13,773 Vaccine Hesitancy in the Polio Context, The Drum Beat 769, January 23, 2019

* UNDERSTANDING AND MEASURING VH
* EXACERBATING FACTORS
* STRATEGIES FOR ADDRESSING VH
* WINDOW ON A FEW SPECIFIC VH GEOGRAPHIES
* PLEASE LEND YOUR VOICE TO THE CI SURVEY

• 1.Vaccine Hesitancy, Refusal and Access Barriers: The Need for Clarity in Terminology
  by Helen Bedford, Katie Attwell, Margie Danchin, Helen Marshall, Paul Corben and Julie Leask
  The term ‘vaccine hesitancy’ is used by some experts and commentators to explain all partial or non-immunisation. The authors of this article propose that more precision in the term is needed. They critically examine the oft-cited WHO SAGE definition of VH, which cites factors such as confidence (do not trust vaccine or provider), complacency (do not perceive a need for a vaccine, do not value vaccination), and convenience (do not have full access to vaccines due to issues around physical availability, geographical accessibility, or the ability to understand because of language or health literacy). [Aug 2017]
• 2.What Is ‘Confidence’ and What Could Affect It?: A Qualitative Study of Mothers Who Are Hesitant about Vaccines
  by Judith A. Mendel-Van Alstyne, Glen J. Nowak and Ann L. Aikin
  The themes that surfaced in this study indicate that while trust is a major component of confidence, parents’ vaccine confidence also encompasses having a sense of control, familiarity and experience, satisfaction with one’s knowledge, and a high degree of certainty regarding the outcome. This suggests that instilling or strengthening parents’ confidence in vaccines, whether during a physician conversation or through education materials, might benefit from recognising or addressing these factors, particularly if the vaccine or recommendation is relatively new. Similarly, the validity of efforts to measure parent vaccine confidence may increase if they include items that assess these dimensions. [Sep 2017]
• 3.Beyond Confidence: Development of a Measure Assessing the 5C Psychological Antecedents of Vaccination
  by Cornelia Betsch, Philipp Schmid, Dorothee Heinemeier, Lars Korn, Cindy Holtmann and Robert Böhm
  Most existing measures assessing VH focus primarily on confidence in vaccines and the system that delivers them. However, empirical and theoretical work has found that complacency (not perceiving diseases as high risk), constraints (structural and psychological barriers), calculation (engagement in extensive information searching), and aspects pertaining to collective responsibility (willingness to protect others) also play a role in explaining vaccination behaviour. The objective of this study was therefore to develop a validated measure of these «5C» psychological antecedents of vaccination. [Dec 2018]
• 4.Measuring Vaccine Hesitancy: Field Testing the WHO SAGE Working Group on Vaccine Hesitancy Survey Tool in Guatemala
  by Gretchen J. Domek, Sean T. O’Leary, Sheana Bull, Michael Bronsert, Ingrid L. Contreras-Roldan, Guillermo Antonio Bolaños Ventura, Allison Kempe and Edwin J. Asturias
  The SAGE Working Group on Vaccine Hesitancy developed a common diagnostic tool, the Vaccine Hesitancy Scale (VHS), to identify and compare hesitancy in different global settings. This study investigates the reliability and validity of the VHS measure applied in urban and rural Guatemala using a factor analysis. The researchers argue that future modification of the VHS would benefit from including multiple dimensions of VH, especially related to the concept of convenience. [Jul 2018]
• See also:
  * Review of Vaccine Hesitancy: Rationale, Remit and Methods
  * Vaccine Hesitancy: Understanding Better to Address Better
  * Introduction of Inactivated Polio Vaccine and Specific Determinants of Vaccine Hesitancy
  * Measuring Trust in Vaccination: A Systematic Review

• 5.Public Trust in Vaccination: An Analytical Framework
  by Vijayaprasad Gopichandran
  With a focus on the Indian context, this paper develops an analytical framework to assess trust in vaccination and addresses specific issues pertaining to mistrust in vaccination. «In certain districts of Uttar Pradesh and Bihar, there was serious resistance to the polio vaccination due to widespread misinformation among the minority communities that it was a western ploy to sterilise the minority populations and thus reduce their numbers….A deeper analysis…revealed that…the community was tired of the repeated rounds of the pulse polio campaign, which had led to suspicions, and the minority community was even less amenable to vaccination because the complete apathy of the mainstream health system towards their other healthcare needs had left them feeling marginalised and oppressed….This highlights how trust in vaccination is strongly influenced by trust in the health system and the social, historical and political context.» It is argued that active communit! y engagement with respect to vaccination policies is one of the key measures for ensuring that the vaccination policy and health system are viewed as trustworthy. [April-June 2017]
• 6.Science and Politics in the Polio Vaccination Debate on Facebook: A Mixed-Methods Approach to Public Engagement in a Science-Based Dialogue
  by Daniela Orr
  In the context of this study on public engagement with the 2013 polio crisis in Israel in a social media environment, the researchers point out that the vast majority of the public are not biologists or epidemiologists, and they thus need to trust the sources that deliver the information to them and act upon guidance from these sources. This opens the door to political considerations and evaluations of the sources who deliver the information. The researchers consider «political» anything that involves power relations, including dialogue and public engagement in the scientific realm. They characterise mainstream media and social media as «among the most important and powerful agents that mediate between science and the public». [Mar 2018]
• 7.Media Representation of Vaccine Side Effects and Its Impact on Utilization of Vaccination Services in Vietnam
  by Bach Xuan Tran, Victoria L Boggiano, Long Hoang Nguyen, Carl A Latkin, Huong Lan Thi Nguyen, Tung Thanh Tran, Huong Thi Le, Thuc Thi Minh Vu, Cyrus SH Ho and Roger CM Ho
  Vietnam’s vaccine-related milestones include becoming polio free in 2000. However, there have been examples in which reports in the media of adverse effects following immunisations (AEFIs) have threatened these successes. For instance, in 2013, a few AEFIs were reported after infants received the Quinvaxem vaccine, which triggered controversies in many print and internet-based Vietnamese newspapers. A total of 68.2% of subjects hesitated to receive vaccines after hearing about AEFIs in the media, and 12.4% subjects would refuse vaccination altogether after hearing about AEFIs. Receiving information from community health workers and their relatives, colleagues, and friends was negatively associated with VH, but facilitated vaccine refusal after reading about AEFIs in the media. [Sep 2018]
• See also:
  * Sentiment, Contents, and Retweets: A Study of Two Vaccine-Related Twitter Datasets
  * Misinformation Lingers in Memory: Failure of Three Pro-Vaccination Strategies
  * Silent refusals and distrust of vaccines is a big challenge for vaccination teams
  * Vaccine Hesitancy: Towards a Better Understanding of Drivers and Barriers to Awareness, Acceptance and Activation

• 8.Vaccine Hesitancy among Mobile Pastoralists in Chad: A Qualitative Study
  by Mahamat Fayiz Abakar, Djimet Seli, Filippo Lechthaler, Esther Schelling, Nhan Tran, Jakob Zinsstag and Daniel Cobos Muñoz
  The types of demand-side barriers reported most frequently among the mobile pastoralists in Chad studied were mistrust of the Expanded Programme on Immunization (EPI) and polio vaccination outreach services, followed by health system issues and concerns related to potential harm of vaccines. In addition to the language barrier between health professionals and nomadic communities, health workers seemed to ignore the basic cultural and religious norms in the camps, and there were few Muslim health workers. [Nov 2018]
• 9.Polio Vaccine Hesitancy in the Networks and Neighborhoods of Malegaon, India
  by Jukka-Pekka Onnela, Bruce E. Landon, Anna-Lea Kahn, Danish Ahmed, Harish Verma, A. James O’Malley, Sunil Bahl, Roland W. Sutter and Nicholas A. Christakis
  To learn about social network factors associated with polio VH, the researchers investigated social and spatial clustering of households by their vaccine acceptance status in Malegaon, India, an area known for vaccine refusal and repeated detection of polio cases. In short, there was both social and geographic clustering. «[T]aking into account people’s social network position can enhance the effectiveness and efficiency of public health messaging and interventions.» [Feb 2016]
• 10.Successful Polio Supplementary Immunisation Activities in a Security Compromised Zone – Experiences from the Southwest Region of Cameroon
  by Eposi C. Haddison, Dorine Ngono, Gael T. Kouamen and Benjamin M. Kagina
  According to the authors, the 2018 polio supplementary immunisation activity (SIA) in the Southwest region of Cameroon was successful due to: political will, optimal planning and co-ordination, support from partners, widespread sensitisation and mobilisation of the members of the community before and during the SIA, and dedication by the teams involved. Several challenges were faced that were either resolved or circumvented. For example, misunderstanding of the objectives of immunisation and fear that vaccines might transmit diseases or be used as a weapon by the authorities during times of conflict may lead to VH. To prevent such mistrust, the WHO and UNICEF were portrayed as the main organisers. This strategy permitted vaccination in certain districts where the population was suspicious of the government. [Oct 2018]
• 11.Understanding vaccine hesitancy in polio eradication in northern Nigeria
  by Taylor S, Khan M, Muhammad A, Akpala O, van Strien M, Morry C, Feek W and Ogden E
  This study is based on a purposive sampling survey of 1,653 households in high- and low-performing (relative to VH) rural, semiurban, and urban areas of 3 high-risk states of northern Nigeria in 2013-14 (Sokoto, Kano, and Bauchi). One finding: Women in very low-risk settlements were considerably more likely to have participated in community meetings, regardless of type of meeting. The results suggest that strategies to address the micro-political dimension of vaccination – expanding community-level engagement, strengthening the role of local government in public health, and enhancing public participation of women – should be pursued to reduce non-compliance as a set of strategies complementary to conventional didactic/educational approaches and working through religious and traditional «influencers». [Oct 2017]
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• See also:
  * Vaccine Hesitancy Prevalence and Correlates in Riyadh, Saudi Arabia
  * The Impact of Access to Immunization Information on Vaccine Acceptance in Three Countries [Botswana, the Dominican Republic (DR), and Greece]
  * State of Vaccine Confidence in the EU: 2018
  * Vaccine Acceptance, Hesitancy and Refusal in Canada: Challenges and Potential Approaches

• 12.Simulated Encounters With Vaccine-Hesitant Parents: Arts-Based Video Scenario and a Writing Exercise
  by Kaisu Koski, Juho T. Lehto and Kati Hakkarainen
  The SAGE Working Group for Vaccine Hesitancy calls for appropriate training for medical and healthcare students concerning encounters with vaccine-hesitant individuals. This study, conducted among vaccine-critical parents in the Netherlands and Finland, is an experimental pilot test in stimulating medical students’ understanding of, and ability to respond to, vaccine-hesitant parents’ beliefs and questions. An arts-based video scenario and a writing exercise are used to demonstrate a rich narrative case by realistically portraying the complexity of patient presentation and interaction, stimulating the students’ holistic awareness of VH. [Aug 2018]
• 13.Identification of Preliminary Core Outcome Domains for Communication about Childhood Vaccination: An Online Delphi Survey
  by Jessica Kaufman, Rebecca Ryan, Simon Lewin, Xavier Bosch-Capblanch, Claire Glenton, Julie Cliff, Angela Oyo-Ita, Artur Manuel Muloliwa, Afiong Oku, Heather Ames, Gabriel Rada, Yuri Cartier and Sophie Hill
  The researchers focused on 3 common types of vaccination communication interventions with potential to address VH, defined by their purposes: communication to (i) inform or educate, (ii) remind or recall, or (iii) enhance community ownership. Using an online Delphi survey, they asked different stakeholders to rate the importance of outcome domains that could be measured for each communication type. [Aug 2017]
• 14.Motivational Interviewing: A Promising Tool to Address Vaccine Hesitancy
  by Arnaud Gagneur, Virginie Gosselin and Eve Dubé
  The authors of this commentary suggest that motivational interviewing (MI) is a promising avenue to address the complex issue of VH. MI is a patient-centred intervention style that seeks to enhance patients’ internal motivation to change behaviour by exploring and resolving their own ambivalence. It is based on 4 main principles: (i) avoid the «righting reflex» (the tendency of health professionals to advise patients about the right path for good health), (ii) listen with empathy, (iii) explore and understand the patient’s own motivations, and (iv) encourage and support self-efficacy. The underlying spirit of MI is based on partnership, acceptance, compassion, and evocation. [Jul 2018]
• See also:
  * Addressing Barriers to Vaccine Acceptance: An Overview
  * Catalogue of Interventions Addressing Vaccine Hesitancy
  * Countering Vaccine Hesitancy
  * Web-based Social Media Intervention to Increase Vaccine Acceptance: A Randomized Controlled Trial
  * Addressing Vaccine Hesitancy Requires an Ethically Consistent Health Strategy
  * Let’s Talk about Hesitancy: Enhancing Confidence in Vaccination and Uptake
  * Going with the Grain of Cognition: Applying Insights from Psychology to Build Support for Childhood Vaccination
  * A Guide for Exploring Health Worker/Caregiver Interactions on Immunization

• To access much more content on VH and communication, search (and use filters to refine – e.g., by geography) The CI’s polio site here.

Full list of the CI Partners:
ANDI, BBC Media Action, Bernard van Leer Foundation, Breakthrough, Citurna TV, Fundación Imaginario, Fundación Nuevo Periodismo Iberoamericano (FNPI), Heartlines,Johns Hopkins Center for Communication Programs, Maternal and Child Survival Program (MCSP), MISA, Open Society Foundations, Oxfam Novib, PAHO, The Panos Institute, Puntos de Encuentro, SAfAIDS, Sesame Workshop, Soul City, STEPS International, UNAIDS, UNICEF, Universidad de los Andes, World Health Organization (WHO), W.K. Kellogg Foundation

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Executive Director: Warren Feek wfeek@comminit.com