Measuring and monitoring vaccine confidence Emilie Karafillakis Vaccine Confidence Project London School of Hygiene & Tropical Medicine emilie.karafillakis@lshtm.ac.uk IAMI Regional Meeting Madrid, 2 February 2017 1
Man, too, is a stubborn microbe Jean Giono, The Horseman on the Roof 2
Confidence in vaccines Confidence in providers Confidence in systems Confidence in sexual & reproductive health interventions Director: Heidi Larson Co-director: Pauline Paterson Communication: Jay Dowle Researchers: Emilie Karafillakis, Clarissa Simas, William Schulz, Elizabeth Smout 3 PhD students: Rose Wilson, Richard Clarke, Antonis Kousoulis, Suzanne Hurst
Confidence crises are varied and contextspecific Childhood vaccines - Mercury MMR - Autism Polio - Sterilisation, Politics, mistrust HPV Mass fainting episodes Tetanus Sterilisation, religious beliefs 4
Need for quick monitoring and measurement tools Heidi J. Larson et al: Tracking the global spread of vaccine sentiments: The global response to Japan s suspension of its HPV vaccine recommendation. Human Vaccines & Immunotherapeutic 9, no 10 (2014):1-8. 5
Measuring vaccine confidence Understand nature and scale of waning confidence to inform appropriate interventions Monitor changes in vaccine confidence to detect and investigate drops in confidence early Use diverse types of data, combine different measurement approaches 6 Heidi Larson
The Vaccine Confidence Project Framework Sustaining and amplifying factors Rumour prompters Adverse Events Following Immunisation (AEFI) New research reported (e.g. Wakefield) New recommendation or policy change (e.g. removal of thimerosol from vaccines) New product (or change of current product source or packaging) Political motivations Geographic spread of rumours Frequency of rumours Media reports Historic bad experience that lowers public trust Socio-economic marginalisation (general distrust in the system ) Influencers (e.g. celebrities publicly against vaccines) Outcome/impact Vaccine refusals Vaccine suspended Vaccine preventable disease outbreaks 7 Heidi Larson
Theoretical framework to measure vaccine hesitancy: engagement and trust Trust toward health authorities Passive Conformism + + Enlightened conformism - + Risk culture, Healthism Passive hesitancy Rationalised hesitancy - Refusal 8 (Peretti-Watel, Plos Current Outbreaks, 2015)
9 Karafillakis E, et al. Vaccine hesitancy among healthcare workers in Europe: a qualitative study. Vaccine (2016). Qualitative analysis to understand drivers of change in vaccine confidence 4-country European qualitative study on HCW vaccine hesitancy (ECDC) Inconsistencies in perceptions about vaccination: praising benefits of vaccines and sharing concerns Most important concern: vaccine safety Important impact of anti-vaccination content in media Doctors have high feelings of trust in health authorities but mistrust pharmaceutical companies HCWs believe it is their role to respond to patient hesitancy
Understanding the gap to address it Identify key determinants of trust/distrust over time and factors that influence vaccine decision-making Isolate predictors of problems Design engagement strategies Anti-vaccine Vaccine hesitancy Immunisation as norm Pro-vaccine Where are the tipping points? 10 Heidi Larson
Systematic review of determinants of VH in Europe Vaccine safety Low risk of contracting VPD VPD not severe Vaccines don't work Lack information, misunderstandings Vaccines not necessary Not enough evidence, testing Not offered, recommended against Strong immune system Do not qualify Vaccines too new Too young Risks > benefits Not priority Negative media reports Against vaccination in general Natural alternatives Mistrust pharmaceutical companies Mistrust health authorities Vaccine cause the disease they prevent Mistrust governments Influenced by family/friends VPD have benefits Promiscuity, STI vaccine Concerns about injections Mistrust doctors Never had/get VPD Too many vaccines Negative experience (personal) Conflicting messages Immune system too weak 5 5 5 5 6 6 6 6 7 7 7 7 8 8 9 9 12 12 11 11 11 15 21 20 20 24 32 31 36 VPDs not severe 51 Low risk of contracting VPDs 0 20 40 60 80 100 120 107 Fear of side effects Frequency of concerns: number of qualitative studies where concerns were mentioned + number of quantitative studies where more than 20% of participants mentioned those concerns 11 Karafillakis & Larson (2015). Analysis of public concerns and perceptions related to benefits and risks of vaccines. ADVANCE D1.4 Report
12 Larson H, et al. The state of vaccine confidence 2016: global insights through a 67-country survey. Ebiomedicine (2016). Surveys: the state of vaccine confidence in the world 65,819 individuals, 67 countries September-December 2015 Online, telephone, or face-to-face Four key components: 1. Vaccines are important for children to have 2. Overall, I think vaccines are safe 3. Overall, I think vaccines are effective 4. Vaccines are compatible with my religious beliefs
13 Larson H, et al. The state of vaccine confidence 2016: global insights through a 67-country survey. Ebiomedicine (2016). Interactive Country Data Viewer Available at: www.vaccineconfidence.org
Overall, I think vaccines are safe 14 Larson H, et al. The state of vaccine confidence 2016: global insights through a 67-country survey. Ebiomedicine (2016).
15 Larson H, et al. The state of vaccine confidence 2016: global insights through a 67-country survey. Ebiomedicine (2016). Main conclusions from the survey Vaccine sentiment more negative in European and West Pacific regions Western & Northern Europe > Eastern & Southern Europe USA, Canada, Mexico > South American countries Risk of transnational influences of vaccine sentiments Education does not always imply confidence Perceptions of vaccine important (higher than safety) may mitigate losses in vaccination uptake
Real-time media monitoring of public pulse Larson H, et al. Measuring vaccine confidence: analysis of data obtained by a media surveillance system used to analyse public concerns about vaccines. Lancet Infectious Diseases (2013). 16
9/10/2015 9/12/2015 9/14/2015 9/16/2015 9/18/2015 9/20/2015 9/22/2015 9/24/2015 9/26/2015 9/28/2015 9/30/2015 10/2/2015 10/4/2015 10/6/2015 10/8/2015 10/10/2015 10/12/2015 10/14/2015 10/16/2015 10/18/2015 10/20/2015 10/22/2015 10/24/2015 10/26/2015 10/28/2015 10/30/2015 11/1/2015 11/3/2015 11/5/2015 11/7/2015 11/9/2015 11/11/2015 11/13/2015 11/15/2015 Global media monitoring of HPV vaccines Global online news media (no social media) 10 September 15 November 2015, GoogleAlerts Wide search strategy around HPV vaccine with colloquial as well as scientific terms in English Before and after EMA report on HPV vaccine safety 30 25 20 15 10 5 0 PRELIMINARY DATA DO NOT DUPLICATE - EMILIE KARAFILLAKIS 2017 17
Themes identified by HPV media monitoring Denmark Benefits Safety EMA review Morality Not needed Mandates Japan Parent groups Industry influence Doctorpatient influence PRELIMINARY DATA DO NOT DUPLICATE - EMILIE KARAFILLAKIS 2017 18
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20 The Vaccine Confidence Project (2015). The state of vaccine confidence 2015. London: LSHTM. Measuring vaccine confidence: no single metric tells the story Hesitancy Rates & reasons Language Sentiment Analysis Real-Time Detection Socioeconomic correlates Historical, Political, Analysis Timeseries analysis of coverage
Sometimes the solution lies outside the vaccination programme 21 The Vaccine Confidence Project (2015). The state of vaccine confidence 2015. London: LSHTM.
www.vaccineconfidence.org 22