Vaccine Communication

Transcription

1 Vaccine Communication NCIRS 20 th Anniversary 3 November, 2017 Julie Leask Associate Professor, Sydney Nursing School School of Public Health, Sydney Medical School Visiting Fellow, NCIRS Julie.leask@sydney.edu.au The University of Sydney 1

2 Acknowledgements Kerrie Wiley, USYD Catherine King, Helen Quinn, NCIRS Sami Carlson, USYD Catherine Helps, USYD Maria Chow, USYD Hal Willaby, USYD Telphia Joseph, UNSW Amy Creighton Peter Massey, Hunter New England LHD Adam Dunn, Macquirie Univ Katie Attwell, UWA Spring Cooper, CUNY Paul Corben, North Coast LHD The University of Sydney SKAI TEAM Julie Leask, Nina Berry, Lyndal Trevena, Penelope Robinson, Sue Randall USYD Kristine Macartney NCIRS Margie Danchin, Murdoch Children s Research Institute Tom Snelling Telethon Kids Institute Paul Kinnersley, Cardiff University Holly Witteman, University de Laval, Canada

3 The University of Sydney The current concerns

4 Opportunity and capability still a barrier 100% 90% 80% 92% Fully vaccinated ~4.7% ~3.3% 1 70% 10% Lack of Opportunity or Capability Lack of Acceptance 0% Beard FH et al. Trends and patterns in vaccination objection, Australia, Medical Journal of Australia 2016; 204 (7):275 Michie et al Behaviour Change Wheel s COM-B model, Implementation Science The University of Sydney Senn A. Human rights and capabilities. Journal of Human Development. 2005;6:

5 The place of communication Helps improve coverage in conjunction with measures to remind, access etc. Important for good process Is a process of exchange of information among multiple stakeholders Understanding the communication context is vital What we learnt in 20 years of research at NCIRS and beyond.

6 Activism then

7 Activism now

8 Anti-vaccination themes then and now

9 Now - civil society pushback

10 Andrew Wakefield then and now

11 Newspapers then 5% 5% Pro-vaccine or neutral Anti vaccine 90% Anti-anti vaccine Leask J-A, Chapman S. An attempt to swindle nature : press antiimmunisation reportage Australian and New Zealand Journal of Public Health 1998; 22:

12 The web now Ave score = 30/100 Anti-Vaccine N=10 (13%) Wiley et al. An audit of the quality of online immunisation information available to Australian parents. BMC Public Health (2017) 17:76 Pro-Vaccine N=65 (87%) Ave score = 61/100

13 Then binary Provaccine Antivaccine

14 Now - ordinal Antivaccination activists Decliners..of all vaccines Never did, or no longer vaccinate Hesitant delay/selective Cherry pick Seek out information Vaccinate Partially Hesitant acceptors Many concerns but comply with schedule Cautious Acceptors Minor concerns Hope nothing goes wrong Vaccinate Fully Unquestioning Acceptors No questions or concerns Sources: Leask et al BMC Pediatrics 2012 Benin et al Pediatrics2009 Chow et al AFP 2017

15 Then and now - influencers Belief systems Stories Visible outcomes Social groups and norms Experiences Health professionals New mother: I ve got a fair amount of faith in my doctor and I tend to trust what she says and trust her opinion, so I think that I would believe what she would say before I d believe anything I saw on TV (Leask et al, Vaccine, 2006)

16 Chow M, Danchin M, Willaby HW, Pemberton S, Leask J. Parental attitudes, beliefs, behaviours and concerns towards childhood vaccinations in Australia: a national online survey. Australian Family Physician 2017;46(3):

17 Maternal influenza vaccine uptake Would take up an influenza vaccine while pregnant if GP recommended it Adjusted Odds Ratio 7.67 ( ) Has received a recommendation to have an influenza vaccine during this pregnancy Adjusted Odds Ratio ( ) Wiley KE, Massey PD, Cooper SC, Wood NJ, Ho J, Quinn HE, Leask J. Uptake of influenza vaccine by pregnant women: a cross-sectional survey. Med J Aust 2013;198:

18 Child influenza vaccine uptake Chow MY, King C, Booy R, Leask J. Parents Intentions and behavior regarding seasonal influenza vaccination for their children: a survey in child-care centers in Sydney, Australia. Journal of Pediatric Infectious Diseases 2012;7(2): 89-96

19 New - indicators of community coverage Dunn AG, Surian D, Leask J, Dey A, Mandl KD, Coiera E. Mapping information exposure on social media to explain differences in HPV vaccine coverage in the United States, Vaccine 2017; 35(23):

20 Newer timing the engagement Antenatal survey, North Coast NSW 2016, Paul Corben - unpublished

21 Then and now: health care providers can have their own vaccine concerns Additives in vaccines may be harmful Concurrent immunisation might overload immune system Children get too many vaccines in the first two years of life Agree Unsure Disagree Good eating habits/healthy lifestyle reduce need for immunisation Complementary health practices reduce need for immunisation 0% 20% 40% 60% 80% 100% Leask J, Quinn HE, Macartney K, et al. Immunisation attitudes, knowledge and practices of health professionals in regional NSW. Aust N Z J Public Health 2008;32:224-9.

22 Then the facts are not enough The University of Sydney Page 24

23 Now more communication science The University of Sydney Page 25

24 Debunking Cook J and Lewandowsky S ook.pdf Familiarity backfire effect Worldview backfire effect Debunk well then fill the gap

25 Making use of what we have learnt Communication in the clinic

26 Strategies and Resources for primary care Integrated package of resources and structured communication for primary care providers Aims to move parents towards vaccination Build trust among non-vaccinators, support the hesitant, facilitate consent Empirically supported: Research on provider practices Communication science Motivational interviewing Calgary Cambridge Model Investigators: Julie Leask, Nina Berry, Margie Danchin, Lyndal Trevena, Kristine Macartney, Tom Snelling, Paul Kinnersley, Holly Witteman. Funding: Department of Health and National Centre for Immunisation Research and Surveillance

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28 Resources Core fact Avoid repeating myth The myth Moderate language Play the issue, not the opponent Explain core fact Authors and qualifications Funding source Fill the gap Other levels Evidence base Trusted sources

29 Beyond the pamphlets When you understand it you have the power to pass it on. So the service may have spoke to one mum, but guess who that mum has spoken to in the next couple of hours? 20 mums and she is passing that on, you might not have that flash brochure...but the power and the time that you have put into her, she is putting that into her friends. A participant in Gaba Binggi (Good Needles) project by Amy Creighton

30 Working with communities Tailoring Immunization Programmes (TIP): from Montenegro to Maitland and beyond. 33

31 Immunisation Alliance WA Developing evidence based strategies for addressing childhood vaccination rejection. NHMRC Project Grant. Leask S, Carter S, Ward P, Barclay L, Degeling C.

32 Aim COSSI Collaboration of Social Science in Immunisation To inform Australian immunisation policy and practice with high quality evidence from the social sciences by supporting capacity in research and evaluation, collaborations and translation. Steering committee Julie Leask, Kerrie Wiley, Katrina Clark, Marianne Trent, Jane Frawley, Katie Attwell, Holly Seale, Margie Danchin, Sami Carlson, Liz Lewis, Chris Staples, Jody Stephenson, Amy Creighton, Patrick Cashman, Susan Thomas, Kerrie Wiley, Melinda Hassall, Anita Heywood NCIRS website listing 29 projects, 30 members Mailman list - 60 subscribers

33 Looking forward Take on what we have learnt Facts are important but not a panacea Make what, when, and with whom we communicate evidence informed How you communicate is even more important Action is a form of communication More precision in descriptive research questions More intervention research Improving adult coverage The role of nurses and midwives Preparedness for safety signals (Catherine King) Start before the scare Plan who will communicate and how Communicate early and often Err on the side of disclosure Sustain trust Funding, sustaining and building on a body of knowledge in the social science of vaccination is vital for resilient programs.