Upload
others
View
6
Download
0
Embed Size (px)
Citation preview
Measuring and monitoring vaccine
confidence
1
Emilie Karafillakis Vaccine Confidence Project
London School of Hygiene & Tropical Medicine
IAMI Regional Meeting
Madrid, 2 February 2017
“Man, too, is a stubborn microbe”Jean Giono, The Horseman on the Roof
2
Director: Heidi Larson
Co-director: Pauline Paterson
Communication: Jay Dowle
Researchers: Emilie Karafillakis, Clarissa Simas, William Schulz, Elizabeth Smout
PhD students: Rose Wilson, Richard Clarke, Antonis Kousoulis, Suzanne Hurst
Confidence in vaccines
Confidence in systems
Confidence in providers
Confidence in sexual & reproductive
health interventions
3
Confidence crises are varied and context-
specific
Childhood vaccines -Mercury
MMR - Autism
HPV – Mass fainting episodes
Polio - Sterilisation,Politics, mistrust
Tetanus – Sterilisation, religious beliefs
4
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.
Need for quick monitoring and measurement
tools
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
6Heidi Larson
The Vaccine Confidence Project Framework
7
Rumour prompters Outcome/impact
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
Vaccine refusals
Vaccine suspended
Vaccine preventable
disease outbreaks
Sustaining and
amplifying factors
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)
Heidi Larson
Trust toward health authorities
Risk culture,
Healthism
+
+
Enlightened
conformism
Passive
Conformism
Passive
hesitancy
Rationalised
hesitancy
-
-
+
Refusal
Theoretical framework to measure
vaccine hesitancy: engagement and trust
(Peretti-Watel, Plos Current Outbreaks, 2015)8
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
9
Karafillakis E, et al. Vaccine hesitancy among healthcare workers in Europe: a qualitative study. Vaccine (2016).
Understanding the gap to address it
Identify key determinants of
trust/distrust over time and factors that
influence vaccine decision-making
Isolate predictors of
problemsDesign engagement
strategies
Where are the tipping points?
Immunisation as “norm” Pro-vaccine
Vaccine hesitancyAnti-vaccine
Heidi Larson10
Systematic review of determinants of VH in Europe
5
5
5
5
6
6
6
6
7
7
7
7
8
8
9
9
11
11
11
12
12
15
20
20
21
24
31
32
36
51
107
0 20 40 60 80 100 120
Immune system too weak
Conflicting messages
Negative experience (personal)
Too many vaccines
Never had/get VPD
Mistrust doctors
Concerns about injections
Promiscuity, STI vaccine
VPD have benefits
Influenced by family/friends
Mistrust governments
Vaccine cause the disease they prevent
Mistrust health authorities
Mistrust pharmaceutical companies
Natural alternatives
Against vaccination in general
Negative media reports
Not priority
Risks > benefits
Too young
Vaccines too new
Do not qualify
Strong immune system
Not offered, recommended against
Not enough evidence, testing
Vaccines not necessary
Lack information, misunderstandings
Vaccines don't work
VPD not severe
Low risk of contracting VPD
Vaccine safety
Low risk of contracting VPDs
Fear of side effectsVPDs not
severe
Karafillakis & Larson (2015). Analysis of public concerns and perceptions related to benefits and risks of vaccines. ADVANCE D1.4 Report
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
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
12
Larson H, et al. The state of vaccine confidence 2016: global insights through a 67-country survey. Ebiomedicine (2016).
Interactive Country Data Viewer
13
Larson H, et al. The state of vaccine confidence 2016: global insights through a 67-country survey. Ebiomedicine (2016).
Available at: www.vaccineconfidence.org
14
“Overall, I think vaccines are safe”
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
15
Larson H, et al. The state of vaccine confidence 2016: global insights through a 67-country survey. Ebiomedicine (2016).
Real-time media monitoring of public pulse
16Larson 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).
Global media monitoring of HPV vaccines
17
• 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
0
5
10
15
20
25
30
9/1
0/2
01
5
9/1
2/2
01
5
9/1
4/2
01
5
9/1
6/2
01
5
9/1
8/2
01
5
9/2
0/2
01
5
9/2
2/2
01
5
9/2
4/2
01
5
9/2
6/2
01
5
9/2
8/2
01
5
9/3
0/2
01
5
10
/2/2
01
5
10
/4/2
01
5
10
/6/2
01
5
10
/8/2
01
5
10
/10
/20
15
10
/12
/20
15
10
/14
/20
15
10
/16
/20
15
10
/18
/20
15
10
/20
/20
15
10
/22
/20
15
10
/24
/20
15
10
/26
/20
15
10
/28
/20
15
10
/30
/20
15
11
/1/2
01
5
11
/3/2
01
5
11
/5/2
01
5
11
/7/2
01
5
11
/9/2
01
5
11
/11
/20
15
11
/13
/20
15
11
/15
/20
15
PRELIMINARY DATA – DO NOT DUPLICATE - EMILIE KARAFILLAKIS 2017
Themes identified by HPV media monitoring
18PRELIMINARY DATA – DO NOT DUPLICATE - EMILIE KARAFILLAKIS 2017
Safety
Parent groups
Not needed
Morality
Mandates
EMA review
Japan
Denmark
Industry influence
Doctor-patient
influence
Benefits
19
Measuring vaccine confidence:
no single metric tells the story
20
The Vaccine Confidence Project (2015). The state of vaccine confidence 2015. London: LSHTM.
HesitancyRates & reasons
LanguageSentiment
Analysis
Real-Time Detection
Socio-economic correlates
Time-series
analysis of coverage
Historical, Political, Analysis
21
Sometimes the solution lies outside the vaccination programme
The Vaccine Confidence Project (2015). The state of vaccine confidence 2015. London: LSHTM.
22
www.vaccineconfidence.org