-19 vaccine of Jewish and Arab citizens of Israel.

Methods

The research hypotheses are examined using a relatively large sample of the Israeli public, including 208 Arab and 600 Jewish adults, who have responded to an anonymous questionnaire pertaining, among other issues, to partial social integration and the individual level of vaccine uptake.

Results

Higher levels of PPSI were found to be associated with higher levels of vaccine rejection, in both Jewish and Arab samples. The Arab minority group regards themselves as less socially integrated into the Israeli society and therefore rejects the COVID-19 vaccine to a greater extent than the majority group. The Arab respondents expressed a higher level of psychological distress and a lower level of resilience compared with the Jewish participants. The perceived partial social integration score significantly predicted the levels of distress and resilience of the Jewish but not the Arab sample.

Discussion

The study indicates that increasing the vaccination rates depends more substantially on trust in the authorities than on leveraging greater pressure on individuals that reject the vaccine. Increased trust in the authorities and regarding oneself as an integral component of society are two vital conditions for vaccine acquiescence. Insufficient social integration is a major reason for vaccine rejection.

Vaccine Hesitancy: Obstacles and Challenges

Purpose of Review

In 2019, vaccine hesitancy (VH) was named as one of the top 10 threats to global health by the World Health Organization (WHO). We highlight the factors affecting VH, the role of VH in limiting vaccine uptake and inability to achieve collective immunity, and possible solutions.

Recent Findings

There are still uncertainties and concerns about the safety and efficacy of vaccines, which promote VH and undermine public confidence in immunization. WHO has designed the behavioral and social drivers (BeSD) tools and survey instruments that can be used by countries to assess reasons for poor vaccine uptake in childhood for COVID-19 and plan national vaccination programs to counter these misconceptions.

Summary

Vaccines are one of the best preventative measures that public health care has to offer. Evidence from across the world both in high-income countries (HICs) and low/middle-income countries (LMICs) show that VH is a significant phenomenon which is translating into geographical clustering of epidemics. A reasonably high acceptance and coverage rates are necessary for an immunization program to be successful. A context-specific and multifactorial intervention with more high-quality research is needed globally.