Conference reportVaccine acceptance: Science, policy, and practice in a ‘post-fact’ world☆
Introduction
Suboptimal vaccination uptake is associated with outbreaks of vaccine-preventable diseases such as measles, whooping cough, rubella, and mumps in many parts of the world. For example, between November 2016, and October 2017, 13,726 cases of measles were reported in 30 EU/EEA Member States, with the highest number of cases reported by Romania (5605), Italy (4973) and Germany (952) [1]. During this 12-month period 30 measles-associated deaths were reported in Romania (20 cases), Italy (4), and 6 other countries. Among the cases with known vaccination status 87% were unvaccinated and 8% had received only one dose of vaccine. Vaccination uptake for the second dose of measles-containing vaccine in 2015–2016 was below the 95% threshold in 20 of the 30 EU/EEA countries that submitted routine surveillance data to the European Surveillance System (TESSy) on a monthly basis [1]. In Romania the average vaccination rates have fallen from 95% to 86% since 2007. Under- and non-vaccination can be partly attributed to vaccine hesitancy, defined by the World Health Organization SAGE Working Group on Vaccine Hesitancy as ‘delay in acceptance or refusal of vaccines despite availability of vaccine services’ [2].
Some outbreaks have been associated with clustering of vaccine hesitancy or refusal, including the measles outbreaks in Romania [3], [4], [5]. An outbreak of more than 23,000 cases of measles reported in the first six months of 2017 in Yobe, a state in Northeast Nigeria, may have also been due to mistrust of authorities and the ‘poor attitude of parents’ in terms of bringing their children for vaccination [6]. However, vaccine acceptance should always be seen in the context of other possible reasons for sub-optimal vaccination uptake such as access, affordability or awareness challenges [7]. Even when hesitancy is suspected, vaccine confidence may not be the primary reason for low vaccination uptake. In one study in Australia, where hesitancy was expected to explain the gap in vaccination uptake, research showed that the majority of incompletely immunized infants did not have a mother who disagreed with immunization [8].
Recently politicians in some countries, such as the USA and Italy, have used anti-vaccination stances in their manifestos. In contrast, various jurisdictions in Europe, Eurasia and North America have introduced or are considering the introduction of mandates for childhood immunization to address this increasingly worrying public health crisis [9], [10].
At the same time, public confidence faces a threat from legal decisions. For example, in June 2017 the EU High Court ruled that vaccines may be associated with illnesses without any scientific evidence of causality if there is specific and consistent evidence relating to timeliness, a prior healthy status, lack of family history and multiple cases [11]. This ruling may lead to vaccination being judged responsible for adverse events following immunization in individuals without justification. The rise of vaccine mandates accompanied by this weakening of evidentiary requirements for lawsuits places policymakers and vaccine advocates in a dilemma, i.e., populations will be compelled by the state to vaccinate themselves and their children, while they may become more vaccine hesitant.
To address these concerns, researchers and practitioners working on improving vaccine acceptance and uptake gathered together to share their experiences with policies and practices that are working or could work to build and sustain trust in vaccines for a fruitful fifth annual three-day meeting at Fondation Mérieux’s Les Pensières, Center for Global Health in France [12]. The organizing committee chose to highlight the ‘post-fact’ world in the meeting’s title as the context for present and future work on vaccine acceptance and uptake. In a salient definition of the ‘post-fact’concept, Farhad Manjoo stated ‘Increasingly, our arguments aren’t over what we should be doing … but instead over what is happening. Political scientists have characterized our epoch as one of heightened polarization … the creeping partisanship has begun to distort our very perceptions about what is “real” and what isn’t… [W]e’re now fighting over competing versions of reality [13].’ Ongoing debates about the safety and efficacy of mass vaccination programs – sporadically fueled by those in high office – epitomize such contestations. They render the work of encouraging vaccine acceptance both challenging and ongoing. Accordingly, the key themes of the meeting, representing the cutting edge of vaccination social research and policy questions, were:
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The role of social marketing in improving vaccination acceptance and uptake
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Enabling healthcare professionals (HCPs) to foster trust in vaccination
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The role of mandates in promoting and sustaining vaccination acceptance and uptake
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Alignment of research goals with public health needs
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Community of practice
Here we share a summary of our deliberations on these themes to communicate with the medical and public health communities and to encourage individuals to join our informal community of practice working on vaccine acceptance and uptake.
Section snippets
The role of social marketing in improving vaccination acceptance and uptake
In 2014 the WHO Sage Working Group on Vaccine Hesitancy reviewed approaches for changing vaccination behavior [14]. They suggested that social marketing could be useful in changing vaccination behavior by reducing vaccine hesitancy, as has been described previously [15]. Discussion focusing on social marketing played a central role at the meeting, with participants recognizing that when vaccination is voluntary, people need to be convinced of its value to them and their communities. Social
Community of practice
Annual meetings on vaccine acceptance and confidence organized by the Fondation Mérieux at their conference center near Annecy in France since 2011 have effectively nurtured an informal global community of practice [52], [53], [54]. The field of vaccine acceptance and confidence is interdisciplinary – for example, the authors of this article come from fields as diverse as political science, anthropology, medicine, public health and communication science, and the annual meetings have aimed to
Conclusions: keep on keeping on
“Keep on keeping on,” as stressed by Jo Yarwood of the UK Health Protection Unit in the keynote address entitled: ‘Turmoil, trust and truth: Immunizing today’s ‘post-fact’ world’, emphasizes the fact that we must continue our efforts to promote vaccine acceptance, along with access, affordability (both financial and opportunity costs) and awareness, to ensure high vaccination rates. The emphasis on sustaining such work reflected the attention the speaker’s own country, the UK (where vaccination
Acknowledgements
The authors would like to thank Margaret Haugh, MediCom Consult, Villeurbanne, France for providing medical writing and editorial services. The meeting was funded by an unrestricted grant from Sanofi Pasteur.
Potential conflicts of interest
Katie Attwell has previously received travel and accommodation provided by GSK. One of her previous research projects was funded by Sanofi Pasteur. Angus Thomson is employed by Sanofi Pasteur. The other authors do not have any potential conflicts of interest to declare.
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5th Annual meeting held at Fondation Mérieux, Les Pensières, Center for Global Health, Veyrier-du-Lac, France on 25–27 September 2017.