Vaccine uptake and barriers to vaccination among at-risk adult populations in the US

To reduce morbidity and mortality associated with vaccine-preventable diseases (VPD), it is imperative that vaccination programs are implemented and prioritized throughout all stages of life across all populations. This study aimed to determine vaccine uptake and barriers to vaccination against VPDs among at-risk adult populations in the United States. We conducted a systematic literature review for articles published between January 2010 and June 2020 and identified 153 publications. The review identified 17 at-risk populations. Vaccine uptake was suboptimal among many populations, with factors including age, gender, and disease severity, associated with uptake. This review identified several barriers that impact vaccine uptake among at-risk populations, with concerns over safety, vaccine costs, lack of insurance, and lack of provider recommendation commonly reported across populations. Embracing a national life-course immunization framework that integrates developing policies, guidelines, and education would be a step to addressing these barriers.

Immediate and informative feedback during a pandemic: Using stated preference analysis to predict vaccine uptake rates

In response to an emerging pandemic, there is urgent need for information regarding individual evaluation of risk and preferences toward mitigation strategies such as vaccinations. However, with social distancing policies and financial stress during an outbreak, traditional robust survey methodologies of face-to-face, probabilistic sampling, may not be feasible to deploy quickly, especially in developing countries. We recommend a protocol that calls for a sensitive survey design, acceptance of a web-based approach and adjustments for uncertainty of respondents, to deliver urgently needed information to policymakers as the public health crisis unfolds, rather than in its aftermath. This information is critical to tailor comprehensive vaccination campaigns that reach critical immunity thresholds. We apply our recommendations in a regional study of 16 Latin American countries in the month following index cases of COVID-19. We use a split-sample, contingent valuation approach to evaluate the effects of cost, duration of immunity and effectiveness of the vaccine. Our results show that cost and duration of immunity are significant factors in the decision to vaccinate, while the degree of effectiveness is insignificant, unless the vaccine is 100% effective. Income as well as perceived risk and severity of the virus are important determinants also.

Vaccine coverage in England: the impact of health service reorganisation

AIM

To evaluate the impact of reorganisation of the health service and a change in the definition used to collect immunisation coverage statistics on vaccine coverage data in England.

METHODS

Denominator data from the Cover Of Vaccination Evaluated Rapidly (COVER) programme, the national programme for the collection of immunisation coverage statistics, were compared to the Office for National Statistics (ONS) population data; the impact of any discrepancies between the two data sources on vaccine coverage was assessed.

RESULTS

ONS populations were generally larger than COVER populations. This was particularly true for 2002, the year Primary Care Trusts (PCTs) came into existence, suggesting that some children are being missed by the COVER programme. On average, in 1998-2001 around 10,000 children per year (approximately 2%) were lost to the COVER population estimates compared to data from ONS. This increased to around 20,000-40,000 (approximately 3-8%) children in 2002, but decreased again in 2003 to 2000-8000 (approximately 1%) children. Assuming all the "lost" COVER children were vaccinated, vaccine coverage appeared very similar to that seen in the COVER programme for all antigens. However, assuming all the "lost" children were unvaccinated, coverage would be substantially lower for all antigens (range 2.7-3.5%).

DISCUSSION

This analysis provides a quantitative example of how changes such as restructuring of the health service directly impact on public health surveillance. Such changes have potential risks for information and may affect important data used to inform public health policy.

Health and social care service changes: the potential to increase inequalities

Perspective on the paper by Granerod et al (see page 805)