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Tippins E, Ysseldyk R, Peneycad C, Anisman H. Believing in science: Linking religious beliefs and identity with vaccination intentions and trust in science during the COVID-19 pandemic. PUBLIC UNDERSTANDING OF SCIENCE (BRISTOL, ENGLAND) 2023; 32:1003-1020. [PMID: 37278005 PMCID: PMC10247686 DOI: 10.1177/09636625231174845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Despite evidence supporting numerous scientific issues (e.g. climate change, vaccinations) many people still doubt the legitimacy of science. Moreover, individuals may be prone to scepticism about scientific findings that misalign with their ideological beliefs and identities. This research investigated whether trust in science (as well as government and media) and COVID-19 vaccination intentions varied as a function of (non)religious group identity, religiosity, religion-science compatibility beliefs, and/or political orientation in two online studies (N = 565) with university students and a Canadian community sample between January and June 2021. In both studies, vaccination intentions and trust in science varied as a function of (non)religious group identity and beliefs. Vaccine hesitancy was further linked to religiosity through a lack of trust in science. Given the ideological divides that the pandemic has exacerbated, this research has implications for informing public health strategies for relaying scientific findings to the public and encouraging vaccine uptake in culturally appropriate ways.
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Tandy CB, Odoi A. Geographic disparities and predictors of vaccination exemptions in Florida: a retrospective study. PeerJ 2022; 10:e12973. [PMID: 35223209 PMCID: PMC8877400 DOI: 10.7717/peerj.12973] [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: 09/07/2021] [Accepted: 01/31/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND In the United States, state-level policies requiring vaccination of school-going children constitute a critical strategy for improving vaccination coverage. However, policies allowing vaccination exemptions have also been implemented and contribute to reductions in vaccination coverage and potential increases in the burden of vaccine-preventable diseases. Understanding the geographic disparities in the distribution of vaccination exemptions and identifying high risk areas is necessary for guiding resource allocation and public health control strategies. This study investigated geographic disparities in vaccination exemptions as well as socioeconomic and demographic predictors of vaccination exemptions in Florida. METHODS Vaccination exemption data were obtained from the Florida Department of Health's Florida HealthCHARTS web interface. Spatial patterns in geographic distribution of total and non-medical vaccination exemptions were assessed using county-level choropleth maps. Negative binomial models were used to identify significant predictors of county-level risks of both total and non-medical vaccination exemptions. RESULTS Total exemptions varied from 0 to 30.2 per 10,000 people. Nine counties had exemption risks in the top two classes (10.4-15.9 and 15.9-30.2 exemptions per 10,000 people). These counties were distributed in five distinct areas: Western Panhandle, central northern area, central, South-eastern coastal area, and the southern coastal border of the state. Non-medical exemptions varied from 0 to 10.4 per 10,000 people. Fifteen counties had exemption risks in the top two classes (3.7-5.6 and 5.6-10.4 exemptions per 10,000 people), and were located in six distinct areas: Western and Central Panhandle, Northeastern, Central-eastern coastal area, Central-western coastal area, and the South-western coastal border of the state. Predictors of high risk of total vaccination exemptions were high density of primary care providers (p < 0.001), high median income (p = 0.001), high percentage of Hispanic population (p = 0.046), and low percentage of population with a college education (p = 0.013). A predictor of high risk of non-medical vaccination exemptions was high percentage of White population (p = 0.045). However, predictors of low risks of non-medical exemptions were high percentages of population: living in rural areas (p = 0.023), with college education (p = 0.013), with high school education (p = 0.009), and with less than high school education (p < 0.001). CONCLUSIONS There is evidence of county-level geographic disparities in both total and non-medical vaccination exemption risks in Florida. These disparities are explained by differences in county-level socioeconomic and demographic factors. Study findings are important in guiding resource allocation for health planning aimed at improving vaccination rates and reducing incidence of vaccine-preventable diseases.
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Older adolescents and young adults willingness to receive the COVID-19 vaccine: Implications for informing public health strategies. Vaccine 2021; 39:3473-3479. [PMID: 34023134 PMCID: PMC8114588 DOI: 10.1016/j.vaccine.2021.05.026] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/26/2021] [Accepted: 05/08/2021] [Indexed: 12/22/2022]
Abstract
Importance The success in ending the COVID-19 pandemic rests partly on the mass uptake of the COVID-19 vaccine. Little work has been done to understand vaccine willingness among older adolescents and young adults. This is important since this age group may be less likely to adhere to public health guidelines. Objective To understand willingness of getting a vaccine and reasons for vaccine hesitancy among a sample of older adolescents and young adults. Design Data were from the Well-Being and Experiences study (The WE Study), a longitudinal community-based sample of older adolescents and young adults collected from Winnipeg, Manitoba, Canada from 2017 to 2020 (n = 664). Setting The study setting was a community-based observational longitudinal study. Participants Participants for the study were aged 14 to 17 years old at baseline in 2016–17 (n = 1000). Data were also collected on one parent/caregiver. Waves 2 (n = 747) and 3 (n = 664) were collected in 2019 and 2020, respectively. Exposures The main exposures were sociodemographic factors, health conditions, COVID-19 knowledge, and adversity history. Main Outcomes The main outcomes were COVID-19 vaccine willingness, hesitancy, and reasons for hesitancy. Results Willingness to get a COVID-19 vaccine was 65.4%. Willingness did not differ by age, sex, or mental health conditions, but did differ for other sociodemographic characteristics, physical health conditions, COVID-19 knowledge, practicing social/physical distancing, and adversity history. The most common reasons for not wanting a vaccine were related to safety, knowledge, and effectiveness. Sex differences were noted. Conclusions and Relevance Increasing uptake of the COVID-19 vaccine among older adolescents and young adults may rely on targeting individuals from households with lower income, financial burden, and adversity history, and generating public health messaging specifically aimed at vaccine safety, how it works to protect against illness, and why it is important to protect oneself against a COVID-19 infection.
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Paquette ET. In the Wake of a Pandemic: Revisiting School Approaches to Nonmedical Exemptions to Mandatory Vaccination in the US. J Pediatr 2021; 231:17-23. [PMID: 33484695 PMCID: PMC7816863 DOI: 10.1016/j.jpeds.2021.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/23/2020] [Accepted: 01/11/2021] [Indexed: 12/02/2022]
Abstract
Mandatory school vaccination policies with exclusion of unvaccinated students can be a powerful tool in ensuring high vaccination rates. Some parents may object to mandatory vaccination policies, claiming exemptions based on medical, religious, or philosophical reasons. Individual schools, school systems, or local or regional governments have different policies with respect to whether, and what kind of, exemptions may be allowed. In the setting of the current pandemic, questions regarding the acceptability of exemptions have resurfaced, as schools and local governments struggle with how to safely return children to school. Anticipating that school attendance will be facilitated by the development of a vaccine, school systems will face decisions about whether to mandate vaccination and whether to permit exemptions. The American Academy of Pediatrics promulgates policy favoring the elimination of nonmedical exemptions generally in schools. This discussion considers whether schools should eliminate nonmedical exemptions to vaccination as proposed in the American Academy of Pediatrics policy, ultimately concluding that broad elimination of exemptions is not justified and advocating a more nuanced approach that encourages school attendance while promoting vaccination and broader public health goals.
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Affiliation(s)
- Erin Talati Paquette
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Stanley Manne Children's Research Institute; and the Northwestern Pritzker School of Law,∗ Chicago, IL.
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Wilson SE, Bunko A, Johnson S, Murray J, Wang Y, Deeks SL, Crowcroft NS, Friedman L, Loh LC, MacLeod M, Taylor C, Li Y. The geographic distribution of un-immunized children in Ontario, Canada: Hotspot detection using Bayesian spatial analysis. Vaccine 2021; 39:1349-1357. [PMID: 33518467 DOI: 10.1016/j.vaccine.2020.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND In Ontario, Canada, little is currently known about the extent to which un-immunized children may cluster geographically. Our objectives were to: describe the geographic distribution of fully un-immunized children; identify geographic clusters (hotspots) of un-immunized children; and to characterize the contribution of spatial effects and covariates on hotspots, where found. METHODS Our analytic cohort consisted of Ontario students aged 7-17 years in the 2016-2017 school year. We defined students as un-immunized if they had zero doses of any vaccine and a non-medical exemption recorded in Ontario's registry. We calculated unadjusted proportions of un-immunized students by Census Subdivision (CSD) and then used a sequential approach to identify hotspots starting first with hotspot identification at the CSD level and then probed identified hotspots further by Dissemination Area (DA) and including covariates. Hotspots were identified using the Besag-York-Mollie Bayesian spatial model and were defined as areas with >95% probability of having two times the proportion of un-immunized students, relative to the province overall. RESULTS We identified 15,208 (0.94%) un-immunized children within our cohort consisting of more than 1.61 million students. Unadjusted proportions of un-immunized students varied greatly by geography, ranging from 0% to 21.5% by CSD. We identified 16 hotspot CSDs which clustered in five distinct areas, all of which were located in southern Ontario. The contribution of covariates and spatial effects on the risk of having un-immunized students varied greatly across hotspot areas. CONCLUSIONS Although the provincial proportion (0.94%) of un-immunized students is small, geographical clustering of such students is evident in Ontario and in some areas presents an important risk for future outbreaks. Further qualitative work within these hotspot areas would be a helpful next step to better characterize the factors associated with vaccine refusal in these communities.
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Affiliation(s)
- Sarah E Wilson
- Public Health Ontario, 480 University Avenue, Suite 1701, Toronto, Ontario M5G 1M1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada; ICES, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
| | - Andrean Bunko
- Public Health Ontario, 480 University Avenue, Suite 1701, Toronto, Ontario M5G 1M1, Canada
| | - Steven Johnson
- Public Health Ontario, 480 University Avenue, Suite 1701, Toronto, Ontario M5G 1M1, Canada
| | - Jillian Murray
- Public Health Ontario, 480 University Avenue, Suite 1701, Toronto, Ontario M5G 1M1, Canada
| | - Yue Wang
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada
| | - Shelley L Deeks
- Public Health Ontario, 480 University Avenue, Suite 1701, Toronto, Ontario M5G 1M1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada
| | - Natasha S Crowcroft
- Public Health Ontario, 480 University Avenue, Suite 1701, Toronto, Ontario M5G 1M1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada; ICES, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada
| | - Lindsay Friedman
- Public Health Ontario, 480 University Avenue, Suite 1701, Toronto, Ontario M5G 1M1, Canada
| | - Lawrence C Loh
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada; Peel Public Health, 7120 Hurontario Street, Mississauga, Ontario L5W 1N4, Canada
| | - Melissa MacLeod
- Southwestern Public Health, 410 Buller Street, Woodstock, Ontario N4S 6G9, Canada
| | - Christina Taylor
- Huron Perth Public Health, 77722B London Road R.R. 5, Clinton, Ontario N0M 1L0, Canada
| | - Ye Li
- Public Health Ontario, 480 University Avenue, Suite 1701, Toronto, Ontario M5G 1M1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada
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Thomas B, Flood CM. Eliminating Religious and Philosophical Exemptions: The Next Step in Ontario's Campaign against Vaccine Hesitancy. ACTA ACUST UNITED AC 2020; 16:14-20. [PMID: 33337310 DOI: 10.12927/hcpol.2020.26357] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Ontario families are required to provide up-to-date vaccination records as children begin schooling. Exemptions are allowed on both medical and nonmedical (religious or philosophical) grounds. In a recent report, Toronto Public Health (2019) called for an end to nonmedical exemptions - a proposal some allege infringes the Canadian Charter of Rights and Freedoms right to freedom of religion and conscience. This paper explores whether and to what extent vaccine refusal is protected under the Charter and argues that the elimination of nonmedical exemptions can be justified under Section 1 of the Charter. The issue of mandatory vaccination may take on special urgency in the coming months and years, if and when a vaccine is found for COVID-19.
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Affiliation(s)
- Bryan Thomas
- Senior Research Associate and Adjunct Professor, Centre for Health Law, Policy and Ethics, University of Ottawa, Ottawa, ON
| | - Colleen M Flood
- University Research Chair and Director, Centre for Health Law, Policy and Ethics, University of Ottawa, Ottawa, ON
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Ashfield S, Donelle L. Parental Online Information Access and Childhood Vaccination Decisions in North America: Scoping Review. J Med Internet Res 2020; 22:e20002. [PMID: 33048055 PMCID: PMC7592069 DOI: 10.2196/20002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/14/2020] [Accepted: 09/02/2020] [Indexed: 01/17/2023] Open
Abstract
Background Immunizing children throughout their early years prevents the spread of communicable disease and decreases the morbidity and mortality associated with many vaccine-preventable diseases. Searching online allows individuals rapid access to health information. Objective The purpose of this review was to develop an understanding of the existing literature of parents’ online health information-seeking behaviors to inform their vaccination choices for their children and to identify gaps in the literature around parents’ use of online health information and their vaccination choices. Methods A scoping review of peer-reviewed literature from Canada and the United States was performed. The following databases were utilized to perform the search: PubMed, CINAHL, Nursing & Allied Health Database, Scopus, and PsycINFO. The purpose of this review was to examine parents’ use of online information seeking related to vaccine information and to understand how parents utilize this information to inform decisions about vaccinating their children. Of the 34 papers included in the review, 4 relevant themes and subthemes were identified: information seeking, online information resources, online vaccine content, and trust in health care providers. Results Examination of the literature revealed conflicting information regarding parents’ use of social media and online resources to inform decisions around vaccinating their children. There is evidence of significant misinformation regarding vaccine risks online. Parents’ digital health literacy levels are unknown and may affect their ability to appraise online vaccination information. Conclusions Parents are seeking vaccine information from online sources. However, the influence of online vaccine information on parental vaccine practices remains uncertain.
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Schellenberg N, Crizzle AM. Vaccine hesitancy among parents of preschoolers in Canada: a systematic literature review. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2020; 111:562-584. [PMID: 32783144 PMCID: PMC7438392 DOI: 10.17269/s41997-020-00390-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/10/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The purpose was to synthesize the available literature on what factors influence vaccine hesitancy of parents of preschoolers in Canada. METHODS Databases (e.g., CINAHL, PubMed, OVID, Proquest) were searched for relevant research articles produced between January 2009 and October 2019. Articles were required to examine vaccine uptake in children aged 0-7, in the English language, and focused within a Canadian context. Articles were excluded if they focused on uptake of the influenza vaccine and if the study population was children with chronic health conditions. A total of 367 articles were reviewed and 12 met the criteria for inclusion in this review. SYNTHESIS This review found that between 50% and 70% of children are completely vaccinated at 2 years old, with up to 97% having received at least one vaccine, and 2-5% receiving no vaccines. This review found that trust and access to health care providers is significantly associated with vaccine uptake, likely more important than parents' vaccine knowledge, and may compensate for challenges related to socio-economic status and family dynamics. CONCLUSION Vaccine programs need to be created that are accessible to all families, with an awareness of the significant impact of trust on vaccine uptake. Future research should include consistent measures of vaccine uptake, and data from First Nation communities, and should examine how increased trust between health care providers and parents of preschool children would increase vaccine uptake in Canada.
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Abstract
The avalanche of online information on immunization is having a major impact on the percentage of the population who choose to get vaccinated. Vaccine misinformation spreads widely with the interactive Web 2.0 and social media; this can bury science-based information. A plethora of immunization misinformation online is affecting trust in health care professionals and in public immunization programs. There are no simple solutions to this, but seven evidence-based strategies can help. First, listen to patients' and parents' concerns, and demonstrate responsiveness by adopting best immunization practices, such as pain mitigation. Second, recognize and alert others to anti-immunization tactics, namely, conspiracy theories, fake experts, selectivity, demands that vaccines be 100% safe and effective, misrepresentation and false logic. Third, avoid unproductive debates with those who have strongly held views, both in person and when using social media. Be respectful, stick to your key message, identify where to find useful information and exit. Fourth, consider establishing an attractive, easily searchable online presence that reflects the complex art of persuasion. Emphasize the benefits of vaccine, use reader-friendly graphics and highlight facts with stories to strengthen your case. Fifth, work with social media platform providers, not to stifle freedom of expression, but to help ensure that misinformation is not favoured in searches. Sixth, promote curriculum development in the schools to improve students' understanding of the benefits and safety of immunization and to foster critical thinking skills. To do this, optimize the use of age-appropriate comics and interactive learning tools such as electronic games. Seventh, to shift the narrative in specific communities with low vaccination rates, work with community leaders to build tailored programs that foster trust and reflect local values.
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Gianfredi V, Moretti M, Lopalco PL. Countering vaccine hesitancy through immunization information systems, a narrative review. Hum Vaccin Immunother 2019; 15:2508-2526. [PMID: 30932725 PMCID: PMC6930057 DOI: 10.1080/21645515.2019.1599675] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/06/2019] [Accepted: 03/15/2019] [Indexed: 01/02/2023] Open
Abstract
Immunization is one of the most important public health interventions to contrast infectious disease; however, many people nowadays refuse vaccination. Vaccine hesitancy (VH) is due to several factors that influence the complex decision-making process. Information technology tools might play an important role in vaccination programs. In particular, immunization information systems (IISs) have the potential to improve performance of vaccination programs and to increase vaccine uptake. This review aimed to present IIS functionalities in order to counter VH. In detail, we analyzed the automatic reminder/recall system, the interoperability of the system, the decision support system, the web page interface and the possibility to record adverse events following immunization. IIS could concretely represent a valid instrument to increase vaccine confidence, especially trust in both health-care workers and decision makers. There are not enough trials aimed to evaluate the efficacy of IIS to counter VH. Further researches might focalize on this aspect.
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Affiliation(s)
- Vincenza Gianfredi
- Post-Graduate School of Hygiene and Preventive Medicine, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Massimo Moretti
- Department of Pharmaceutical Science, Unit of Public Health, University of Perugia, Perugia, Italy
| | - Pier Luigi Lopalco
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Wilson SE, Murray J, Bunko A, Johnson S, Buchan SA, Crowcroft NS, Dubey V, Loh LC, MacLeod M, Taylor C, Deeks SL. Characteristics of immunized and un-immunized students, including non-medical exemptions, in Ontario, Canada: 2016–2017 school year. Vaccine 2019; 37:3123-3132. [DOI: 10.1016/j.vaccine.2019.04.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 10/27/2022]
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MacDonald NE, Harmon S, Dube E, Taylor B, Steenbeek A, Crowcroft N, Graham J. Is physician dismissal of vaccine refusers an acceptable practice in Canada? A 2018 overview. Paediatr Child Health 2018; 24:92-97. [PMID: 30996599 DOI: 10.1093/pch/pxy116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/28/2018] [Indexed: 12/25/2022] Open
Abstract
Despite robust evidence that routine immunization is effective and safe, some parents refuse some or all vaccines for their children. In 2007, concern that Canadian paediatricians and family physicians might be considering dismissal of vaccine refusers from their practices prompted an ethical, legal, and public health analysis which concluded that dismissal was professionally problematic. We now reassess this important issue in the Canadian context updating ethical, legal, and public health considerations highlighting changes since 2007. In light of the recent strengthening of Ontario's school immunization requirements that include stiffer steps to qualify for a medical, conscience, or religious belief exemption, physicians and health care workers may be under more pressure from vaccine refusers in their practice leading some to contemplate dismissal or even consider no longer offering immunizations at all in their practice. Given the challenges that vaccine refusers may present, we offer an overview for managing vaccine refusal by parents/patients in a medical practice.
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Affiliation(s)
- Noni E MacDonald
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia
| | - Shawn Harmon
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia.,JK Mason Institute for Medicine, Life Sciences and Law, University of Edinburgh, Edinburgh, UK
| | - Eve Dube
- Institut National de Santé Publique du Québec and Université Laval, Québec, Québec
| | - Beth Taylor
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia
| | - Audrey Steenbeek
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia
| | - Natasha Crowcroft
- Public Health Ontario, Laboratory Medicine and Pathobiology and Dalla Lana School of Public Health University of Toronto, Toronto Ontario
| | - Janice Graham
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia.,Technoscience and Regulation Research Unit, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia
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MacDonald NE, Harmon S, Dube E, Steenbeek A, Crowcroft N, Opel DJ, Faour D, Leask J, Butler R. Mandatory infant & childhood immunization: Rationales, issues and knowledge gaps. Vaccine 2018; 36:5811-5818. [DOI: 10.1016/j.vaccine.2018.08.042] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/16/2018] [Accepted: 08/15/2018] [Indexed: 01/08/2023]
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Robinson JL. Potential strategies to improve childhood immunization rates in Canada. Paediatr Child Health 2018; 23:353-356. [PMID: 30657136 PMCID: PMC6054155 DOI: 10.1093/pch/pxy052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Immunization rates in Canada are suboptimal. Strategies such as making immunization mandatory for child care or school entry and financial incentives are used in other countries. Additional strategies that could work in the Canadian context include requiring accurate immunization records at school entry, implementing immunization registries at the provincial/territorial level, educating parents and school-aged children about vaccine-preventable diseases and making it more convenient for parents to ensure their children are fully immunized.
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Affiliation(s)
- Joan L Robinson
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario
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Dubé E, Gagnon D, Ouakki M, Bettinger JA, Witteman HO, MacDonald S, Fisher W, Saini V, Greyson D. Measuring vaccine acceptance among Canadian parents: A survey of the Canadian Immunization Research Network. Vaccine 2017; 36:545-552. [PMID: 29233605 DOI: 10.1016/j.vaccine.2017.12.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 11/17/2017] [Accepted: 12/01/2017] [Indexed: 12/13/2022]
Abstract
Parental decision making about childhood vaccinations is complex and multidimensional. There is a perception that the number of parents having concerns regarding childhood vaccinations has been increasing in Canada. The aim of this study was to explore vaccine hesitancy among Canadian parents and to examine factors associated with a parent's intention to vaccinate his/her child. Informed by the Theory of Planned Behaviour (TPB) this study assesses potential associations between parents' knowledge, attitudes and beliefs toward vaccination and their intention to vaccinate their child in the future. A national sample of Canadian parents of children aged 24-59 months (N = 2013) was surveyed using an online survey methodology. Half of the surveyed parents strongly intended to have their child vaccinated in the future. Parents' information needs and searches as well as parents' trust in different institutions were associated with intention to vaccinate. Parents who reported having frequently looked for vaccine information, who considered that it was their role as parents to question vaccines, or who had previously experienced difficulty accessing vaccination services were less likely to strongly intend to vaccinate their child in the future. Parents who had a high level of trust in doctors and public health were most likely to strongly intend to vaccinate their child. Results of the multivariate analysis showed that positive attitudes (aOR = 8.0; 95% CI: 6.0, 10.4), higher perceived social support (aOR = 3.0; 95% CI: 2.3, 3.93), and higher perceived behavioural control (aOR = 1.8; 95% CI: 1.4, 2.43) were associated with parents' intention to vaccinate their child. Findings of this study suggest that trust-building interventions that promote pro-vaccine social norms and that address negative attitudes toward vaccination could enhance vaccine acceptance among Canadian parents.
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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
| | - 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; Department of Obstetrics and Gynaecology, University of Western Ontario, London, Ontario, Canada
| | - Vineet Saini
- Department of Production Animal Health, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Calgary, Alberta, Canada
| | - Devon Greyson
- Vaccine Evaluation Center, BC Children's Hospital, and University of British Columbia, Vancouver, British Columbia, Canada
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Dubé E, Bettinger JA, Fisher WA, Naus M, Mahmud SM, Hilderman T. Vaccine acceptance, hesitancy and refusal in Canada: Challenges and potential approaches. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2016; 42:246-251. [PMID: 29769995 PMCID: PMC5757714 DOI: 10.14745/ccdr.v42i12a02] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
"Vaccine hesitancy" is a concept used frequently in vaccination discourse and is challenging previously held perspective that individual vaccination attitudes and behaviours are a simple dichotomy of accept or reject. Given the importance of achieving high vaccine coverage in Canada to avoid vaccine preventable diseases and their consequences, vaccine hesitancy is an important issue that needs to be addressed. This article describes the scope and causes of vaccine hesitancy in Canada and proposes potential approaches to address it.
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Affiliation(s)
- E Dubé
- Institut national de santé publique du Québec, Québec, QC
| | - JA Bettinger
- Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia, Vancouver, BC
| | - WA Fisher
- University of Western Ontario, London, ON
| | - M Naus
- BC Centre for Disease Control, Vancouver, BC
| | - SM Mahmud
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB
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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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Lee C, Robinson JL. Systematic review of the effect of immunization mandates on uptake of routine childhood immunizations. J Infect 2016; 72:659-666. [PMID: 27063281 DOI: 10.1016/j.jinf.2016.04.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 03/28/2016] [Accepted: 04/01/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE The efficacy of immunization mandates for childcare or school entry is a long-standing controversy. The United States (US) adopted school entry immunization mandates in the 1800s, while most countries still do not have mandates. The objective of this systematic review was to analyze the evidence that immunization uptake increases with mandates. METHODS A search was conducted for studies that compared immunization uptake in a population prior to and after mandates, or in similar populations with one group having and the other not having mandates. Data were extracted and synthesized qualitatively due to the heterogeneity of study design. RESULTS Eleven before-and-after studies and ten studies comparing uptake in similar populations with and without mandates were included. Studies were from the US (n = 18), France (n = 1) and Canada (n = 2). Eleven of the 21 studies looked at middle school mandates. All but two studies showed at least a trend towards increased uptake with mandates. Higher uptake was associated with a more long-standing mandate. CONCLUSIONS Immunization mandates have generally led to increased short-term and long-term uptake in the group to whom the mandate applies. Many studies have centered around middle school mandates in the US and there is a paucity of studies of childcare mandates or of studies of mandates in other countries or in settings with relatively high baseline immunization uptake.
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Affiliation(s)
- Cecilia Lee
- Stollery Children's Hospital and University of Alberta, Canada.
| | - Joan L Robinson
- Stollery Children's Hospital and University of Alberta, Canada.
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Affiliation(s)
- Eve Dubé
- Institut national de santé publique du Québec, and Centre de recherche du CHU de Québec (Dubé), Université Laval, Que.; Dalhousie University and Canadian Centre for Vaccinology (MacDonald), IWK Health Centre, Halifax, NS
| | - Noni E MacDonald
- Institut national de santé publique du Québec, and Centre de recherche du CHU de Québec (Dubé), Université Laval, Que.; Dalhousie University and Canadian Centre for Vaccinology (MacDonald), IWK Health Centre, Halifax, NS
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