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Zapf AJ, Schuh HB, Dudley MZ, Rimal RN, Harvey SA, Shaw J, Balgobin K, Salmon DA. Knowledge, attitudes, and intentions regarding COVID-19 vaccination in the general population and the effect of different framing messages for a brief video on intentions to get vaccinated among unvaccinated individuals in the United States during July 2021. Patient Educ Couns 2024; 124:108258. [PMID: 38608538 DOI: 10.1016/j.pec.2024.108258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/26/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE To identify knowledge, attitudes, and beliefs (KABs) associated with COVID-19 vaccination intentions and assess the impact of vaccine-promoting messages on vaccination intentions. METHODS Our nationally representative survey measured KABs of COVID-19 vaccination and incorporated a randomized experiment to assess the impact of different framing messages for a video encouraging vaccination intentions among unvaccinated adults in the US. Multivariable multinomial logistic regression models were fitted to investigate the relationships of KABs, trust in public health authorities (PHAs), and vaccine confidence with vaccination intentions. Difference-in-difference estimation was conducted to assess the impact of framing messages for a video on unvaccinated individuals' vaccination intentions. RESULTS We observed that people with increasingly favorable vaccine KABs, trust in PHAs, and vaccine confidence were more likely to be vaccinated or intend to get vaccinated against COVID-19. Difference-in-difference estimates indicated a positive impact of exposure to the video on vaccination intentions while framing messages in some cases appeared to lower vaccination intentions. Associations between the video and vaccination intentions were more pronounced among Black/African American and Hispanic/Latinx populations and Democrats; however, associations did not vary by trust in PHAs or vaccine confidence. CONCLUSION Videos that encourage people to get vaccinated may provide an efficient approach to nudge vaccine-hesitant individuals towards getting vaccinated. However, framing messages may negatively impact vaccination intentions and need to be developed carefully. PRACTICE IMPLICATIONS This study provides solid experimental evidence for the importance of tailoring message framing to the characteristics and experience of the audience, while cautioning potential negative impacts of framing that does not match its intended audience. Our findings are applicable to health communication strategies on the population level, such as mass media campaigns, and the use of framing for messages to encourage vaccination but may also be informative for healthcare professionals consulting hesitant individuals about COVID-19 vaccinations.
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Affiliation(s)
- Alexander J Zapf
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Holly B Schuh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Matthew Z Dudley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rajiv N Rimal
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Steven A Harvey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jana Shaw
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Kristian Balgobin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Dudley MZ, Schuh HB, Forr A, Shaw J, Salmon DA. Changes in vaccine attitudes and recommendations among US Healthcare Personnel during the COVID-19 pandemic. NPJ Vaccines 2024; 9:49. [PMID: 38418562 PMCID: PMC10901873 DOI: 10.1038/s41541-024-00826-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/01/2024] [Indexed: 03/01/2024] Open
Abstract
A recommendation from healthcare personnel (HCP) is a strong predictor of vaccination. This study aimed to measure how HCP vaccine attitudes and recommendations changed during the COVID-19 pandemic. HCP were surveyed in January 2023 using a double opt-in network panel. Survey responses were summarized and stratified by HCP type and COVID-19 booster status. Multivariable logistic regression models were fitted. Comparisons were made to a September 2021 survey, with differences tested for significance (p < 0.05) using Pearson's χ2 Test. Nearly 82% of the 1207 HCP surveyed had received a COVID-19 booster, most commonly pediatricians (94%), followed by family medicine doctors (87%), pharmacists (74%), and nurses (73%) (p < 0.01). HCP with high trust in the Centers for Disease Control and Prevention (CDC) had nearly 6 times the odds (OR: 5.5; 95%CI: 3.9-7.7) of being boosted compared to HCP with low trust. From September 2021 to January 2023, the proportion of HCP recommending vaccines (COVID-19 and routine) to their patients decreased substantially for nearly all vaccines and patient populations specified. Trust in CDC also decreased (from 79 to 73%, p < 0.01), as did support for HCP COVID-19 vaccine mandates (from 65 to 46%, p < 0.01). HCP interest in additional online resources to improve their vaccine discussions with patients increased from 46 to 66% (p < 0.01). Additional regularly updated online resources from trusted medical sources that clarify progressing science and address dynamic public concerns are needed to improve vaccine confidence among HCP and help them support their patients' decision-making.
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Affiliation(s)
- Matthew Z Dudley
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Holly B Schuh
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amanda Forr
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Element A LLC, Hershey, PA, USA
| | - Jana Shaw
- Division of Infectious Diseases, Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Daniel A Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Kitano T, Salmon DA, Dudley MZ, Thompson DA, Engineer L. Benefit-Risk Assessment of mRNA COVID-19 Vaccines in Children Aged 6 Months to 4 Years in the Omicron Era. J Pediatric Infect Dis Soc 2024; 13:129-135. [PMID: 38236136 DOI: 10.1093/jpids/piae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND There is no risk and benefit assessment of COVID-19 vaccination for children younger than 5 years using a single health outcomes scale. The objective of this study is to compare the expected risk and benefits of the mRNA primary series of COVID-19 vaccines for children aged 6 months to 4 years in the United States using a single health outcome scale in the Omicron era. METHODS The expected benefits and risks of the primary two-dose series of mRNA COVID-19 vaccines for children aged 6 months to 4 years were stratified by sex, the presence of underlying medical conditions, the presence of infection-induced immunity, and the type of mRNA vaccine (BNT162b2 or mRNA-1273). A scoping literature review was conducted to identify the indicators in the decision tree model. The benefit-risk ratio was the outcome of interest. RESULTS The benefit-risk ratios ranged from 200.4 in BNT162b2 for males aged 6-11 months with underlying medical conditions and without infection-induced immunity to 3.2 in mRNA-1273 for females aged 1-4 years without underlying medical conditions and with infection-induced immunity. CONCLUSIONS The expected benefit of receiving the primary series of mRNA vaccines outweighed the risk among children ages 6 months to 4 years regardless of sex, presence of underlying medical conditions, presence of infection-induced immunity, or type of mRNA vaccines. However, the continuous monitoring of the COVID-19 epidemiology as well as vaccine effectiveness and safety is important.
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Affiliation(s)
- Taito Kitano
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Pediatrics, Nara Prefecture General Medical Center, Nara, Japan
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Matthew Z Dudley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David A Thompson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Lilly Engineer
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Salmon DA, Chen RT, Black S, Sharfstein J. Lessons learned from COVID-19, H1N1, and routine vaccine pharmacovigilance in the United States: a path to a more robust vaccine safety program. Expert Opin Drug Saf 2024; 23:161-175. [PMID: 38343204 DOI: 10.1080/14740338.2024.2305707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/11/2024] [Indexed: 02/15/2024]
Abstract
INTRODUCTION Vaccine pharmacovigilance is an essential component of vaccine safety programs. Vaccine pharmacovigilance refers to detecting uncommon adverse events following immunization (AEFI), determining whether they are due to the vaccine or are only a coincidence, and, for those AEFI considered related to vaccination, characterizing them further. When AEFI are due to vaccination, it is important to characterize the attributable risk and ascertain the biological mechanism causing the adverse reaction to inform efforts to prevent or mitigate the risk. A robust post-authorization safety system is necessary for vaccine decision-making, clinical recommendations, vaccine compensation, and vaccine communication and confidence. AREAS COVERED This paper describes the key characteristics of vaccine pharmacovigilance programs, reviews US vaccine pharmacovigilance for routine vaccination programs, COVID-19, and H1N1, and makes recommendations for improving future vaccine safety systems. EXPERT OPINION The key characteristics of vaccine pharmacovigilance programs include passive surveillance, active surveillance, clinical investigation and special studies, and causality assessment. Recent examples illustrate the strengths of US pharmacovigilance systems, including systems for passive and active surveillance, as well as areas for improvement, including study of pathogenesis, consistent funding, and leadership. We make recommendations that would, if implemented, further strengthen the vaccine safety system for future routine and pandemic immunizations.
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Affiliation(s)
- Daniel A Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert T Chen
- Brighton Collaboration, A program of the Task Force for Global Health, Decatur, GA, USA
| | - Steve Black
- Global Vaccine Data Network, Auckland, New Zealand
| | - Joshua Sharfstein
- Department of Health, Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Kitano T, Dudley MZ, Engineer L, Thompson DA, Salmon DA. Response to Letters regarding "Risk and Benefit of mRNA COVID-19 Vaccines for the Omicron Variant by Age, Sex, and Presence of Comorbidity: A Quality-Adjusted Life Years Analysis". Am J Epidemiol 2023:kwad243. [PMID: 38115177 DOI: 10.1093/aje/kwad243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Affiliation(s)
- Taito Kitano
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Matthew Z Dudley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lilly Engineer
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD USA
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - David A Thompson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Dudley MZ, Schwartz B, Brewer J, Kan L, Bernier R, Gerber JE, Budigan Ni H, Proveaux TM, Rimal RN, Salmon DA. COVID-19 vaccination attitudes, values, intentions: US parents for their children, September 2021. Vaccine 2023; 41:7395-7408. [PMID: 37951793 DOI: 10.1016/j.vaccine.2023.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES To compare vaccine-related attitudes and values of parents of children 2-17 years old to other adults, examine intentions to vaccinate their children, and identify factors associated with intending to vaccinate children. METHODS A nationally representative survey was conducted in September 2021 (just before the EUA for children 5-11 years old) using Ipsos KnowledgePanel, a probability-based web panel. The survey measured COVID-19 vaccination status, intentions, attitudes, values, and trust in public health authorities among US adults. Scale response options to survey items were dichotomized, and cross-tabulations and logistic regressions were performed. RESULTS Parents had lower odds of reporting being vaccinated against COVID-19 than other adults even after adjusting for associated sociodemographic characteristics such as age (aOR: 0.66; 95 %CI: 0.50-0.87). The most prevalent parental concerns about COVID-19 vaccines included the speed of their development (88 %), potential side effects (78 %), suspicion of government (77 %), and suspicion of pharmaceutical companies (72 %). Fewer than half (42 %) of parents intended to vaccinate their children 5-11 years old, while 38 % were uncertain and 20 % were unlikely to ever vaccinate their children. Vaccinated parents had higher odds than unvaccinated parents of intending to vaccinate their children (OR: 675.51; 95 %CI: 106.46-4286.12). Discussions with healthcare providers who encouraged COVID-19 vaccination were positively associated with intent to vaccinate children (OR: 11.29; 95 %CI: 2.60-49.02). CONCLUSIONS We found parental vaccination and conversations with providers were positively associated with intent to vaccinate children. Decisions about childhood vaccination need to be supported by healthcare providers and a public health system that makes vaccine access and related information equitable and accessible. Vaccination-related decision making should be guided by healthcare providers and provide information about safety and risk to children.
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Affiliation(s)
- Matthew Z Dudley
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, United States.
| | | | - Janesse Brewer
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, United States
| | - Lilly Kan
- National Association of County and City Health Officials, United States; The Pew Charitable Trusts, United States
| | - Roger Bernier
- Retired, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, United States
| | | | - Haley Budigan Ni
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, United States; Office of Health Equity, California Department of Public Health, United States
| | - Tina M Proveaux
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, United States
| | - Rajiv N Rimal
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States
| | - Daniel A Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, United States; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States
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Dudley MZ, Schuh HB, Goryn M, Shaw J, Salmon DA. Attitudes toward COVID-19 and Other Vaccines: Comparing Parents to Other Adults, September 2022. Vaccines (Basel) 2023; 11:1735. [PMID: 38140140 PMCID: PMC10748314 DOI: 10.3390/vaccines11121735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/08/2023] [Accepted: 11/18/2023] [Indexed: 12/24/2023] Open
Abstract
Few analyses of COVID-19 vaccine attitudes also cover routine vaccines or focus on parents. In this cross-sectional study, we surveyed US adults in September 2022, immediately following the authorization of updated bivalent COVID-19 boosters for adults but before their authorization for children. The vaccine attitudes of parents were compared to other adults. Fewer parents were up-to-date on COVID-19 vaccines than other adults (54% vs. 67%), even after adjusting for age, education, and race/ethnicity (Adjusted Odds Ratio: 0.58; 95% Confidence Interval: 0.45-0.76). More parents had concerns about COVID-19 vaccines' safety in children (67% vs. 58%; aOR: 1.59; 95%CI: 1.23-2.06) and vaccine ingredients (52% vs. 45%; aOR: 1.41; 95%CI: 1.09-1.81), and more parents perceived COVID-19 in children to be no worse than a cold or the flu (51% vs. 38%; aOR: 1.56; 95%CI: 1.22-2.01). Fewer parents supported COVID-19 vaccine school requirements (52% vs. 57%; aOR: 0.75; 95%CI: 0.58-0.97) and perceived high vaccine coverage among their friends (51% vs. 61%; aOR: 0.60; 95%CI: 0.46-0.78). However, three-quarters of parents intended their child to receive all routinely recommended vaccines, whereas only half of adults intended to receive all routinely recommended vaccines themselves. To improve parental informed vaccine decision-making, public health must ensure pediatric providers have updated resources to support their discussions of vaccine risks and benefits with their patients' parents.
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Affiliation(s)
- Matthew Z. Dudley
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; (H.B.S.); (M.G.); (D.A.S.)
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Holly B. Schuh
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; (H.B.S.); (M.G.); (D.A.S.)
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Michelle Goryn
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; (H.B.S.); (M.G.); (D.A.S.)
| | - Jana Shaw
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY 13210, USA;
| | - Daniel A. Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; (H.B.S.); (M.G.); (D.A.S.)
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Salmon DA, Dudley MZ, Brewer J, Shaw J, Schuh HB, Proveaux TM, Jamison AM, Forr A, Goryn M, Breiman RF, Orenstein WA, Kao LS, Josiah Willock R, Cantu M, Decea T, Mowson R, Tsubata K, Bucci LM, Lawler J, Watkins JD, Moore JW, Fugett JH, Fugal A, Tovar Y, Gay M, Cary AM, Vann I, Smith LB, Kan L, Mankel M, Beekun S, Smith V, Adams SD, Harvey SA, Orton PZ. Corrigendum: LetsTalkShots: personalized vaccine risk communication. Front Public Health 2023; 11:1311055. [PMID: 38026293 PMCID: PMC10643483 DOI: 10.3389/fpubh.2023.1311055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fpubh.2023.1195751.].
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Affiliation(s)
- Daniel A. Salmon
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Matthew Z. Dudley
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Janesse Brewer
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jana Shaw
- Department of Public Health and Preventive Medicine, State University of New York, Upstate Medical University, Syracuse, NY, United States
- Department of Pediatrics, State University of New York, Upstate Medical University, Syracuse, NY, United States
| | - Holly B. Schuh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Tina M. Proveaux
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Amelia M. Jamison
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Amanda Forr
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Michelle Goryn
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Robert F. Breiman
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Walter A. Orenstein
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | | | - Robina Josiah Willock
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, United States
| | - Michelle Cantu
- Department of Immunization, National Association of County and City Health Officials, Washington, DC, United States
| | - Tori Decea
- Department of Immunization, National Association of County and City Health Officials, Washington, DC, United States
| | - Robin Mowson
- Department of Immunization, National Association of County and City Health Officials, Washington, DC, United States
| | | | | | | | - James D. Watkins
- Williams County Combined Health District, Montpelier, OH, United States
| | - Jamie W. Moore
- Guilford County Division of Public Health, Greensboro, NC, United States
| | - James H. Fugett
- Guilford County Division of Public Health, Greensboro, NC, United States
| | - Adriele Fugal
- Monongalia County Health Department, Morgantown, WV, United States
| | - Yazmine Tovar
- Monongalia County Health Department, Morgantown, WV, United States
| | - Marie Gay
- Orange County Department of Health, Goshen, NY, United States
| | - Aleen M. Cary
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Iulia Vann
- Utah County Health Department, Provo, UT, United States
| | - Lee B. Smith
- Guilford County Division of Public Health, Greensboro, NC, United States
| | - Lilly Kan
- Department of Immunization, National Association of County and City Health Officials, Washington, DC, United States
| | - Magda Mankel
- Border Studies Program, Earlham College, Tucson, AZ, United States
| | - Sumayya Beekun
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Center for Indigenous Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Victoria Smith
- Williams County Combined Health District, Montpelier, OH, United States
| | | | - Steven A. Harvey
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Peter Z. Orton
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
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Delamater PL, Buttenheim AM, Salmon DA, Schwartz JL, Omer SB. Kindergarten Vaccination Status in California After Changes to Medical Exemption Policy. JAMA 2023; 330:1585-1587. [PMID: 37782512 PMCID: PMC10546290 DOI: 10.1001/jama.2023.16995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/15/2023] [Indexed: 10/03/2023]
Abstract
This study evaluates changes in medical exemptions and geographic distribution of kindergarteners in California not up to date on vaccination after changes to state legislation.
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Affiliation(s)
- Paul L. Delamater
- Department of Geography, University of North Carolina at Chapel Hill
| | - Alison M. Buttenheim
- Department of Family and Community Health, University of Pennsylvania, Philadelphia
| | - Daniel A. Salmon
- Department of International Health, Johns Hopkins University, Baltimore, Maryland
| | - Jason L. Schwartz
- Department of Health Policy and Management, Yale University, New Haven, Connecticut
| | - Saad B. Omer
- Peter O’Donnell Jr School of Public Health, UT Southwestern, Dallas, Texas
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Schuh HB, Rimal RN, Breiman RF, Orton PZ, Dudley MZ, Kao LS, Sargent RH, Laurie S, Weakland LF, Lavery JV, Orenstein WA, Brewer J, Jamison AM, Shaw J, Josiah Willock R, Gust DA, Salmon DA. Evaluation of online videos to engage viewers and support decision-making for COVID-19 vaccination: how narratives and race/ethnicity enhance viewer experiences. Front Public Health 2023; 11:1192676. [PMID: 37670826 PMCID: PMC10475941 DOI: 10.3389/fpubh.2023.1192676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/17/2023] [Indexed: 09/07/2023] Open
Abstract
Background Vaccine hesitancy has hampered the control of COVID-19 and other vaccine-preventable diseases. Methods We conducted a national internet-based, quasi-experimental study to evaluate COVID-19 vaccine informational videos. Participants received an informational animated video paired with the randomized assignment of (1) a credible source (differing race/ethnicity) and (2) sequencing of a personal narrative before or after the video addressing their primary vaccine concern. We examined viewing time and asked video evaluation questions to those who viewed the full video. Results Among 14,235 participants, 2,422 (17.0%) viewed the full video. Those who viewed a personal story first (concern video second) were 10 times more likely to view the full video (p < 0.01). Respondent-provider race/ethnicity congruence was associated with increased odds of viewing the full video (aOR: 1.89, p < 0.01). Most viewers rated the informational video(s) to be helpful, easy to understand, trustworthy, and likely to impact others' vaccine decisions, with differences by demographics and also vaccine intentions and concerns. Conclusion Using peer-delivered, personal narrative, and/or racially congruent credible sources to introduce and deliver vaccine safety information may improve the openness of vaccine message recipients to messages and engagement.
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Affiliation(s)
- Holly B. Schuh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Rajiv N. Rimal
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Robert F. Breiman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | | | - Matthew Z. Dudley
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | | | | | - Leo F. Weakland
- Center for Global Health Innovation, Atlanta, GA, United States
| | - James V. Lavery
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- Center for Ethics, Emory University, Atlanta, GA, United States
| | - Walter A. Orenstein
- Department of Medicine, Emory University, School of Medicine, Atlanta, GA, United States
| | - Janesse Brewer
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Amelia M. Jamison
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jana Shaw
- Division of Infectious Diseases, Department of Pediatrics, The State University of New York (SUNY) Upstate Medical University, Syracuse, NY, United States
| | - Robina Josiah Willock
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, United States
| | - Deborah A. Gust
- Department of Psychology, Education Division, Gwinnett Technical College, Lawrenceville, GA, United States
| | - Daniel A. Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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11
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Kitano T, Thompson DA, Engineer L, Dudley MZ, Salmon DA. Risk and Benefit of mRNA COVID-19 Vaccines for the Omicron Variant by Age, Sex, and Presence of Comorbidity: A Quality-Adjusted Life Years Analysis. Am J Epidemiol 2023; 192:1137-1147. [PMID: 36920222 DOI: 10.1093/aje/kwad058] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 02/07/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023] Open
Abstract
The development of the mutant omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the coronavirus disease 2019 (COVID-19) pandemic raised the importance of reevaluating the risk and benefit of COVID-19 vaccines. With a decision tree model, we calculated the benefit-risk ratio and the benefit-risk difference of receiving monovalent messenger RNA (mRNA) COVID-19 vaccine (primary 2 doses, a third dose, and a fourth dose) in the 4-5 months after vaccination using quality-adjusted life years. The analysis was stratified by age, sex, and the presence of comorbidity. Evidence from peer-reviewed publications and gray literature was reviewed on September 16, 2022, to inform the study. Benefit-risk ratios for receipt of the BNT162b2 vaccine (Pfizer-BioNTech) ranged from 6.8 for males aged 12-17 years without comorbidity for the primary doses to 221.3 for females aged ≥65 years with comorbidity for the third dose. The benefit-risk ratios for receipt of the mRNA-1273 vaccine (Moderna) ranged from 7.2 for males aged 18-29 years without comorbidity for the primary doses to 101.4 for females aged ≥65 years with comorbidity for the third dose. In all scenarios of the one-way sensitivity analysis, the benefit-risk ratios were more than 1, irrespective of age, sex, comorbidity status, and type of vaccine, for both primary and booster doses. The benefits of mRNA COVID-19 vaccines in protecting against the omicron variant outweigh the risks, irrespective of age, sex, and comorbidity.
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12
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Salmon DA, Dudley MZ, Brewer J, Shaw J, Schuh HB, Proveaux TM, Jamison AM, Forr A, Goryn M, Breiman RF, Orenstein WA, Kao LS, Josiah Willock R, Cantu M, Decea T, Mowson R, Tsubata K, Bucci LM, Lawler J, Watkins JD, Moore JW, Fugett JH, Fugal A, Tovar Y, Gay M, Cary AM, Vann I, Smith LB, Kan L, Mankel M, Beekun S, Smith V, Adams SD, Harvey SA, Orton PZ. LetsTalkShots: personalized vaccine risk communication. Front Public Health 2023; 11:1195751. [PMID: 37457264 PMCID: PMC10348877 DOI: 10.3389/fpubh.2023.1195751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Vaccine hesitancy is a global health threat undermining control of many vaccine-preventable diseases. Patient-level education has largely been ineffective in reducing vaccine concerns and increasing vaccine uptake. We built and evaluated a personalized vaccine risk communication website called LetsTalkShots in English, Spanish and French (Canadian) for vaccines across the lifespan. LetsTalkShots tailors lived experiences, credible sources and informational animations to disseminate the right message from the right messenger to the right person, applying a broad range of behavioral theories. Methods We used mixed-methods research to test our animation and some aspects of credible sources and personal narratives. We conducted 67 discussion groups (n = 325 persons), stratified by race/ethnicity (African American, Hispanic, and White people) and population (e.g., parents, pregnant women, adolescents, younger adults, and older adults). Using a large Ipsos survey among English-speaking respondents (n = 2,272), we tested animations aligned with vaccine concerns and specific to population (e.g., parents of children, parents of adolescents, younger adults, older adults). Results Discussion groups provided robust feedback specific to each animation as well as areas for improvements across animations. Most respondents indicated that the information presented was interesting (85.5%), clear (96.0%), helpful (87.0%), and trustworthy (82.2%). Discussion Tailored vaccine risk communication can assist decision makers as they consider vaccination for themselves, their families, and their communities. LetsTalkShots presents a model for personalized communication in other areas of medicine and public health.
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Affiliation(s)
- Daniel A. Salmon
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Matthew Z. Dudley
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Janesse Brewer
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jana Shaw
- Department of Public Health and Preventive Medicine, State University of New York, Upstate Medical University, Syracuse, NY, United States
- Department of Pediatrics, State University of New York, Upstate Medical University, Syracuse, NY, United States
| | - Holly B. Schuh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Tina M. Proveaux
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Amelia M. Jamison
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Amanda Forr
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Michelle Goryn
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Robert F. Breiman
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Walter A. Orenstein
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | | | - Robina Josiah Willock
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, United States
| | - Michelle Cantu
- Department of Immunization, National Association of County and City Health Officials, Washington, DC, United States
| | - Tori Decea
- Department of Immunization, National Association of County and City Health Officials, Washington, DC, United States
| | - Robin Mowson
- Department of Immunization, National Association of County and City Health Officials, Washington, DC, United States
| | | | | | | | - James D. Watkins
- Williams County Combined Health District, Montpelier, OH, United States
| | - Jamie W. Moore
- Guilford County Division of Public Health, Greensboro, NC, United States
| | - James H. Fugett
- Guilford County Division of Public Health, Greensboro, NC, United States
| | - Adriele Fugal
- Monongalia County Health Department, Morgantown, WV, United States
| | - Yazmine Tovar
- Monongalia County Health Department, Morgantown, WV, United States
| | - Marie Gay
- Orange County Department of Health, Goshen, NY, United States
| | - Aleen M. Cary
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Iulia Vann
- Utah County Health Department, Provo, UT, United States
| | - Lee B. Smith
- Guilford County Division of Public Health, Greensboro, NC, United States
| | - Lilly Kan
- Department of Immunization, National Association of County and City Health Officials, Washington, DC, United States
| | - Magda Mankel
- Border Studies Program, Earlham College, Tucson, AZ, United States
| | - Sumayya Beekun
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
- Center for Indigenous Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Victoria Smith
- Williams County Combined Health District, Montpelier, OH, United States
| | | | - Steven A. Harvey
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Peter Z. Orton
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
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13
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Dudley MZ, Schuh HB, Shaw J, Salmon DA. Attitudes and Values of US Adults Not Yet Up-to-Date on COVID-19 Vaccines in September 2022. J Clin Med 2023; 12:3932. [PMID: 37373627 DOI: 10.3390/jcm12123932] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Periodic resurgences in COVID-19 due to more contagious variants highlight the need to increase coverage of booster doses. (2) Methods: Our September 2022 nationally representative survey of US adults measured COVID-19 vaccination status, intentions, attitudes, values, and confidence in information sources. (3) Findings: Although 85% of the weighted sample reported receiving at least one dose of a COVID-19 vaccine, only 63% reported being up-to-date on COVID-19 vaccines (e.g., received a booster dose). Only 12% of those not yet up-to-date indicated they were likely to get up-to-date as soon as possible, whereas 42% were unlikely to ever get up-to-date, and 46% were still uncertain. Most of those not up-to-date on their COVID-19 vaccines were under 45 years of age (58%), without a bachelor's degree (76%), making under $75,000 annually (53%), and Republican or Independent (82%). Prevalent concerns about COVID-19 vaccines among those uncertain about getting up-to-date included: potential side effects that have not been figured out yet (88%), speed of development (77%), newness (75%), ingredients (69%), drug companies making money (67%), allergic reactions (65%), and experimenting on people (63%). (4) Conclusions: Nearly half of adults not yet up-to-date on COVID-19 vaccines were uncertain about doing so, indicating an opportunity to support their decision-making.
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Affiliation(s)
- Matthew Z Dudley
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Holly B Schuh
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Jana Shaw
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Daniel A Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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14
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Carleton BC, Salmon DA, Ip P, Wong IC, Lai FT. Benefits v. risks of COVID-19 vaccination: an examination of vaccination policy impact on the occurrence of myocarditis and pericarditis. Lancet Reg Health West Pac 2023; 37:100797. [PMID: 37360870 PMCID: PMC10196680 DOI: 10.1016/j.lanwpc.2023.100797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 02/13/2023] [Accepted: 05/07/2023] [Indexed: 06/28/2023]
Abstract
Studies of myocarditis/pericarditis following mRNA COVID-19 vaccines in Hong Kong have been published. Data are consistent with data from other active surveillance or healthcare databases. The mRNA COVID-19 vaccines have been shown to rarely increase risk of myocarditis, with the highest risk among males aged 12-17 after the second dose. An increased risk of pericarditis has also been shown after the second dose, though less common than myocarditis and more evenly distributed among different sex and age groups. Because of the increased risk of post-vaccine myocarditis, Hong Kong implemented a single dose mRNA COVID-19 vaccine policy on September 15, 2021 for adolescents (age 12-17 years). Post-policy, there were no cases of carditis. 40,167 first dose patients did not receive a second dose. This policy was highly successful in the reduction of carditis, but the trade-off is the potential risk of disease and cost to population-level immunity. This commentary brings forward some important global policy considerations.
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Affiliation(s)
- Bruce C. Carleton
- Division of Translational Therapeutics, Department of Paediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, Canada
- BC Children's Hospital Research Institute, Vancouver, Canada
| | - Daniel A. Salmon
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong SAR, China
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | - Ian C.K. Wong
- The University of Hong Kong, Hong Kong SAR, China
- Aston School of Pharmacy, Aston University, Birmingham, United Kingdom
| | - Francicso T.T. Lai
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Salmon DA, Plotkin S, Navar AM. Vaccine Decision-making in a Time of Conflicting Recommendations: A Call to Go Beyond Politics. Pediatr Infect Dis J 2023; 42:e138-e139. [PMID: 36854117 PMCID: PMC10097467 DOI: 10.1097/inf.0000000000003892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 03/02/2023]
Affiliation(s)
- Daniel A. Salmon
- From the Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Ann Marie Navar
- University of Texas Southwestern Medical Center, Dallas, Texas
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Schwartz B, Brewer J, Budigan H, Bernier R, Dudley MZ, Kan L, Proveaux TM, Roberts R, Tafoya N, Hamlin MD, Moore L, Hughes M, Turner B, Al-Dahir S, Velasco E, Privor-Dumm L, Veloz W, White JA, Dubois S, Ooton J, Kipp BJ, Show TJ, Salu K, Chavez B, Montes MDP, Najera R, King T, Salmon DA. Factors Affecting SARS-CoV-2 Vaccination Intent and Decision Making Among African American, Native American, and Hispanic Participants in a Qualitative Study. Public Health Rep 2023; 138:422-427. [PMID: 36971286 PMCID: PMC10050994 DOI: 10.1177/00333549231160871] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Limited studies are available on how decisions and perceptions on SARS-CoV-2 vaccination have changed since the start of vaccination availability. We performed a qualitative study to identify factors critical to SARS-CoV-2 vaccination decision making and how perspectives evolved among African American/Black, Native American, and Hispanic communities disproportionately affected by COVID-19 and social and economic disadvantage. We conducted 16 virtual meetings, with 232 participants in wave 1 meetings (December 2020) and with 206 returning participants in wave 2 meetings (January and February 2021). Wave 1 vaccine concerns in all communities included information needs, vaccine safety, and speed of vaccine development. Lack of trust in government and the pharmaceutical industry was influential, particularly among African American/Black and Native American participants. Participants showed more willingness to get vaccinated at wave 2 than at wave 1, indicating that many of their information needs had been addressed. Hesitancy remained greater among African American/Black and Native American participants than among Hispanic participants. Participants in all groups indicated that conversations tailored to their community and with those most trustworthy to them would be helpful. To overcome vaccine hesitancy, we propose a model of fully considered SARS-CoV-2 vaccine decision making, whereby public health departments supply information, align with community values and recognize lived experiences, offer support for decision making, and make vaccination easy and convenient.
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Affiliation(s)
| | - Janesse Brewer
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Haley Budigan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roger Bernier
- Retired, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew Z. Dudley
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lilly Kan
- National Association of County and City Health Officials, Washington, DC, USA
| | - Tina M. Proveaux
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Lucy Moore
- Lucy Moore Associates, Santa Fe, NM, USA
| | | | - Brian Turner
- Department of Psychology and African American Diaspora Studies Program, Xavier University of Louisiana, New Orleans, LA, USA
| | - Sara Al-Dahir
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA
| | | | - Lois Privor-Dumm
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Jenn Ooton
- City of Glenwood Springs, Glenwood Springs, CO, USA
| | | | | | - Kemi Salu
- Harris County Public Health, Houston, TX, USA
| | - Brisa Chavez
- Garfield County Public Health, Glenwood Springs, CO, USA
| | | | - Rene Najera
- Fairfax County Health Department, Fairfax, VA, USA
| | - Terris King
- Liberty Grace Church of God, Baltimore, MD, USA
| | - Daniel A. Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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17
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Dudley MZ, Gerber JE, Budigan Ni H, Blunt M, Holroyd TA, Carleton BC, Poland GA, Salmon DA. Vaccinomics: A scoping review. Vaccine 2023; 41:2357-2367. [PMID: 36803903 PMCID: PMC10065969 DOI: 10.1016/j.vaccine.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 12/24/2022] [Accepted: 02/03/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND This scoping review summarizes a key aspect of vaccinomics by collating known associations between heterogeneity in human genetics and vaccine immunogenicity and safety. METHODS We searched PubMed for articles in English using terms covering vaccines routinely recommended to the general US population, their effects, and genetics/genomics. Included studies were controlled and demonstrated statistically significant associations with vaccine immunogenicity or safety. Studies of Pandemrix®, an influenza vaccine previously used in Europe, were also included, due to its widely publicized genetically mediated association with narcolepsy. FINDINGS Of the 2,300 articles manually screened, 214 were included for data extraction. Six included articles examined genetic influences on vaccine safety; the rest examined vaccine immunogenicity. Hepatitis B vaccine immunogenicity was reported in 92 articles and associated with 277 genetic determinants across 117 genes. Thirty-three articles identified 291 genetic determinants across 118 genes associated with measles vaccine immunogenicity, 22 articles identified 311 genetic determinants across 110 genes associated with rubella vaccine immunogenicity, and 25 articles identified 48 genetic determinants across 34 genes associated with influenza vaccine immunogenicity. Other vaccines had fewer than 10 studies each identifying genetic determinants of their immunogenicity. Genetic associations were reported with 4 adverse events following influenza vaccination (narcolepsy, GBS, GCA/PMR, high temperature) and 2 adverse events following measles vaccination (fever, febrile seizure). CONCLUSION This scoping review identified numerous genetic associations with vaccine immunogenicity and several genetic associations with vaccine safety. Most associations were only reported in one study. This illustrates both the potential of and need for investment in vaccinomics. Current research in this field is focused on systems and genetic-based studies designed to identify risk signatures for serious vaccine reactions or diminished vaccine immunogenicity. Such research could bolster our ability to develop safer and more effective vaccines.
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Affiliation(s)
- Matthew Z Dudley
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Jennifer E Gerber
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Survey Research Division, RTI International, Washington, DC, USA
| | - Haley Budigan Ni
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Office of Health Equity, California Department of Public Health, Richmond, CA, USA
| | - Madeleine Blunt
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Taylor A Holroyd
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bruce C Carleton
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, BC, Canada; BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Gregory A Poland
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA; Mayo Vaccine Research Group, Mayo Clinic, Rochester, MN, USA
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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18
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Carpiano RM, Callaghan T, DiResta R, Brewer NT, Clinton C, Galvani AP, Lakshmanan R, Parmet WE, Omer SB, Buttenheim AM, Benjamin RM, Caplan A, Elharake JA, Flowers LC, Maldonado YA, Mello MM, Opel DJ, Salmon DA, Schwartz JL, Sharfstein JM, Hotez PJ. Confronting the evolution and expansion of anti-vaccine activism in the USA in the COVID-19 era. Lancet 2023; 401:967-970. [PMID: 36871571 PMCID: PMC9981160 DOI: 10.1016/s0140-6736(23)00136-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/09/2023] [Accepted: 01/19/2023] [Indexed: 03/06/2023]
Affiliation(s)
| | - Timothy Callaghan
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Renee DiResta
- Stanford Internet Observatory, Stanford University, Stanford, CA, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Chelsea Clinton
- Clinton Foundation, New York, NY, USA; Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, CT, USA; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
| | | | - Wendy E Parmet
- Center for Health Policy & Law, Northeastern University, Boston, MA, USA
| | - Saad B Omer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA; Yale School of Nursing, Yale University, New Haven, CT, USA; Yale Institute of Global Health, Yale University, New Haven, CT, USA; Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Alison M Buttenheim
- Department of Family and Community Health, University of Pennsylvania School of Nursing, and Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Arthur Caplan
- New York University Langone School of Medicine, New York University, New York, NY, USA
| | - Jad A Elharake
- Yale Institute of Global Health, Yale University, New Haven, CT, USA
| | - Lisa C Flowers
- Department of Obstetrics & Gynecology, Emory University, Atlanta, GA, USA
| | | | - Michelle M Mello
- Department of Health Policy, Stanford University, Stanford, CA, USA; Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA; Stanford Law School, Stanford University, Stanford, CA, USA
| | - Douglas J Opel
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA; Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
| | - Daniel A Salmon
- Institute for Vaccine Safety, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jason L Schwartz
- Department of Health Policy and Management, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Joshua M Sharfstein
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Peter J Hotez
- Texas Children's Center for Vaccine Development, Departments of Pediatrics and Molecular Virology & Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA; Department of Biology, Baylor University, Waco, TX, USA; Hagler Institute for Advanced Study, Texas A&M University, College Station, TX, USA; Scowcroft Institute of International Affairs, Bush School of Government and Public Service, Texas A&M University, College Station, TX, USA; James A Baker III Institute for Public Policy, Rice University, Houston, TX, USA
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19
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Dudley MZ, Schuh HB, Shaw J, Rimal RN, Harvey SA, Balgobin KR, Zapf AJ, Salmon DA. COVID-19 vaccination among different types of US Healthcare Personnel. Vaccine 2023; 41:1471-1479. [PMID: 36707335 PMCID: PMC9867799 DOI: 10.1016/j.vaccine.2023.01.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/29/2022] [Accepted: 01/14/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Increasing vaccine coverage remains the best way to control the COVID-19 pandemic. Healthcare personnel (HCP) have long been the most credible and frequently used source of vaccine information for the public, and an HCP recommendation is a strong predictor of vaccination. METHODS A survey of HCP was conducted in September 2021 via a double opt-in network panel. Responses to survey items were summarized and stratified by HCP type and adjusted logistic regression models were fitted. RESULTS >94% of the 1074 HCP surveyed reported receiving at least one dose of COVID-19 vaccine or intending to soon, with vaccinating most common among pediatricians (98%), followed by family medicine doctors (96%), pharmacists (94%), and nurses/nurse practitioners/physician assistants (88%). HCP with high trust in the Centers for Disease Control and Prevention had 26 times the odds of vaccinating of HCP with low trust (95%CI: 9, 74). Nearly half of unvaccinated HCP (47%) were concerned about side effects, and one third of unvaccinated HCP (33%) were concerned the vaccine was developed too quickly. About three quarters of HCP reported strongly recommending the Pfizer-BioNTech (75%) and Moderna (70%) vaccines to their patients, compared to about one quarter (24%) strongly recommending Johnson & Johnson. CONCLUSIONS Although most HCP are vaccinated against COVID-19 and strongly recommend vaccination to their patients, some harbor similar concerns to the public. Additional resources - regularly updated to explain the progressing scientific landscape and address ever evolving public concerns - are needed to further improve vaccine coverage among HCP and aid them in supporting the decision-making of their patients.
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Affiliation(s)
- Matthew Z Dudley
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Holly B Schuh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jana Shaw
- Division of Infectious Diseases, Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Rajiv N Rimal
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States
| | - Steven A Harvey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kristian R Balgobin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States
| | - Alexander J Zapf
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Daniel A Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States
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20
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Dudley MZ, Barnett EE, Paulenich A, Omer SB, Schuh H, Proveaux TM, Buttenheim AM, Klein NP, Delamater P, McFadden SM, Patel KM, Salmon DA. Characterization of parental intention to vaccinate elementary school aged children in the state of California. Vaccine 2023; 41:630-635. [PMID: 36543683 PMCID: PMC9762501 DOI: 10.1016/j.vaccine.2022.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
In October 2021, Emergency Use Authorization of Coronavirus Disease 2019 (COVID-19) vaccines was granted for children aged 5-11. To ensure vaccine uptake in children upon approval, California will implement a state-wide executive order mandating COVID-19 vaccination for school children following full US FDA approval. This study uses survey data collected between November 6th, 2020 and December 14th, 2020 (n = 2091) to identify how sociodemographic characteristics and attitudes towards childhood vaccines among California parents were associated with their intentions to vaccinate their child against COVID-19. About one quarter (26 %) of surveyed California parents did not intend to vaccinate their child, suggesting skepticism towards the COVID-19 vaccine for children and the potential for pushback to a COVID-19 vaccine school-entry mandate. However, 17 % were unsure of their decision, suggesting the potential for public health messaging to make a positive impact on COVID-19 vaccine confidence and uptake. This study identifies characteristics of hesitant parents in California to prioritize for research and outreach. These data also provide a baseline for parental attitudes towards vaccinating children against COVID-19 in California, which will be useful for characterizing changes in attitudes towards childhood COVID-19 vaccination over time.
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Affiliation(s)
- Matthew Z Dudley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Erin E Barnett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Alex Paulenich
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Saad B Omer
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States; Yale Institute for Global Health, New Haven, CT, United States; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States; Yale School of Nursing, Orange, CT, United States
| | - Holly Schuh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Tina M Proveaux
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Alison M Buttenheim
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States; Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Oakland, CA, United States
| | - Paul Delamater
- Department of Geography and Carolina Population Center, The University of North Carolina, Chapel Hill, NC, United States
| | - SarahAnn M McFadden
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States; Yale Institute for Global Health, New Haven, CT, United States; School of Nursing, Pacific Lutheran University, Tacoma, WA, United States
| | - Kavin M Patel
- Yale School of Medicine, New Haven, CT, United States
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Health Behavior Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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21
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Opel DJ, Brewer NT, Buttenheim AM, Callaghan T, Carpiano RM, Clinton C, Elharake JA, Flowers LC, Galvani AP, Hotez PJ, Schwartz JL, Benjamin RM, Caplan A, DiResta R, Lakshmanan R, Maldonado YA, Mello MM, Parmet WE, Salmon DA, Sharfstein JM, Omer SB. The legacy of the COVID-19 pandemic for childhood vaccination in the USA. Lancet 2023; 401:75-78. [PMID: 36309017 PMCID: PMC9605265 DOI: 10.1016/s0140-6736(22)01693-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/12/2022] [Accepted: 08/25/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Douglas J Opel
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA; Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA.
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Alison M Buttenheim
- Department of Family and Community Health, University of Pennsylvania School of Nursing and Center for Health Incentives, University of Pennsylvania, Philadelphia, PA, USA; Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy Callaghan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA
| | | | - Chelsea Clinton
- Clinton Foundation, New York, NY, USA; Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jad A Elharake
- Yale Institute for Global Health, New Haven, CT, USA; Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, New Haven, CT, USA
| | - Lisa C Flowers
- Department of Obstetrics & Gynecology, Emory University, Atlanta, GA, USA
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA
| | - Peter J Hotez
- Texas Children's Center for Vaccine Development, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Department of Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX, USA; National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA; Department of Biology, Baylor University, Waco, TX, USA; Hagler Institute for Advanced Study, Texas A&M University, College Station, TX, USA; Scowcroft Institute of International Affairs, Bush School of Government and Public Service, Texas A&M University, College Station, TX, USA; James A Baker III Institute for Public Policy, Rice University, Houston, TX, USA
| | - Jason L Schwartz
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | | | - Arthur Caplan
- New York University Langone School of Medicine, New York University, New York, NY, USA
| | - Renee DiResta
- Stanford Internet Observatory, Stanford University, Stanford, CA, USA
| | | | | | - Michelle M Mello
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA; Stanford Law School, Stanford, CA, USA; Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Wendy E Parmet
- Center for Health Policy & Law, Northeastern University, Boston, MA, USA
| | - Daniel A Salmon
- Institute for Vaccine Safety, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joshua M Sharfstein
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Saad B Omer
- Yale Institute for Global Health, New Haven, CT, USA; Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, New Haven, CT, USA; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA; Yale School of Nursing, Orange, CT, USA
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22
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Budigan Ni H, de Broucker G, Patenaude BN, Dudley MZ, Hampton LM, Salmon DA. Economic impact of vaccine safety incident in Ukraine: The economic case for safety system investment. Vaccine 2023; 41:219-225. [PMID: 36435704 DOI: 10.1016/j.vaccine.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Vaccine confidence and coverage decreased following a death temporally but not causally related to measles vaccination in Ukraine in 2008. Large measles outbreaks including international exportations followed. Herein we characterize this experience including associated costs. METHODS Mixed-methods were used to characterize this vaccine safety incident and quantify health and economic costs. Qualitative interviews illuminate the incident, social climate, and corruption that influenced vaccine confidence in Ukraine. A literature review explored attitudes toward vaccines in the USSR and post-independence Ukraine. Infectious disease incidence was examined before and after the vaccine safety incident. An economic analysis estimated associated healthcare costs, including prevention and outbreak control measures, additional vaccination activities due to failure of the 2008 campaign, treatment costs for new cases domestically and foreign exportation, and productivity loss from treatment time and mortality for new cases. FINDINGS Vaccine hesitancy and distrust in government and public health programs due to corruption existed in Ukraine before the vaccine safety incident. The mishandling of the 2008 incident catalyzed the decline of vaccine confidence and prompted poor procurement decisions, leading to a drop in infant vaccination coverage, increased domestic measles cases, and exportation of measles. The estimated cost of this incident was approximately $140 million from 2008 to 2018. INTERPRETATION Absent a rapid and credible vaccine safety response, a coincidental death following immunization resulted in major outbreaks of measles with substantial economic costs. Adequate investments in a post-licensure safety system may help avoid similar future incidents.
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Affiliation(s)
- Haley Budigan Ni
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; Office of Health Equity, California Department of Public Health, 850 Marina Bay Pkwy, Unit F175, Richmond, CA 94804, USA
| | - Gatien de Broucker
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Bryan N Patenaude
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Matthew Z Dudley
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Lee M Hampton
- Gavi, the Vaccine Alliance, Global Health Campus, Chemin du Pommier 40, 1218 Le Grand-Saconnex, Switzerland
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
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23
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Salmon DA, Black S, Didierlaurent AM, Moulton LH. Commentary on “Common vaccines and the risk of dementia: a population-based cohort study”: Science can be messy but eventually leads to truths. J Infect Dis 2022; 227:1224-1226. [DOI: 10.1093/infdis/jiac487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Daniel A Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD 21205 , USA
| | - Steve Black
- Co-Director, Global Vaccine Data Network , Berkeley California 94705
| | - Arnaud M Didierlaurent
- Center of Vaccinology, Department of Pathology and Immunology, University of Geneva , Geneva , Switzerland
| | - Lawrence H Moulton
- Institute for Vaccine Safety, Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD 21205 , USA
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24
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Dudley MZ, Omer SB, O'Leary ST, Limaye RJ, Ellingson MK, Spina CI, Brewer SE, Bednarczyk RA, Chamberlain AT, Malik F, Frew PM, Church-Balin C, Riley LE, Ault KA, Orenstein WA, Halsey NA, Salmon DA. MomsTalkShots, tailored educational app, improves vaccine attitudes: a randomized controlled trial. BMC Public Health 2022; 22:2134. [PMID: 36411403 PMCID: PMC9676851 DOI: 10.1186/s12889-022-14498-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/13/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Many pregnant women and parents have concerns about vaccines. This analysis examined the impact of MomsTalkShots, an individually tailored educational application, on vaccine attitudes of pregnant women and mothers. METHODS MomsTalkShots was the patient-level component of a multi-level intervention to improve maternal and infant vaccine uptake that also included provider- and practice-level interventions. The impact of these interventions was studied using a two-by-two factorial design, randomizing at both the patient- and the practice-level. Study staff recruited pregnant women from a diverse set of prenatal care practices in Colorado and Georgia between June 2017 and July 2018. All participants (n = 2087) received a baseline survey of maternal and infant vaccine intentions and attitudes, and two follow-up surveys at least 1 month and 1 year after their infant's birth, respectively. Half of participants (n = 1041) were randomly assigned to receive educational videos through MomsTalkShots, algorithmically tailored to their vaccine intentions, attitudes, and demographics. Since the practice/provider intervention did not appear impactful, this analysis focused on MomsTalkShots regardless of the practice/provider intervention. RESULTS By 1 month post-birth, MomsTalkShots increased perceived risk of maternal influenza disease (61% among MomsTalkShots recipients vs 55% among controls; Odds Ratio: 1.61, 95% Confidence Interval: 1.23-2.09), confidence in influenza vaccine efficacy (73% vs 63%; OR: 1.97, 95%CI: 1.47-2.65), and perceived vaccine knowledge (55% vs 48%; OR: 1.39, 95%CI: 1.13-1.72). Among those intending not to vaccinate at baseline, MomsTalkShots increased perceived risk of maternal influenza disease (38% vs 32%; OR: 2.07, 95%CI: 1.15-3.71) and confidence in influenza vaccine efficacy (44% vs 28%; OR: 2.62, 95%CI: 1.46-4.69). By 1 year post-birth, MomsTalkShots increased perceived vaccine knowledge (62% vs 50%; OR: 1.74, 95%CI: 1.36-2.24) and trust in vaccine information from obstetricians and pediatricians (64% vs 55%; OR: 1.53, 95%CI: 1.17-2.00). Among those uncertain about vaccinating at baseline, MomsTalkShots increased perceived vaccine knowledge (47% vs 12%; OR: 6.89, 95%CI: 1.52-31.25) and reduced infant vaccine safety concerns (71% vs 91%; OR: 0.24, 95%CI: 0.06-0.98). CONCLUSIONS MomsTalkShots improved pregnant women's and mothers' knowledge and perceptions of maternal and infant vaccines and the diseases they prevent, and offers a scalable tool to address vaccine hesitancy. TRIAL REGISTRATION Registered at Clinicaltrials.gov on 13/09/2016 (registration number: NCT02898688).
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Affiliation(s)
- Matthew Z Dudley
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, W5041, Baltimore, MD, 21205, USA.
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Saad B Omer
- Yale Institute for Global Health, Yale School of Medicine, New Haven, USA
- Department of Infectious Diseases, Yale School of Medicine, New Haven, USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, USA
| | - Sean T O'Leary
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 1890 N Revere Ct. Mailstop F443, Aurora, CO, 80045, USA
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, Aurora, CO, 80045, USA
| | - Rupali J Limaye
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, W5041, Baltimore, MD, 21205, USA
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- Present address: Merck & Co., Inc., (at Emory University and the University of Nevada - not Merck - when work was performed), NJ, Kenilworth, USA
| | - Mallory K Ellingson
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA
| | - Christine I Spina
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 1890 N Revere Ct. Mailstop F443, Aurora, CO, 80045, USA
| | - Sarah E Brewer
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 1890 N Revere Ct. Mailstop F443, Aurora, CO, 80045, USA
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA
| | - Robert A Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
- Emory Vaccine Center, Emory University, 201 Dowman Drive, Atlanta, GA, 30322, USA
| | - Allison T Chamberlain
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
| | - Fauzia Malik
- Department of Health Policy and Management, Yale School of Public Health, 60 College Street, New Haven, CT, 06520-0834, USA
| | - Paula M Frew
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, 2015 Uppergate Dr, Atlanta, GA, 30322, USA
- School of Public Health; School of Medicine; Population Health & Health Equity Initiative, Office of Research and Economic Development, University of Nevada, 4505 S. Maryland Pkwy, Las Vegas, NV, 89154, USA
- Present address: Merck & Co., Inc., (at Emory University and the University of Nevada - not Merck - when work was performed), NJ, Kenilworth, USA
| | - Cathy Church-Balin
- Center for Communication Programs, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Laura E Riley
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA
| | - Kevin A Ault
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Walter A Orenstein
- Emory Vaccine Center, Emory University, 201 Dowman Drive, Atlanta, GA, 30322, USA
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, 2015 Uppergate Dr, Atlanta, GA, 30322, USA
- Department of Pediatrics, School of Medicine, Emory University, 2015 Uppergate Dr, Atlanta, GA, 30322, USA
| | - Neal A Halsey
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, W5041, Baltimore, MD, 21205, USA
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, W5041, Baltimore, MD, 21205, USA
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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25
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Salmon DA, Schuh HB, Sargent RH, Konja A, Harvey SA, Laurie S, Mai BS, Weakland LF, Lavery JV, Orenstein WA, Breiman RF. Impact of vaccine pause due to Thrombosis with thrombocytopenia syndrome (TTS) following vaccination with the Ad26.COV2.S vaccine manufactured by Janssen/Johnson & Johnson on vaccine hesitancy and acceptance among the unvaccinated population. PLoS One 2022; 17:e0274443. [PMID: 36219617 PMCID: PMC9553048 DOI: 10.1371/journal.pone.0274443] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 08/29/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In response to reports of thrombosis with thrombocytopenia syndrome (TTS) post-vaccination, the Johnson & Johnson (J&J) vaccine was paused and then restarted in April 2021. Our objective was to assess whether this pause adversely impacted vaccine confidence. METHODS Two large internet-based surveys were conducted in the US among adults to measure knowledge, attitudes and perceptions of the J&J vaccine pause and rates of vaccine hesitancy among unvaccinated persons before, during and after the pause. RESULTS Among 66% of respondents aware of the pause, 44% identified blood clots as the reason for the pause without prompting. The impact of the pause on vaccine behavior among unvaccinated persons and perception of the vaccine safety system was mixed and modified by trust in the public health authorities. Those who were less willing to get vaccinated because of the pause were less inclined for all vaccines, not only the J&J product. Moreover, a notable proportion (22.1%) of the small number of persons (n = 30) vaccinated with the J&J vaccine after the pause reported not receiving information about the risk of TTS. The proportion of unvaccinated persons who were hesitant was increasing before and during the pause and then leveled off after the pause. CONCLUSIONS The J&J vaccine pause is unlikely to be a major barrier to vaccine uptake. Public attitudes about vaccines may be more resilient than appreciated, especially when safety issues are investigated with transparent communication. This paper has important implications for messaging and program administration with future vaccine-specific adverse events. Efforts may be warranted to ensure all persons being offered the J&J vaccine are made aware of the risk of TTS.
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Affiliation(s)
- Daniel A. Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Holly B. Schuh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Alexis Konja
- Global Health Crisis Coordination Center (GHC3), Atlanta, Georgia, United States of America
| | - Steven A. Harvey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Brandy S. Mai
- Global Health Crisis Coordination Center (GHC3), Atlanta, Georgia, United States of America
| | - Leo F. Weakland
- Global Health Crisis Coordination Center (GHC3), Atlanta, Georgia, United States of America
| | - James V. Lavery
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Center for Ethics, Emory University, Atlanta, Georgia, United States of America
| | - Walter A. Orenstein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Robert F. Breiman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- School of Medicine, Emory University, Atlanta, Georgia, United States of America
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Mello MM, Opel DJ, Benjamin RM, Callaghan T, DiResta R, Elharake JA, Flowers LC, Galvani AP, Salmon DA, Schwartz JL, Brewer NT, Buttenheim AM, Carpiano RM, Clinton C, Hotez PJ, Lakshmanan R, Maldonado YA, Omer SB, Sharfstein JM, Caplan A. Effectiveness of vaccination mandates in improving uptake of COVID-19 vaccines in the USA. Lancet 2022; 400:535-538. [PMID: 35817078 PMCID: PMC9270060 DOI: 10.1016/s0140-6736(22)00875-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/26/2022] [Accepted: 05/05/2022] [Indexed: 10/26/2022]
Affiliation(s)
- Michelle M Mello
- Stanford Law School, Stanford University, Stanford, CA, USA; Department of Health Policy, Stanford University, Stanford, CA, USA; School of Medicine, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA.
| | - Douglas J Opel
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA; Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
| | | | - Timothy Callaghan
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Renee DiResta
- Stanford Internet Observatory, Stanford University, Stanford, CA, USA
| | - Jad A Elharake
- Yale Institute for Global Health and Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, Yale School of Public Health, New Haven, CT, USA
| | - Lisa C Flowers
- Department of Obstetrics & Gynecology, Emory University, Atlanta, GA, USA
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA
| | - Daniel A Salmon
- Institute for Vaccine Safety, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jason L Schwartz
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Alison M Buttenheim
- Department of Family and Community Health, School of Nursing, and Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Chelsea Clinton
- Clinton Foundation, New York, NY, USA; Clinton Health Access Initiative, Boston, MA, USA; Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Peter J Hotez
- Texas Children's Center for Vaccine Development, Departments of Pediatrics and Molecular Virology & Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA; James A Baker III Institute for Public Policy, Rice University, Houston, TX, USA; Department of Biology, Baylor University, Waco, TX, USA; Hagler Institute for Advanced Study and Scowcroft Institute of International Affairs, Bush School of Government and Public Service, Texas A&M University, College Station, TX, USA
| | - Rekha Lakshmanan
- James A Baker III Institute for Public Policy, Rice University, Houston, TX, USA; The Immunization Partnership, Houston, TX, USA
| | - Yvonne A Maldonado
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA; Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Saad B Omer
- Yale Institute for Global Health and Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, Yale School of Public Health, New Haven, CT, USA; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA; Yale School of Nursing, Orange, CT, USA
| | - Joshua M Sharfstein
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Arthur Caplan
- Langone School of Medicine, New York University, New York, NY, USA
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27
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Omer SB, O'Leary ST, Bednarczyk RA, Ellingson MK, Spina CI, Dudley MZ, Chamberlain AT, Limaye RJ, Brewer SE, Frew PM, Malik FA, Orenstein W, Halsey N, Ault K, Salmon DA. Multi-tiered intervention to increase maternal immunization coverage: A randomized, controlled trial. Vaccine 2022; 40:4955-4963. [PMID: 35817646 DOI: 10.1016/j.vaccine.2022.06.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 05/13/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate the impact of a multi-component intervention package of maternal immunization uptake in obstetric care clinics. METHODS In a multi-level, cluster- and individually-randomized controlled trial we implemented an evidence-based intervention that targeted practice-, provider- and patient-level barriers to vaccine uptake. Obstetric practices were randomized to receive the practice and provider-level interventions or continue their normal standard of care. We enrolled pregnant women at practices in Georgia and Colorado and randomized women into patient-level intervention and control groups, resulting in four study arms. The primary outcomes were receipt of the influenza and tetanus, diphtheria and acellular pertussis (Tdap) vaccines during pregnancy. A sample size of 550 women per arm (2200 total) was planned and enrolled to compare the intervention between the four study arms. RESULTS Between June 2017 and July 2018, 4907 women were screened and 2200 women were randomized, 550 to each of the four study arms. We were unable to follow-up with 108 women, for a final sample size of 2092. Sample characteristics and sample size were similar among study arms. There was no significant increase in Tdap or influenza vaccine uptake overall. Among women who had no intention of or were unsure about receiving the influenza vaccine during pregnancy, those who received just the patient-level intervention were 61% more likely to receive the influenza vaccine than those in the control arm (Relative risk: 1.61; 95% Confidence Interval: 1.18-2.21). There was no significant difference in vaccine uptake for either influenza or tetanus, diphtheria and acellular pertussis between the four arms of the study. CONCLUSIONS This trial highlights the need for more targeted interventions to improve vaccine uptake. Future work should focus on clinics with low baseline vaccine uptake and the patient-level intervention should be expanded and targeted towards women with low vaccine confidence.
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Affiliation(s)
- Saad B Omer
- Yale Institute for Global Health, Yale University, New Haven, CT, United States; Department of Health Policy and Management, Yale School of Public Health, Yale University, New Haven, CT, United States; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, United States; Yale School of Nursing, Yale University, New Haven, CT, United States
| | - Sean T O'Leary
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Robert A Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Emory Vaccine Center, Emory University, Atlanta, GA, United States
| | - Mallory K Ellingson
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, United States.
| | - Christine I Spina
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States
| | - Matthew Z Dudley
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Allison T Chamberlain
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Rupali J Limaye
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Sarah E Brewer
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States; Department of Family Medicine, University of Colorado Anschutz Medical Campus, United States
| | - Paula M Frew
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Department of Medicine, School of Medicine, Emory University, Atlanta, GA, United States
| | - Fauzia A Malik
- Department of Health Policy and Management, Yale School of Public Health, Yale University, New Haven, CT, United States; Dean's Office, Yale School of Public Health, New Haven, CT, United States
| | - Walter Orenstein
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Emory Vaccine Center, Emory University, Atlanta, GA, United States; Department of Medicine, School of Medicine, Emory University, Atlanta, GA, United States
| | - Neal Halsey
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kevin Ault
- Department of Obstetrics and Gynecology, University of Kansas School of Medicine, Kansas City, KS, United States
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
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28
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Sargent RH, Laurie S, Weakland LF, Lavery JV, Salmon DA, Orenstein WA, Breiman RF. Use of Random Domain Intercept Technology to Track COVID-19 Vaccination Rates in Real-Time Across the United States: Survey Study. J Med Internet Res 2022; 24:e37920. [PMID: 35709335 PMCID: PMC9255361 DOI: 10.2196/37920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background Accurate and timely COVID-19 vaccination coverage data are vital for informing targeted, effective messaging and outreach and identifying barriers to equitable health service access. However, gathering vaccination rate data is challenging, and efforts often result in information that is either limited in scope (eg, limited to administrative data) or delayed (impeding the ability to rapidly respond). The evaluation of innovative technologies and approaches that can assist in addressing these limitations globally are needed. Objective The objective of this survey study was to assess the validity of Random Domain Intercept Technology (RDIT; RIWI Corp) for tracking self-reported vaccination rates in real time at the US national and state levels. RDIT—a form of online intercept sampling—has the potential to address the limitations of current vaccination tracking systems by allowing for the measurement of additional data (eg, attitudinal data) and real-time, rapid data collection anywhere there is web access. Methods We used RDIT from June 30 to July 26, 2021, to reach a broad sample of US adult (aged ≥18 years) web users and asked questions related to COVID-19 vaccination. Self-reported vaccination status was used as the focus of this validation exercise. National- and state-level RDIT-based vaccination rates were compared to Centers for Disease Control and Prevention (CDC)–reported national and state vaccination rates. Johns Hopkins University’s and Emory University’s institutional review boards designated this project as public health practice to inform message development (not human subjects research). Results By using RDIT, 63,853 adult web users reported their vaccination status (6.2% of the entire 1,026,850 American web-using population that was exposed to the survey). At the national level, the RDIT-based estimate of adult COVID-19 vaccine coverage was slightly higher (44,524/63,853, 69.7%; 95% CI 69.4%-70.1%) than the CDC-reported estimate (67.9%) on July 15, 2021 (ie, midway through data collection; t63,852=10.06; P<.001). The RDIT-based and CDC-reported state-level estimates were strongly and positively correlated (r=0.90; P<.001). RDIT-based estimates were within 5 percentage points of the CDC’s estimates for 29 states. Conclusions This broad-reaching, real-time data stream may provide unique advantages for tracking the use of a range of vaccines and for the timely evaluation of vaccination interventions. Moreover, RDIT could be harnessed to rapidly assess demographic, attitudinal, and behavioral constructs that are not available in administrative data, which could allow for deeper insights into the real-time predictors of vaccine uptake–enabling targeted and timely interventions.
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Affiliation(s)
| | - Shaelyn Laurie
- RIWI, Corp., 180 Bloor Street West Suite 1000, Toronto, CA
| | | | - James V Lavery
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, US.,Center for Ethics, Emory University, Atlanta, US
| | - Daniel A Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, US.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, US.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, US
| | - Walter A Orenstein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, US.,School of Medicine, Emory University, Atlanta, US
| | - Robert F Breiman
- Center for Global Health Innovation, Atlanta, US.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, US.,School of Medicine, Emory University, Atlanta, US
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29
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Sargent RH, Laurie S, Moncada L, Weakland LF, Lavery JV, Salmon DA, Orenstein WA, Breiman RF. Masks, money, and mandates: A national survey on efforts to increase COVID-19 vaccination intentions in the United States. PLoS One 2022; 17:e0267154. [PMID: 35446922 PMCID: PMC9022841 DOI: 10.1371/journal.pone.0267154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/03/2022] [Indexed: 11/19/2022] Open
Abstract
Various efforts to increase COVID-19 vaccination rates have been employed in the United States. We sought to rapidly investigate public reactions to these efforts to increase vaccination, including self-reported responses to widespread reduced masking behavior, monetary incentive programs to get vaccinated, and work vaccination requirements. Using a unique method for data collection (Random Domain Intercept Technology), we captured a large (N = 14,152), broad-based sample of the United States Web-using population (data collected from June 30 -July 26, 2021). About 3/4 of respondents reported being vaccinated. The likelihood of vaccination and vaccination intention differed across various demographic indicators (e.g., gender, age, income, political leaning). We observed mixed reactions to efforts aimed at increasing vaccination rates among unvaccinated respondents. While some reported that specific efforts would increase their likelihood of getting vaccinated (between 16% and 32%), others reported that efforts would decrease their likelihood of getting vaccinated (between 17% and 42%). Reactions differed by general vaccination intention, as well as other demographic indicators (e.g., race, education). Our results highlight the need to fully understand reactions to policy changes, programs, and mandates before they are communicated to the public and employed. Moreover, the results emphasize the importance of understanding how reactions differ across groups, as this information can assist in targeting intervention efforts and minimizing potentially differential negative impact.
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Affiliation(s)
| | | | | | - Leo F. Weakland
- Center for Global Health Innovation, Atlanta, Georgia, United States of America
| | - James V. Lavery
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Center for Ethics, Emory University, Atlanta, Georgia, United States of America
| | - Daniel A. Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Walter A. Orenstein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Robert F. Breiman
- Center for Global Health Innovation, Atlanta, Georgia, United States of America
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- School of Medicine, Emory University, Atlanta, Georgia, United States of America
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30
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Brewer NT, Buttenheim AM, Clinton CV, Mello MM, Benjamin RM, Callaghan T, Caplan A, Carpiano RM, DiResta R, Elharake JA, Flowers LC, Galvani AP, Hotez PJ, Lakshmanan R, Maldonado YA, Omer SB, Salmon DA, Schwartz JL, Sharfstein JM, Opel DJ. Incentives for COVID-19 vaccination. Lancet Reg Health Am 2022; 8:100205. [PMID: 35229080 PMCID: PMC8866051 DOI: 10.1016/j.lana.2022.100205] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Noel T. Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 325 Rosenau Hall CB7440, Chapel Hill, NC 27599, USA,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA,Corresponding author at: Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 325 Rosenau Hall CB7440, Chapel Hill, NC 27599, USA.
| | - Alison M. Buttenheim
- Department of Family and Community Health, University of Pennsylvania School of Nursing, and Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Chelsea V. Clinton
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY, USA,Clinton Foundation, New York, NY, USA
| | - Michelle M. Mello
- Stanford Law School and Stanford School of Medicine, Stanford University, USA,Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA,Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA
| | | | - Timothy Callaghan
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Arthur Caplan
- New York University Langone School of Medicine, New York University, New York, NY, USA
| | | | - Renee DiResta
- Stanford Internet Observatory, Stanford University, Stanford, CA, USA
| | - Jad A. Elharake
- Yale Institute for Global Health, New Haven, CT, USA,Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, New Haven, CT, USA
| | - Lisa C. Flowers
- Department of Obstetrics and Gynecology, Emory University, Atlanta, Georgia, USA
| | - Alison P. Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA
| | - Peter J. Hotez
- Texas Children's Center for Vaccine Development, Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA,Department of Biology, Baylor University, Waco, TX, USA,Hagler Institute for Advanced Study at Texas A&M University, College Station, TX, USA,James A Baker III Institute for Public Policy, Rice University, Houston, TX, USA,Scowcroft Institute of International Affairs, Bush School of Government and Public Service, Texas A&M University, College Station, TX, USA
| | | | | | - Saad B. Omer
- Yale Institute for Global Health, New Haven, CT, USA,Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, New Haven, CT, USA,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA,Yale School of Nursing, Orange, CT, USA
| | - Daniel A. Salmon
- Department of International Health, Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jason L. Schwartz
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Joshua M. Sharfstein
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Douglas J. Opel
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA,Seattle Children's Research Institute, Seattle, WA, USA
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31
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Patel KM, McFadden SM, Mohanty S, Joyce CM, Delamater PL, Klein NP, Salmon DA, Omer SB, Buttenheim AM. Evaluation of Trends in Homeschooling Rates After Elimination of Nonmedical Exemptions to Childhood Immunizations in California, 2012-2020. JAMA Netw Open 2022; 5:e2146467. [PMID: 35107573 PMCID: PMC8811639 DOI: 10.1001/jamanetworkopen.2021.46467] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In 2015, California passed Senate Bill No. 277 (SB 277) and became the first state in more than 30 years to eliminate nonmedical exemptions to mandatory childhood immunizations for school entry. One concern that emerged was that the law created an incentive for parents to remove children from brick-and-mortar schools to bypass the immunization requirements. OBJECTIVE To assess the trends in homeschooling rates after the elimination of nonmedical exemptions to the requirement of childhood immunizations for school entry. DESIGN, SETTING, AND PARTICIPANTS This preintervention-postintervention cross-sectional study calculated homeschooling rates as the number of students in kindergarten through grade 8 (K-8) enrolled through each of California's 3 homeschooling mechanisms (independent study program, private school affidavit, and private school satellite program) divided by all K-8 students enrolled in the same academic year. Data on homeschooling rates were obtained from the California Department of Education. Interrupted time series analyses were conducted using a linear regression model in which the outcome variable was the percentage of students enrolled in a homeschool program before and after SB 277. Data were collected and analyzed from October 3, 2012, to October 2, 2019. INTERVENTION Passage of SB 277, which eliminated nonmedical exemptions to childhood immunizations for school entry. MAIN OUTCOMES AND MEASURES Homeschooling rates for K-8 students. RESULTS Among the students included in the analysis, the homeschooling enrollment for K-8 students in California increased from 35 122 students (0.8%) during the 2012-2013 school year to 86 574 students (1.9%) during the 2019-2020 school year; however, the implementation of SB 277 was not associated with an increase in the percentage of students enrolled in homeschooling programs in California beyond the secular trend. The increase in homeschooling was greatest for the lower grade levels: kindergarten homeschooling enrollment increased from 2068 students (0.4%) in the 2012-2013 school year to 10 553 students (1.9%) in the 2019-2020 school year, whereas the grade 8 homeschool enrollment rate increased from 5146 students (1.0%) in the 2012-2013 school year to 10 485 students (2.0%) in the 2019-2020 school year. Independent study programs accounted for 20 149 students (45.3%) of homeschooling enrollment, private school affidavits accounted for 19 333 students (43.5%), and private school satellite programs accounted for 4935 students (11.1%) during the 2015-2016 school year. CONCLUSIONS AND RELEVANCE The findings of this study suggest that legislative action to limit nonmedical exemptions for compulsory vaccination for school entry is not associated with removal of students from classroom-based instruction in brick-and-mortar institutions.
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Affiliation(s)
- Kavin M Patel
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - SarahAnn M McFadden
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Institute for Global Health, New Haven, Connecticut
| | - Salini Mohanty
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia
| | - Caroline M Joyce
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Paul L Delamater
- Department of Geography and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Oakland, California
| | - Daniel A Salmon
- Institute for Vaccine Safety, Departments of International Health and Health Behavior Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Saad B Omer
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Institute for Global Health, New Haven, Connecticut
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Alison M Buttenheim
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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32
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Trent MJ, Salmon DA, MacIntyre CR. Predictors of pneumococcal vaccination among Australian adults at high risk of pneumococcal disease. Vaccine 2022; 40:1152-1161. [DOI: 10.1016/j.vaccine.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/04/2022] [Accepted: 01/08/2022] [Indexed: 01/31/2023]
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33
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Omer SB, Benjamin RM, Brewer NT, Buttenheim AM, Callaghan T, Caplan A, Carpiano RM, Clinton C, DiResta R, Elharake JA, Flowers LC, Galvani AP, Lakshmanan R, Maldonado YA, McFadden SM, Mello MM, Opel DJ, Reiss DR, Salmon DA, Schwartz JL, Sharfstein JM, Hotez PJ. Promoting COVID-19 vaccine acceptance: recommendations from the Lancet Commission on Vaccine Refusal, Acceptance, and Demand in the USA. Lancet 2021; 398:2186-2192. [PMID: 34793741 PMCID: PMC8592561 DOI: 10.1016/s0140-6736(21)02507-1] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/31/2021] [Accepted: 09/16/2021] [Indexed: 12/26/2022]
Abstract
Since the first case of COVID-19 was identified in the USA in January, 2020, over 46 million people in the country have tested positive for SARS-CoV-2 infection. Several COVID-19 vaccines have received emergency use authorisations from the US Food and Drug Administration, with the Pfizer-BioNTech vaccine receiving full approval on Aug 23, 2021. When paired with masking, physical distancing, and ventilation, COVID-19 vaccines are the best intervention to sustainably control the pandemic. However, surveys have consistently found that a sizeable minority of US residents do not plan to get a COVID-19 vaccine. The most severe consequence of an inadequate uptake of COVID-19 vaccines has been sustained community transmission (including of the delta [B.1.617.2] variant, a surge of which began in July, 2021). Exacerbating the direct impact of the virus, a low uptake of COVID-19 vaccines will prolong the social and economic repercussions of the pandemic on families and communities, especially low-income and minority ethnic groups, into 2022, or even longer. The scale and challenges of the COVID-19 vaccination campaign are unprecedented. Therefore, through a series of recommendations, we present a coordinated, evidence-based education, communication, and behavioural intervention strategy that is likely to improve the success of COVID-19 vaccine programmes across the USA.
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Affiliation(s)
- Saad B Omer
- Yale Institute for Global Health, Yale University, New Haven, CT, USA; Infectious Diseases Section, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Epidemiology of Microbial Diseases, Yale University, New Haven, CT, USA; Yale School of Nursing, Yale University, Orange, CT, USA.
| | | | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Alison M Buttenheim
- Department of Family and Community Health, University of Pennsylvania School of Nursing, and Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy Callaghan
- Department of Health Policy and Management, School of Public Health, A&M University, College Station, TX, USA
| | - Arthur Caplan
- Langone School of Medicine, New York University, New York, NY, USA
| | | | - Chelsea Clinton
- Clinton Foundation, New York, NY, USA; Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Renee DiResta
- Stanford Internet Observatory, Stanford University, Stanford, CA, USA
| | - Jad A Elharake
- Yale Institute for Global Health, Yale University, New Haven, CT, USA; Infectious Diseases Section, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Lisa C Flowers
- Department of Obstetrics & Gynecology, Emory University, Atlanta, GA, USA
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale University, New Haven, CT, USA
| | | | | | - SarahAnn M McFadden
- Yale Institute for Global Health, Yale University, New Haven, CT, USA; Infectious Diseases Section, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Michelle M Mello
- School of Medicine, Stanford University, Stanford, CA, USA; Stanford Law School, Stanford University, Stanford, CA, USA; Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA
| | - Douglas J Opel
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA; UC Hastings College of Law, University of California, San Francisco, CA, USA
| | - Dorit R Reiss
- UC Hastings College of Law, University of California, San Francisco, CA, USA
| | - Daniel A Salmon
- Institute for Vaccine Safety, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jason L Schwartz
- Department of Health Policy and Management, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Joshua M Sharfstein
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Peter J Hotez
- Hagler Institute for Advanced Study at Texas A&M University, A&M University, College Station, TX, USA; Scowcroft Institute of International Affairs, Bush School of Government and Public Service Texas, A&M University, College Station, TX, USA; Texas Children's Center for Vaccine Development, Departments of Pediatrics and Molecular Virology & Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA; Department of Biology, Baylor University, Waco, TX, USA; James A Baker III Institute for Public Policy, Rice University, Houston, TX, USA
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Sharfstein JM, Callaghan T, Carpiano RM, Sgaier SK, Brewer NT, Galvani AP, Lakshmanan R, McFadden SM, Reiss DR, Salmon DA, Hotez PJ. Uncoupling vaccination from politics: a call to action. Lancet 2021; 398:1211-1212. [PMID: 34537104 PMCID: PMC8445735 DOI: 10.1016/s0140-6736(21)02099-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/08/2021] [Accepted: 09/14/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Joshua M Sharfstein
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Timothy Callaghan
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA
| | | | - Sema K Sgaier
- Surgo Ventures, Washington DC, USA; Harvard University T H Chan School of Public Health, Boston, MA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA
| | | | - SarahAnn M McFadden
- Yale Institute for Global Health, New Haven, CT, USA; Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, New Haven, CT, USA
| | | | - Daniel A Salmon
- Institute for Vaccine Safety, Department of International, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Peter J Hotez
- Hagler Institute for Advanced Study, Texas A&M University, College Station, TX, USA; Scowcroft Institute of International Affairs, Bush School of Government and Public Service, Texas A&M University, College Station, TX, USA; Texas Children's Center for Vaccine Development, Departments of Pediatrics and Molecular Virology & Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA; Department of Biology, Baylor University, Waco, TX, USA; James A Baker III Institute for Public Policy, Rice University, Houston, TX, USA
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Dudley MZ, Bernier R, Brewer J, Salmon DA. Walking the Tightrope: Reevaluating science communication in the era of COVID-19 vaccines. Vaccine 2021; 39:5453-5455. [PMID: 34446317 DOI: 10.1016/j.vaccine.2021.08.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 11/18/2022]
Abstract
Scientists are trained to be skeptical and not overstate the existing evidence. This cautiousness is a valuable asset when working in scientific research, where the goal is the pursuit of knowledge and truth. It becomes a handicap when scientists are asked to communicate to the public about pressing topics such as COVID-19 vaccines. Often in such contexts, immediate recommendations are sought, and decisions must be made even when complete evidence is lacking. For scientists to be effective public communicators, they must adjust their mindset and embrace brevity, clarity, and other principles of effective communication. Focusing messages on what is known fosters public confidence in taking needed actions, whereas focusing on what is still unknown fosters inaction and seeds doubt. The implementation of principles of effective communication does not inherently conflict with maintaining scientific accuracy and acknowledging uncertainty, but it does require additional care, effort, and training.
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Affiliation(s)
- Matthew Z Dudley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
| | - Roger Bernier
- Senior Epidemiologist Editor, The Epidemiology Monitor, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Janesse Brewer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
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36
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Gerber JE, Brewer J, Limaye RJ, Sutherland A, Blunt M, Holroyd TA, Geller G, Carleton B, Kahn J, Salmon DA. Vaccinomics: a cross-sectional survey of public values. Hum Vaccin Immunother 2021; 17:2999-3015. [PMID: 34152932 PMCID: PMC8381829 DOI: 10.1080/21645515.2021.1911217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022] Open
Abstract
Objective: We characterize public values regarding vaccinomics, which aims to improve vaccine safety and effectiveness using genomics.Methods: Panel survey (2020) of ≥18-year-olds with embedded animation introduced vaccinomics. Sociodemographic, health, and vaccination-related items were adapted from validated scales. Novel items measured trust in public health authorities, vaccinomics-related values, and preferences for federal funding: vaccinomics compared with vaccine issues and chronic diseases. Beginning and end of survey confidence in vaccine safety was measured to assess potential changes. Data were weighted to the U.S. Census. Vaccinomics-related concerns were stratified by sociodemographic characteristics, vaccine hesitancy status (composite outcome), reported serious vaccine reactions, and trust in public health authorities (PHA). Log binomial regression models estimated associations between these variables and agency to make vaccine-related decisions.Results: Most (70.7%, N = 1,925) respondents expected vaccinomics would increase their vaccine confidence compared to now. Agreement was highest among those without serious vaccine reaction experience (unexperienced: 74.2% versus experienced: 62.3%), with high trust in PHA (high: 83.3% versus low: 57.4%), and low vaccine hesitancy among parents of teenagers (low: 78.8% versus high: 62.5%) and adults without minor children (low: 79.8% versus high: 60.6%; all p < .01). Belief that vaccination was an individual's choice was associated with reported serious reactions (adjusted Prevalence Ratio (aPR): 1.16; 95% CI: 1.07, 1.25) and low trust (aPR: 0.91; 0.84, 0.98). Beginning versus end of survey vaccine safety perceptions were similar.Conclusion: Federal funding, communications, and policies should assure the public that vaccinomics will not remove their decision-making power and engender trust in PHA.
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Affiliation(s)
- Jennifer E. Gerber
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Janesse Brewer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rupali J. Limaye
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea Sutherland
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Madeleine Blunt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Taylor A. Holroyd
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gail Geller
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Bruce Carleton
- Pharmaceutical Outcomes Programme, BC Children’s Hospital, Vancouver, BC, Canada
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Jeffery Kahn
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel A. Salmon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Shaw J, Hanley S, Stewart T, Salmon DA, Ortiz C, Trief PM, Asiago Reddy E, Morley CP, Thomas SJ, Anderson KB. Healthcare Personnel (HCP) Attitudes About Coronavirus Disease 2019 (COVID-19) Vaccination After Emergency Use Authorization. Clin Infect Dis 2021; 75:e814-e821. [PMID: 34467370 PMCID: PMC8513411 DOI: 10.1093/cid/ciab731] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We previously reported on coronavirus disease 2019 (COVID-19) vaccination intent among healthcare personnel (HCP) before emergency use authorization. We found widespread hesitancy and a substantial proportion of HCP did not intend to vaccinate. METHODS We conducted a cross-sectional survey of HCP, including clinical and nonclinical staff, researchers, and trainees between 21 February and 19 March 2021. The survey evaluated vaccine attitudes, beliefs, intent, and acceptance. RESULTS Overall, 3981 (87.7%) of respondents had already received a COVID-19 vaccine or planned to get vaccinated. There were significant differences in vaccine acceptance by gender, age, race, and hospital role. Males (93.7%) were more likely than females (89.8%) to report vaccine acceptance (P < .001). Mean age was higher among those reporting vaccine acceptance (P < .001). Physicians and scientists showed the highest acceptance rate (97.3%), whereas staff in ancillary services showed the lowest acceptance rate (79.9%). Unvaccinated respondents were more likely to be females, to have refused vaccines in the past due to reasons other than illness or allergy, to care for COVID-19 patients, or to rely on themselves when making vaccination decision. Vaccine acceptance was more than twice previous intent among Black respondents, an increase from 30.8% to 73.8%, and across all hospital roles with all > 80% vaccine acceptance. CONCLUSIONS The majority of HCP were vaccinated, much higher than reporting intent before vaccine was available. However, many HCP-particularly ancillary services-are still hesitant. Feasible and effective interventions to address the hesitant, including individually-tailored education strategies are needed, or vaccine can be mandated.
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Affiliation(s)
- Jana Shaw
- Department of Pediatrics, Division of Infectious Diseases, Upstate Golisano Children’s Hospital, SUNY Upstate Medical University, Syracuse, NY, USA,Corresponding Author: Dr. Jana Shaw, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University, Golisano Children's Hospital, 750 East Adams Street, Syracuse, NY 13210, USA. . Phone: 315-464-6331
| | - Samantha Hanley
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Telisa Stewart
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Daniel A Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christine Ortiz
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Paula M Trief
- Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Christopher P Morley
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Stephen J Thomas
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA,Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, USA,Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Kathryn B Anderson
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA,Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, USA,Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY, USA
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38
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Trent MJ, Salmon DA, MacIntyre CR. Using the health belief model to identify barriers to seasonal influenza vaccination among Australian adults in 2019. Influenza Other Respir Viruses 2021; 15:678-687. [PMID: 33586871 PMCID: PMC8404057 DOI: 10.1111/irv.12843] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/03/2021] [Accepted: 01/12/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Each year tens of thousands of Australians become ill with influenza, resulting in thousands of severe infections that require hospitalisation. However, only 40% of adults receive the annual influenza vaccine. We surveyed Australian adults to provide up to date, population-specific data on the predictors and barriers of seasonal influenza vaccination. METHODS We administered an online survey to a nationally representative sample of Australian adults. We designed survey questions using the theoretical constructs of the health belief model. Using simple and multivariable Poisson regression, we identified attitudes and beliefs associated with influenza vaccination in 2019. RESULTS Among 1,444 respondents, 51.7% self-reported influenza vaccination in 2019. We estimated vaccine coverage to be 44% for adults under 45, 46% for adults aged 45 to 64 and 77% for adults aged 65 and over. The strongest individual predictors of self-reported vaccination were believing the vaccine is effective at preventing influenza (APR = 3.71; 95% CI = 2.87-4.80), followed by recalling their doctor recommending the vaccine (APR = 2.70; 95% CI = 2.31-3.16). Common perceived barriers that predicted self-reported vaccination included believing the vaccine could give you influenza (APR = 0.59; 95% CI = 0.52-0.67), believing the vaccine can make you ill afterwards (APR = 0.68; 95% CI = 0.62-0.74) and preferring to develop immunity "naturally" (APR = 0.38; 95% CI = 0.32-0.45). CONCLUSION Although vaccine uptake in 2019 appears to be higher than previous years, there are perceived barriers which may limit uptake among Australians. Tailored interventions are needed to combat widespread influenza vaccine hesitancy, particularly among high-risk groups.
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Affiliation(s)
- Mallory J. Trent
- Biosecurity ProgramThe Kirby InstituteUniversity of New South WalesSydneyNSWAustralia
| | - Daniel A. Salmon
- Departments of International Health and Health, Behavior and SocietyInstitute for Vaccine SafetyBloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUSA
| | - C. Raina MacIntyre
- Biosecurity ProgramThe Kirby InstituteUniversity of New South WalesSydneyNSWAustralia
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Affiliation(s)
- Lawrence O Gostin
- O'Neill Institute for National and Global Health Law, World Health Organization Collaborating Center on National and Global Health Law, Georgetown Law, Washington, DC
| | - Jana Shaw
- Upstate Golisano Children's Hospital Epidemiologist, Pediatric Infectious Diseases, SUNY Upstate Medical University, Syracuse, New York
| | - Daniel A Salmon
- Institute for Vaccine Safety, Department of International Health, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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40
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Holroyd TA, Howa AC, Proveaux TM, Delamater PL, Klein NP, Buttenheim AM, Limaye RJ, Omer SB, Salmon DA. School-level perceptions and enforcement of the elimination of nonmedical exemptions to vaccination in California. Hum Vaccin Immunother 2021; 17:1986-1993. [PMID: 33493075 DOI: 10.1080/21645515.2020.1857202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
In 2015, California passed Senate Bill 277 eliminating all nonmedical exemptions to school vaccinations. We aimed to explore school-level modes of SB277 enforcement, characterize vaccination knowledge, attitudes, and beliefs of school officials, and identify whether school vaccination policies are associated with medical exemptions being granted. Surveys were mailed to a stratified random sample of 1,450 schools in California. School personnel (n = 752) reported their medical training, vaccination beliefs, enforcement of vaccination policies, and school rates of medical exemptions. Multiple logistic regression was used to assess whether school policies are associated with the likelihood of medical exemption requests being granted. Nurses were more likely than non-nurses to hold beliefs recognizing the importance of vaccination. A school where the survey respondent was a nurse was more likely to have granted a medical exemption request compared to a school where the respondent was not a nurse (OR 2.11, 95% CI 1.34-3.36). The training of school officials and school-level practices may impact the enforcement of medical exemptions. Equipping school officials as competent sources of vaccine information for concerned parents will be valuable in improving parental vaccine uptake.
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Affiliation(s)
- Taylor A Holroyd
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amanda C Howa
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Tina M Proveaux
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Paul L Delamater
- Department of Geography and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Alison M Buttenheim
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Rupali J Limaye
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Saad B Omer
- Yale Institute for Global Health, Yale University, New Haven, CT, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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41
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Salmon DA, Lambert PH, Nohynek HM, Gee J, Parashar UD, Tate JE, Wilder-Smith A, Hartigan-Go KY, Smith PG, Zuber PLF. Novel vaccine safety issues and areas that would benefit from further research. BMJ Glob Health 2021; 6:bmjgh-2020-003814. [PMID: 34011502 PMCID: PMC8137224 DOI: 10.1136/bmjgh-2020-003814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/01/2020] [Accepted: 01/06/2021] [Indexed: 12/20/2022] Open
Abstract
Vaccine licensure requires a very high safety standard and vaccines routinely used are very safe. Vaccine safety monitoring prelicensure and postlicensure enables continual assessment to ensure the benefits outweigh the risks and, when safety problems arise, they are quickly identified, characterised and further problems prevented when possible. We review five vaccine safety case studies: (1) dengue vaccine and enhanced dengue disease, (2) pandemic influenza vaccine and narcolepsy, (3) rotavirus vaccine and intussusception, (4) human papillomavirus vaccine and postural orthostatic tachycardia syndrome and complex regional pain syndrome, and (5) RTS, S/adjuvant system 01 malaria vaccine and meningitis, cerebral malaria, female mortality and rebound severe malaria. These case studies were selected because they are recent and varied in the vaccine safety challenges they elucidate. Bringing these case studies together, we develop lessons learned that can be useful for addressing some of the potential safety issues that will inevitably arise with new vaccines.
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Affiliation(s)
- Daniel A Salmon
- Global Disease Epidemiology and Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Hanna M Nohynek
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Uusimaa, Finland
| | - Julianne Gee
- Division of Healthcare Quality Promotion, National Center of Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia, USA
| | - Umesh D Parashar
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
| | - Jacqueline E Tate
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
| | | | | | - Peter G Smith
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, London, UK
| | - Patrick Louis F Zuber
- Essential Medicines and Health Products, Organisation Mondiale de la Sante, Geneve, Switzerland
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42
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Limaye RJ, Opel DJ, Dempsey A, Ellingson M, Spina C, Omer SB, Dudley MZ, Salmon DA, Leary SO. Communicating With Vaccine-Hesitant Parents: A Narrative Review. Acad Pediatr 2021; 21:S24-S29. [PMID: 33958087 DOI: 10.1016/j.acap.2021.01.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/21/2021] [Accepted: 01/29/2021] [Indexed: 01/04/2023]
Abstract
Although vaccines are considered one of the most effective medical interventions to prevent vaccine preventable disease and associated morbidity and mortality, a number of recent outbreaks are threatening the gains made by vaccines. Vaccine hesitancy is a key driver of vaccine refusal and has been associated with vaccine preventable outbreaks. While parents seek information from many sources to inform their vaccine decision-making process, they continue to view their child's pediatric provider as a trusted source of vaccine information. The communication that occurs between a provider and parent with regards to vaccination is critical in reducing concerns and nudging parents toward vaccine acceptance. However, vaccine-hesitant parents raise issues in this encounter that many providers feel ill-equipped to answer, due to lack of training on evidence-based communication strategies. We focus on promising approaches related to patient-provider communication within the context of vaccination. We found empirical evidence that the use of a presumptive format to recommend vaccines, motivational interviewing, and tailoring information to increase message salience are approaches that can positively affect vaccine acceptance. As providers continue to serve as important influencers in the vaccine decision-making process, it is evident that there is a need to continue to identify evidence-based, and practically implementable approaches to mitigate parental vaccine hesitancy. Providers play a key role in improving coverage rates, and therefore it is paramount to seek ways to improve how providers communicate about vaccines.
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Affiliation(s)
- Rupali J Limaye
- Johns Hopkins Bloomberg School of Public Health (RJ Limaye, MZ Dudley, and DA Salmon), Baltimore, Md.
| | | | - Amanda Dempsey
- University of Colorado Denver (A Dempsey, C Spina, and SO Leary), Denver, Colo
| | | | - Christine Spina
- University of Colorado Denver (A Dempsey, C Spina, and SO Leary), Denver, Colo
| | - Saad B Omer
- Yale School of Medicine (M Ellingson and SB Omer), New Haven, Conn
| | - Matthew Z Dudley
- Johns Hopkins Bloomberg School of Public Health (RJ Limaye, MZ Dudley, and DA Salmon), Baltimore, Md
| | - Daniel A Salmon
- Johns Hopkins Bloomberg School of Public Health (RJ Limaye, MZ Dudley, and DA Salmon), Baltimore, Md
| | - Sean O Leary
- University of Colorado Denver (A Dempsey, C Spina, and SO Leary), Denver, Colo
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43
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Trent MJ, Salmon DA, MacIntyre CR. Pharmacy, workplace or primary care? Where Australian adults get their influenza vaccines. Aust N Z J Public Health 2021; 45:385-390. [PMID: 33818843 DOI: 10.1111/1753-6405.13094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/01/2021] [Accepted: 02/01/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To estimate the proportion of influenza vaccines administered in non-medical settings in Australia in 2019 and identify factors associated with vaccination site. METHODS We surveyed 1,444 Australian adults online in October 2019. To identify factors associated with vaccination site, we used Pearson's chi-square test. We used thematic analysis to describe responses to the question, 'Please explain why you chose to get vaccinated there'. RESULTS Most participants (73%) received the influenza vaccine in a medical setting, while 13% received it at a pharmacy and 14% at their workplace. Being vaccinated in pharmacy was associated with being under 65 years of age (p<0.01), marital status (p=0.01), and not having a high-risk comorbidity (p<0.01). Workplace vaccination was associated with being under 65 (p<0.01), household income (p<0.01), not having a regular general physician/practice (p=0.01), having private insurance (p<0.01), and not having a high-risk comorbidity (p<0.01). There was no association between site of vaccination and first-time vaccination (p=0.71, p=0.22). CONCLUSIONS Despite new policies allowing pharmacists to administer influenza vaccines, most Australian adults are still vaccinated in medical settings. Pharmacy and workplace vaccination settings were more common among younger adults without high-risk comorbidities. Implications for public health: Workplaces, pharmacies and other non-medical settings may provide an opportunity to increase influenza vaccination among healthy, working-age adults who might otherwise forego annual vaccination. Pharmacies may also provide a convenient location for the rollout of the COVID-19 vaccine, particularly in medically underserved areas.
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Affiliation(s)
- Mallory J Trent
- Biosecurity Program, The Kirby Institute, University of New South Wales
| | - Daniel A Salmon
- Departments of International Health and Health, Behavior and Society, Institute for Vaccine Safety, Bloomberg School of Public Health, Johns Hopkins University, United States
| | - C Raina MacIntyre
- Biosecurity Program, The Kirby Institute, University of New South Wales
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Holroyd TA, Limaye RJ, Gerber JE, Rimal RN, Musci RJ, Brewer J, Sutherland A, Blunt M, Geller G, Salmon DA. Development of a Scale to Measure Trust in Public Health Authorities: Prevalence of Trust and Association with Vaccination. J Health Commun 2021; 26:272-280. [PMID: 33998402 PMCID: PMC8225577 DOI: 10.1080/10810730.2021.1927259] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Infectious disease outbreaks highlight the importance of trust in public health authorities to avoid fear and improve adherence to recommendations. There is currently no established and validated measure for trust in public health authorities. We aimed to develop and validate an instrument that measures trust in public health authorities and to assess the association between trust in public health authorities and vaccine attitudes. We developed 20 items to measure trust in public health authorities. After implementing a survey in January 2020, we investigated relationships between the items, reduced the number of items, and identified latent constructs of the scale. We assessed variability in trust and how trust was associated with vaccine attitudes, beliefs, and self-reported vaccine acceptance. The pool was reduced to a 14-item trust in public health authorities scale and we found that this trust model was strongly associated with acceptance of vaccines. Our scale can be used to examine the relationship between trust in public health authorities and adherence to public health recommendations. The measure needs to be validated in other settings to determine whether they are associated with other areas where the public question public health authority recommendations.
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Affiliation(s)
- Taylor A. Holroyd
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Rupali J. Limaye
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jennifer E. Gerber
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Rajiv N. Rimal
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Rashelle J. Musci
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Janesse Brewer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Andrea Sutherland
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD
| | - Madeleine Blunt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Gail Geller
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Daniel A. Salmon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Hotez PJ, Cooney RE, Benjamin RM, Brewer NT, Buttenheim AM, Callaghan T, Caplan A, Carpiano RM, Clinton C, DiResta R, Elharake JA, Flowers LC, Galvani AP, Lakshmanan R, Maldonado YA, McFadden SM, Mello MM, Opel DJ, Reiss DR, Salmon DA, Schwartz JL, Sharfstein JM, Omer SB. Announcing the Lancet Commission on Vaccine Refusal, Acceptance, and Demand in the USA. Lancet 2021; 397:1165-1167. [PMID: 33639088 DOI: 10.1016/s0140-6736(21)00372-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/10/2021] [Indexed: 11/26/2022]
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Salmon DA, Dudley MZ, Brewer J, Kan L, Gerber JE, Budigan H, Proveaux TM, Bernier R, Rimal R, Schwartz B. COVID-19 vaccination attitudes, values and intentions among United States adults prior to emergency use authorization. Vaccine 2021; 39:2698-2711. [PMID: 33781601 PMCID: PMC7988387 DOI: 10.1016/j.vaccine.2021.03.034] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/04/2021] [Accepted: 03/08/2021] [Indexed: 01/29/2023]
Abstract
Introduction Safe and effective vaccines against Coronavirus Disease 2019 (COVID-19) provide the best opportunity to control the pandemic. Having safe and efficacious vaccines available is only half the equation; people must also take them. We describe a study to identify COVID-19 vaccine attitudes, values and intentions immediately preceding authorization of COVID-19 vaccines in the US. Methods A national panel survey was conducted to measure intent to receive COVID-19 vaccines as well as disease and vaccine attitudes, values and trust in local, state and federal public health authorities. Results Greater than 80% of respondents reported confidence they could adhere to COVID recommendations such as mask wearing, social distancing and hand washing. The majority of respondents (70%) reported believing that current drugs were somewhat or very good at treating COVID-19 infection. Vaccine intent fell into three groups: Intenders (50%), Wait and Learn (40%), and Unlikelys (10%). Intent to get vaccinated was substantially lower among African American (32%), and higher among men (56%), those over 60 years of age (61%), those with a Bachelor’s degree or higher (63%), and Democrats (63%). The Wait and Learn group, compared to the Intenders, were less likely to report being diagnosed with a high risk condition for COVID-19, receiving an influenza vaccine in the past 12 months, discussing COVID-19 vaccine with their healthcare provider, perceiving COVID-19 as severe, considering a COVID-19 vaccine important to stop the spread of infection, and wering a mask usually or almost always. Conclusion Only half of US adults intend to accept COVID-19 vaccines; most others (40%) are uncertain. Levels of immunity associated with community protection will not be achieved without reaching those who are currently uncertain. Characterizing COVID-19 vaccine attitudes and intentions and ascertaining values and trust in local, state, and federal public health authorities that impact vaccine decision-making are essential.
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Affiliation(s)
- Daniel A Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, United States; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States.
| | - Matthew Z Dudley
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, United States
| | - Janesse Brewer
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, United States
| | - Lilly Kan
- National Association of County and City Health Officials, United States
| | | | - Haley Budigan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, United States
| | - Tina M Proveaux
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, United States
| | | | - Rajiv Rimal
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, United States
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Gerber JE, Brewer J, Limaye RJ, Sutherland A, Geller G, Spina CI, Salmon DA. Ethical and policy implications of vaccinomics in the United States: community members' perspectives. Hum Vaccin Immunother 2021; 17:2133-2144. [PMID: 33626296 PMCID: PMC8189107 DOI: 10.1080/21645515.2020.1859318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objectives: We aimed to elucidate public values regarding the use of genomics to improve vaccine development and use (vaccinomics). Methods: Adults ≥18 years-old were recruited through social media and community organizations, and randomly assigned to one of four nested discussion groups in Boulder, CO and Baltimore, MD. Participants rated their confidence in vaccine safety and effectiveness prior to and after discussing vaccinomics. Before departing, they prioritized funding for vaccinomics versus federal priorities (vaccine safety and efficacy, new vaccines, and free vaccines) and chronic diseases (cancer, heart disease, and diabetes). Grounded Theory-influenced methods were used to identify themes. Results: Participants broadly supported vaccinomics. Emergent themes: concerns about reduced privacy/confidentiality, increased genetically based stigma/discrimination, and reduced agency to make vaccine-related decisions through genetically based prioritization. Participants supported vaccinomics’ potential for increased personalization. Some participants favored prioritizing others over themselves during a vaccine shortage, while others did not. Some participants worried health insurance companies would discriminate against them based on information discovered through vaccinomics. Participants feared inequitable implementation of vaccinomics would contribute to discrimination and marginalization of vulnerable populations. Discussing vaccinomics did not impact perceptions of vaccine safety and effectiveness. Federal funding for vaccinomics was broadly supported. Conclusion: Participants supported vaccinomics’ potential for increased personalization, noting policy safeguards to facilitate equitable implementation and protect privacy were needed. Despite some concerns, participants hoped vaccinomics would improve vaccine safety and effectiveness. Policies regarding vaccinomics’ implementation must address public concerns about the privacy and confidentiality of genetic information and potential inequities in access to vaccinomics’ benefits.
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Affiliation(s)
- Jennifer E Gerber
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Janesse Brewer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rupali J Limaye
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public, Baltimore, MD, USA.,International Vaccine Access Center, International Vaccine Access Center, Baltimore, MD, USA
| | - Andrea Sutherland
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gail Geller
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public, Baltimore, MD, USA.,Department of Medicine, Johns Hopkins School of Medicine.,Department of Health Policy, Johns Hopkins Bloomberg School of Public, Baltimore, MD, USA.,Berman Institute of Bioethics, Deering Hall, Baltimore, MD, USA
| | - Christine I Spina
- Department of Health Policy, Johns Hopkins Bloomberg School of Public, Baltimore, MD, USA
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public, Baltimore, MD, USA.,Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Children's Hospital Colorado, Aurora, CO, USA
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Salmon DA, Dudley MZ, Carleton BC. Guillain-Barré Syndrome Following Influenza Vaccines Affords Opportunity to Improve Vaccine Confidence. J Infect Dis 2021; 223:355-358. [PMID: 33137189 PMCID: PMC8502426 DOI: 10.1093/infdis/jiaa544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 08/25/2023] Open
Affiliation(s)
- Daniel A Salmon
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Matthew Z Dudley
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bruce C Carleton
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia, Vancouver, Canada
- British Columbia Children’s Hospital Research Institute, University of British Columbia, Vancouver, Canada
- Pharmaceutical Outcomes Program, British Columbia Children’s Hospital, Vancouver, Canada
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Affiliation(s)
- Lawrence O Gostin
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC
| | - Daniel A Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Heidi J Larson
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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Dudley MZ, Limaye RJ, Salmon DA, Omer SB, O'Leary ST, Ellingson MK, Spina CI, Brewer SE, Bednarczyk RA, Malik F, Frew PM, Chamberlain AT. Racial/Ethnic Disparities in Maternal Vaccine Knowledge, Attitudes, and Intentions. Public Health Rep 2021; 136:699-709. [PMID: 33508208 DOI: 10.1177/0033354920974660] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Although disparities in maternal vaccine acceptance among racial/ethnic groups are well documented, the reasons for these disparities are unclear. The objective of this study was to describe differences in pregnant women's knowledge, attitudes, beliefs, intentions, and trust regarding maternal and infant vaccines by race/ethnicity. METHODS We collected survey data from 1862 pregnant women from diverse prenatal care practices in Georgia and Colorado from June 2017 through July 2018. We performed multiple logistic regressions to determine differences in intentions, knowledge, attitudes, beliefs, and trust by race/ethnicity and calculated odds ratios (ORs) and 95% CIs. RESULTS Compared with White women, Black and Hispanic women were less confident in vaccine safety and efficacy and less likely to perceive risk of acquiring vaccine-preventable diseases, report provaccine social norms, indicate having enough vaccine knowledge, and trust vaccine information from health care providers and public health authorities. Black women were the least confident in the safety of the maternal influenza vaccine (OR = 0.37; 95% CI, 0.27-0.49); maternal tetanus, diphtheria, and acellular pertussis vaccine (OR = 0.37; 95% CI, 0.27-0.52); and infant vaccines overall (OR = 0.40; 95% CI, 0.28-0.58), and were least likely to intend to receive both maternal vaccines (OR = 0.35; 95% CI, 0.27-0.47) or all infant vaccines on time (OR = 0.45; 95% CI, 0.34-0.61) as compared with White women. CONCLUSIONS Understanding differences in behavioral constructs integral to vaccine decision making among women of different races/ethnicities can lead to tailored interventions to improve vaccine acceptance.
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Affiliation(s)
- Matthew Z Dudley
- 25802 Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,1466 Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rupali J Limaye
- 25802 Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,1466 Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Daniel A Salmon
- 25802 Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,1466 Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Saad B Omer
- 12228 Yale Institute for Global Health, Yale School of Medicine, New Haven, CT, USA.,Department of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.,Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Sean T O'Leary
- 129263 Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA.,Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mallory K Ellingson
- Department of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Christine I Spina
- 129263 Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
| | - Sarah E Brewer
- 129263 Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA.,Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Robert A Bednarczyk
- 25798 Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,1371 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Emory Vaccine Center, Emory University, Atlanta, GA, USA
| | - Fauzia Malik
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Paula M Frew
- 14722 School of Community Health Sciences and Office of Research and Economic Development, University of Nevada, Las Vegas, NV, USA.,Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
| | - Allison T Chamberlain
- 1371 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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