Reflection and decision-making process

Role of public health

Risk perception and evaluation

Role of healthcare professionals

MD RN Alternative med

Counselling

Training

Religious literacy

Open attitude

Payment vs time spent counselling

Vaccine delivery services

Vaccination programs

Impartiality / avoiding

appearance of conflict of interest

Relationship of trust

Leave time for the

decision to be made

Continuity Relationship of trust

Accurate information

Empowerment

Historic and socio-cultural

context

Link of trust

Religious and cultural

particularities

Communications and media

Social media

Internet

Ethics Spirituality

Medical expertise

Science PharmaceuticalcompaniesGovernment

Healthcare systems

Vaccine coverage

Rigorous evaluation

Vaccination registers

Avoid VPD epidemics

Population effects

Individual effects

Laws / incentives?

Message

Statistical data

Vaccine safety

Consequences / gravity of VPD

Different for each person

May not be rational

Perception changes when children or the vulnerable

involved

Low risk of undesirable

events

Very low incidence of

diseases, thus poorly known

Vaccine hesitancy

Communication skills

Medical and epidemiological

knowledge

Hesitant professionals

Educating Patients/parents

Recommend vaccination

Continuum of hesitancy

refusal acceptance

WORKSHOP ON THE CULTURAL AND RELIGIOUS ROOTS OF VACCINE HESITANCY:

ContextVaccine hesitancy causes a decrease in vaccine coverage and increases the risk of outbreaks and epidemics of vaccine-preventable diseases. Diseases believed to be controlled, such as measles, are reappearing today. A workshop was held on December 5, 2011, in Longueuil, Quebec, to consider this phenomenon of vaccine hesitancy. Some forty experts from various fields and from several Canadian provinces met to share their views (Figure 1). The workshop was structured as follows: short presentations were made on various themes related to vaccine hesitancy, for the purpose of encouraging a long period of discussion and debate among participants.

PurposeTo report workshop participants’ opinions.

During the workshop, the debates were recorded, and a short self-administered questionnaire was filled out by participants, whose opinions on factors contributing to vaccine hesitancy were solicited by means of several open questions. Minutes of the discussions were then written up and the content validated using the recordings. The questionnaire responses were compiled on Excel. A content analysis was carried out on all the material.

Method

The questionnaire response rate was 59% (22/37). For four major subjects—the role of healthcare professionals, the role of public health, the population’s perception and evaluation of risk, and the reflection and decision-making process (Figure 2), seven categories of factors were identified: communications and public exposure to vaccine information, the public’s level of knowledge about immunization, risk evaluation and decision-making, trust/mistrust, personal factors, the socio-cultural context, and the vaccination context (Table 1).

Results

Emotional, cultural, social and spiritual factors seem to influence the vaccination decision as much as cognitive factors. Healthcare professionals and public health bodies play a unique role with regard to vaccine-hesitant people. A dialogue must be established regarding vaccination decisions. To help professionals assume an empathetic, open-minded support role toward the hesitant population, the publication of a book on the subject is planned that will bring together the learning and ideas shared during this workshop.

Conclusion

Category Factors mentioned

Communication and public’s exposure to information(13/22)

Information communicated to the public (e.g. type of information, reliability, quantity, credibility)Information conveyed by health professionals (often hesitant themselves)Messages communicated by public health bodiesEducation offered on immunizationMedia, Internet, social networksExposure to anti-vaccination messages Importance placed on anecdotal data or controversies surrounding vaccines

Public’s level of knowledge about immunization(11/22)

Access to enough information on vaccinationKnowledge / lack of knowledge of risks of vaccine-preventable diseasesDifficulty observing directly the effects of vaccine-preventable diseasesKnowledge / lack of knowledge of vaccine efficacyKnowledge / lack of knowledge of scientific bases of vaccination

Risk evaluation and decision-making process(10/22)

Risk and benefit assessment process Enlightened decision-making Fear of side effects of vaccinesFear of undesirable adverse events of immunizationImportance placed on anecdotal events

Trust/mistrust(10/22)

Mistrust (general)Trust/mistrust in science, government, medicine, conventional healthcare, the health system, public healthMistrust of the big three (pharma, government and business)

Personal factors: - perceptions - personal opinions - membership groups (9/22)

Beliefs, values, knowledge, attitudesIdeologiesPersonal experiences or in one’s entourageSocio-economic status Religious or cultural membershipBelief in alternative medicine

Socio-cultural context (3/22)

Possibility of relying on group immunitySocial norms/acceptancePolarization of opinionsSocial valuesCultureReligionHistorical events / population’s experience

Vaccine delivery context(1/22)

Increase in number of vaccines recommended on the vaccine schedule Role played by health professionals

EXPLANATIONS AND IMPLICATIONS FOR CANADIAN HEALTHCARE (draft – do not disseminate)

Figure 2 – Determinants of vaccine hesitancy: schema summary of discussions

Hesitant mother

AnthropologistsMedical historian

Experts in ethics, psychology and risk perception

Expert in religious studies and multiculturalism

Humanities and social sciences

NursesFamily doctorsPediatricians

InternistMicrobiologistsChiropractor

Biomedical sciences

Family doctors Nurses

Medical specialistsEpidemiologists

Communication agents

Public health

Figure 1 – Workshop participants

Table 1 – Factors in vaccine hesitancy as mentioned by participants on the questionnaire (x mentions / 22 respondents)

Caroline Laberge; Maryse Guay; Paule Clément; Paul Bramadat; Réal Roy; Julie Bettinger