Vaccine hesitancy in the EU: state of play and impact on vaccination programmes
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Lucia PASTORE CELENTANO, MD, MSc Head of the Vaccine Preventable Diseases Programme, ECDC “Addressing vaccine hesitancy in challenging times” European Health Forum Gastein, 05 October 2017
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Vaccine hesitancy in the EU: state of play and impact on vaccination programmes
- 1. Vaccine hesitancy in the EU: state of play and impact on vaccination programmes Lucia PASTORE CELENTANO, MD, MSc Head of the Vaccine Preventable Diseases Programme, ECDC “Addressing vaccine hesitancy in challenging times” European Health Forum Gastein, 05 October 2017
- 2. The Vaccination Paradox in the post factual era vaccine safety disease incidence Doctors trust Parents trust vaccine coverage
- 3. Determinants of vaccine hesitancy in Europe ECDC. Rapid literature review on motivating hesitant population groups in Europe to vaccinate. Stockholm: ECDC; 2015
- 4. Vaccine and vaccination specific influences No perceived need for vaccine Access Financial cost Lack of recommendation from providers, or inconsistent advice from providers New vaccines ECDC. Rapid literature review on motivating hesitant population groups in Europe to vaccinate. Stockholm: ECDC; 2015 Challenges on the demand side, but also on supply side: HOW EFFECTIVE ARE WE ?
- 5. Which groups are hesitant? No group is entirely hesitant but pockets of hesitancy can be found in all population groups: Parents and mothers Teenagers Healthcare workers Pregnant women Some religious communities Underserved populations Social media users… Concerns about the possible formation of clusters of vaccine hesitant populations which might expand and affect the general public (i.e. doctors influencing their patients) ECDC. Rapid literature review on motivating hesitant population groups in Europe to vaccinate. Stockholm: ECDC; 2015
- 6. Hesitancy in healthcare workers in Europe Vaccine hesitancy in HCWs is present in all the countries which took part of the ECDC study (Croatia, France, Greece and Romania); Inconsistencies in perceptions about vaccination: praising benefits of vaccines but also sharing concerns; Most important concern: vaccine safety; Important role of the media in vaccine hesitancy; Doctors have high feelings of trust in health authorities but mistrust pharmaceutical companies; HCWs believe it is their role to respond to patient hesitancy; Attitude and knowledge of HCWs can influence their vaccine uptake, their intention to recommend vaccination, and overall vaccination coverage. ECDC. Vaccine hesitancy among healthcare workers and their patients in Europe – A qualitative study. Stockholm: ECDC, 2015.
- 7. Hesitancy is often a vaccine and country specific phenomenon Autism and MMR in UK POTS and HPV in Denmark
- 8. But the negative effects are widely spread in other EU countries Austrian article: Kreidl P, de Kat C. Utilization and impact of European immunization week to increase measles, mumps, rubella vaccine uptake in Austria in 2016. Vaccine (2017), http://dx.doi.org/10.1016/j.vaccine.2017.07.047 France MMR VC Ireland Italy In France, alternative medicines practicing is associated with hesitancy Verger Pierre et al. Prevalence and correlates of vaccine hesitancy among general practitioners: a cross-sectional telephone survey in France, April to July 2014. Euro Surveill. 2016;21(47):pii=30406.
- 9. Evidence Generation (to inform research, policy, practice) Document attitudes towards vaccines and vaccination Analyse barriers and drivers to uptake, incl. vaccine-specific analyses Knowledge, attitudes, and practices, part. of HCWs Effective public health communications strategies Communications guides and toolkits Tools to help improving healthcare workers’ interpersonal messaging Improving knowledge of ‘enabling’ actors (e.g. programme managers) Adaptation and contextualisation of outputs at national level Pilot collaboration on real-time media monitoring Piloting tools to capture evidence through media and social media (HPV focus) Better capture sentiment, as well get to grips with main questions Launch of Technical Advisory Group on communications to increase VCR Provide EU forum to discuss practice and strategies Use of online media, responding to un-scientific facts, and crisis communication https://ecdc.europa.eu/en/immunisation-vaccines/vaccine-hesitancy ECDC activities to support countries
- 10. Cultural adaptation of health communication guidance Background information Between 2012 and 2017 a stakeholder approach to translation and adaptation was developed, tested and refined through early country experience in Bulgaria, Czech Republic, Hungary and Romania and served as a process guide for subsequent national projects in Austria, Estonia, Greece and Italy. The ECDC Guides were developed through systematic reviews and formative qualitative research that involved a variety of countries and stakeholder groups: health professionals, health authorities, non-governmental advocates, beneficiaries (including parents and grandparents, representatives of “poorly reached ” populations such as Roma), communicators and social marketers.
Editor's Notes
- Could also be used to highlight that although concerns around vaccine safety are as old as vaccine themselves, as disease rates have gone down and the widespread use of vaccines has grown, so have anxieties about vaccine safety and their regulation. And the challenge today is that modern day communication capacities have provided many new platforms for speeding up the spread of these anxieties. Could also briefly define the notion of ‘post-factual’ era or perhaps Jonas might cover that and we could just mention that there are broader dynamics impacting trust and decision-making as part of dynamics that are broader and outside the immunisation programme
- The second biggest type of influence in Europe are vaccine and vaccination specific. Some individuals (particularly healthcare workers for influenza) do not perceive a medical need for the vaccine. This does not necessarily mean a lack of trust in the effectiveness of the vaccine – but more a lack of perceived personal need for vaccination (i.e. not being in a risk group) Some have a problem of access – either because of a lack of time or because of issues with availability of vaccines Some vaccines can be particularly expensive and this might cause a barrier to vaccination Sometimes there can be a lack of recommendation from providers or they can provided inconsistent advice (different providers giving different information) New vaccines are also particularly feared (i.e. HPV), mainly because of a fear of insufficient testing and knowledge about the vaccine (in terms of vaccine safety, and effectiveness)
- While no population group is entirely hesitant, studies have shown that pockets of hesitancy can be found in all population groups (in Europe but also in the world). Including parents and mothers, teenagers, healthcare workers, pregnant women, some religious communities, social media users… but not only. These are the most commonly studied groups, but there are many more. Researchers have raised concerns about the possible formation of clusters of vaccine hesitant populations, which might expand and affect the general public. For instance, if a high proportion of vaccine providers and doctors become hesitant, this might impact vaccine uptake – as doctors are often perceived as the most trusted source of information.
- The results from the qualitative interviews with HCWs from Croatia, France, Greece and Romania revealed that vaccine hesitancy is present in all four countries among patients, but also their vaccine providers. Some inconsistencies in perceptions about vaccination were observed amongst many HCWs, who may have been praising the benefits of vaccines while at the same time sharing some concerns about their effectiveness or safety. The most important concern across all countries was vaccine safety, and the fear of vaccine side effects. New vaccines, such as the HPV vaccine, were singled out due to perceived lack of testing for vaccine safety and efficacy. High trust was expressed in the health authorities but mistrust of pharmaceutical companies who not only have financial interests but do not communicate sufficient information about side effects and exert pressure on doctors. HCWs in Greece showed particularly high mistrust of pharmaceutical companies, as well as of the government and the health system, which could have been influenced by the political and economic situation in which the interviews were conducted and requires intervention to avoid collateral damage on vaccination uptake. The notion that it is a doctor’s responsibility to respond to hesitant patients was reported in all countries. Most HCWs felt comfortable responding to patients, and believed they had sufficient resources. Some HCWs believed they should do even more and try to influence patients to make sure they get vaccinated. However, in France, most study participants described their role as providers of neutral information, explaining patients should make that decision for themselves. HCWs are often seen as having the greatest influence on patients’ decision to get vaccinated. It is therefore important they not only communicate with hesitant patients, but that they know how to respond to concerns or doubts. Although some commonalities between countries can be found, determinants of hesitancy have also been shown to be country- and context-specific and need to be addressed as such. National vaccination programmes have to be strengthened to develop the capacity of identifying local determinants of vaccine hesitancy, whether in patients or in healthcare workers. Programmes need to develop strategies adapted to address these determinants, in a social, cultural, political and economic context. This is particularly important as the attitude and knowledge of HCWs can influence their vaccine uptake, their intention to recommend vaccination, and overall vaccination coverage.