Jeremy Ward

Vaccine hesitancy: clarifying a theoretical framework for an ambiguous notion.

Today, according to many public health experts, public confidence in vaccines is waning. The term “vaccine hesitancy” (VH) is increasingly used to describe the spread of such vaccine reluctance. But VH is an ambiguous notion and its theoretical background appears uncertain. To clarify this concept, we first review the current definitions of VH in the public health literature and examine its most prominent characteristics. VH has been defined as a set of beliefs, attitudes, or behaviours, or some combination of them, shared by a large and heterogeneous portion of the population and including people who exhibit reluctant conformism (they may either decline a vaccine, delay it or accept it despite their doubts) and vaccine-specific behaviours. Secondly, we underline some of the ambiguities of this notion and argue that it is more a catchall category than a real concept. We also call into question the usefulness of understanding VH as an intermediate position along a continuum ranging from anti-vaccine to pro-vaccine attitudes, and we discuss its qualification as a belief, attitude or behaviour. Thirdly, we propose a theoretical framework, based on previous literature and taking into account some major structural features of contemporary societies, that considers VH as a kind of decision-making process that depends on people’s level of commitment to healthism/risk culture and on their level of confidence in the health authorities and mainstream medicine.

Understanding influenza vaccination behaviors: a comprehensive sociocultural framework

Despite the existence of an effective pharmaceutical means for its prevention available now for about 70 years, influenza remains an important contributor to morbidity and mortality figures due to respiratory infectious diseases through the world. Understanding why people accept or reject being vaccinated in our societies may contribute to improve substantially public health interventions in this domain by addressing the main reasons that lead individuals and groups to neglect immunization. Research into the cognitive and social causes of influenza vaccination patterns has developed over the last decades. However, it has yielded mostly inconsistent or contradictory results. To make sense of the body of data available and to improve future research, the authors argue for the adoption of a comprehensive sociocultural understanding of vaccination behavior. This could be constructed from existing social stratification models used in social sciences and should take into account how culture determines cognition.

Vaccine criticism on the Internet: Propositions for future research.

ABSTRACT Research on vaccine criticism on the Internet is now at a crossroads, with an already important body of knowledge published on the subject but also a continuous and even growing interest in the scientific community. In this commentary, we reflect on the published literature from the standpoint of sociologists interested in social movements and their activists and the influence they can have on vaccination behaviors. We suggest several avenues of research for future studies of vaccine criticism on the Internet: 1) paying more attention to the actors who publish vaccine critical contents and to their use of the Internet in relationship to the other means through which they try to mobilize the population - the production of vaccine critical information on the Internet, and not only its nature and its reception, should therefore become one of the main objects of this strand of research -; 2) paying closer attention to what distinguishes the different strands of vaccine criticism regarding both what they dislike about vaccines (or about a given vaccine) and how this fight is integrated in a more general political or cultural struggle; 3) investigating further how the new forms of social interactions allowed by the Internet affect the transmission of vaccine related information and the capacity of vaccine critical actors to enroll members of the public in their political or cultural struggle.

France's risky vaccine mandates

In the past decade, insufficient vaccination coverage and vaccine hesitancy have become pressing problems in many countries. In France, vaccine-related controversies in the media have multiplied, and the proportion of the population doubting the safety of vaccines has risen to approximately 40% ([ 1

‘I don’t know if I’m making the right decision’: French mothers and HPV vaccination in a context of controversy

Human papillomavirus (HPV) vaccination coverage in France has fallen substantially since 2010 and the onset of a media controversy on the subject of its safety and efficacy. In this article we examine how and why mothers agree or do not agree to HPV vaccination for their daughters. We draw on data from a survey of French mothers of girls within the HPV vaccination target population (11–14 years old). We used semi-structured interviews to examine their perceptions of this relatively new vaccine and how such perceptions were shaped by their past experiences of vaccines and health in general. We also talked to them about their sources of information, their level of trust in these sources, and how their perception of risk changed as they accessed different and often contradictory information. We found that mothers’ fears of side effects and of ‘new’ vaccines was one of the main reason why they either refused to get their daughters vaccinated or hesitated. Mothers told us that they consulted several different sources, tended to trust their doctors most, but still questioned their recommendations. Although they presented the media and the Internet as untrustworthy, the information from those sources, whether gathered proactively or in passing, significantly influenced their decisions by introducing doubt or by prompting more information-seeking. In this article we show the dynamic nature of this decision-making process and we found that a substantial number of the mothers in our study said that they had been advised by at least one of their doctors not to have their daughter vaccinated.

Socioeconomic differences in childhood vaccination in developed countries: a systematic review of quantitative studies

ABSTRACT Introduction: The reasons for vaccine hesitancy and its relation to individual socioeconomic status (SES) must be better understood. Areas covered: This review focused on developed countries with programs addressing major financial barriers to vaccination access. We systematically reviewed differences by SES in uptake of publicly funded childhood vaccines and in cognitive determinants (beliefs, attitudes) of parental decisions about vaccinating their children. Using the PRISMA statement to guide this review, we searched three electronic databases from January 2000 through April 2016. We retained 43 articles; 34 analyzed SES differences in childhood vaccine uptake, 7 examined differences in its cognitive determinants, and 2 both outcomes. Expert commentary: Results suggest that barriers to vaccination access persist among low-SES children in several settings. Vaccination programs could be improved to provide all mandatory and recommended vaccines 100% free of charge, in both public organizations and private practices, and to reimburse vaccine administration. Multicomponent interventions adapted to the context could also be effective in reducing these inequalities. For specific vaccines (notably for measles, mumps, and rubella), in UK and Germany, uptake was lowest among the most affluent. Interventions carefully tailored to respond to specific concerns of vaccine-hesitant parents, without reinforcing hesitancy, are needed.

Are Perceived Prevalences of Infection also Biased and How? Lessons from Large Epidemics of Mosquito-Borne Diseases in Tropical Regions:

Background. Although people are likely to underestimate the frequencies of risks to health from common diseases and overestimate those from rare diseases, we still do not know much about reasons for this systematic bias, which is also referred to as “primary bias” in the literature. In this study, we take advantage of a series of large epidemics of mosquito-borne diseases to examine the accuracy of judgments of risk frequencies. In this aim, we assessed the perceived v. observed prevalence of infection by Zika, chikungunya or dengue fever during these outbreaks, as well as their variations among different subpopulations and epidemiological settings. Methods. We used data drawn from 4 telephone surveys, conducted between 2006 and 2016, among representative samples of the adult population in tropical regions (Reunion, Martinique, and French Guiana). The participants were asked to estimate the prevalence of these infections by using a natural frequency scale. Results. The surveys showed that 1) most people greatly overestimated the prevalence of infection by arbovirus, 2) these risk overestimations fell considerably as the actual prevalence of these diseases increased, 3) the better-educated and male participants consistently yielded less inaccurate risk estimates across epidemics, and 4) these biases in the perception of prevalence of these infectious diseases are relatively well predicted by the probability weighting function developed in the field of behavioral decision making. Conclusions. These findings suggest that the primary bias, which has been found in laboratory experiments to characterize a variety of probabilistic judgments, equally affects perception of prevalence of acute infectious diseases in epidemic settings. They also indicate that numeracy may play a considerable role in people’s ability to transform epidemiological observations from their social environment to more accurate risk estimates.

Flu vaccination among patients with diabetes: motives, perceptions, trust, and risk culture - a qualitative survey

BackgroundVaccination against seasonal influenza (SIV) is recommended for patients with diabetes, but their vaccination coverage is unsatisfactory in France and elsewhere. This qualitative survey of people with diabetes sought to explore 1) the extent to which SIV-related behaviour is more or less automatic; 2) reasons they choose/reject SIV; 3) their trust/distrust in authorities, science, and medicine.MethodsWe conducted semi-structured in-depth interviews of 19 adults with diabetes in 2014. We recruited them through physicians or patient associations and implemented an analysis of thematic content.ResultsEight patients were vaccinated against flu in the preceding flu season and 11 were not. SIV uptake and refusal were stable over time and justified by multiple arguments. Coupons for free vaccines and regular doctor visits contributed to the habit of vaccination. Vaccination decisions were frequently anchored in past experiences of influenza and its vaccine. Patients often justified non-vaccination with attitudes of trivialisation/relativisation of influenza-associated risks and the perception that these can be controlled by means other than vaccination (e.g., through the avoidance of exposure). Some misbeliefs (e.g., SIV causes influenza) and doubts about SIV effectiveness and safety also existed. Several patients reported increased mistrust of SIV since the A/H1N1 pandemic in 2009. Patients trusted their doctors strongly regardless of their SIV behaviour, but unvaccinated patients had little trust in the government and pharmaceutical companies. Some discordances were found between perceptions and behaviour (e.g., remaining vaccinated despite doubts about SIV effectiveness or remaining unvaccinated despite feelings of vulnerability towards influenza complication), suggesting the existence of some vaccine hesitancy among patients.ConclusionThis study among patients with diabetes suggest that SIV uptake is stable, thanks to a favourable environment. Nonetheless, SIV refusal is also stable over time. Unvaccinated patients used multiple arguments to justify SIV refusal, including compensatory health beliefs. Physicians should take every opportunity to recommend SIV. The necessary individualised patient education regarding SIV requires better physician training in patients priorities. While almost all patients strongly trust their doctors, unvaccinated patients distrust distal stakeholders: it is absolutely essential to restore trust in them and to develop new more effective influenza vaccines.