measuring and monitoring vaccine confidence - sabin vaccine … · 2017-02-08 · measuring and...

Measuring and monitoring vaccine

confidence

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Emilie Karafillakis Vaccine Confidence Project

London School of Hygiene & Tropical Medicine

[email protected]

IAMI Regional Meeting

Madrid, 2 February 2017

“Man, too, is a stubborn microbe”Jean Giono, The Horseman on the Roof

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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

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Confidence crises are varied and context-

specific

Childhood vaccines -Mercury

MMR - Autism

HPV – Mass fainting episodes

Polio - Sterilisation,Politics, mistrust

Tetanus – Sterilisation, religious beliefs

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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

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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

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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

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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

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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

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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

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Larson H, et al. The state of vaccine confidence 2016: global insights through a 67-country survey. Ebiomedicine (2016).

Interactive Country Data Viewer

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Available at: www.vaccineconfidence.org

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“Overall, I think vaccines are safe”


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

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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

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• 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

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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

Measuring vaccine confidence:

no single metric tells the story

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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

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Sometimes the solution lies outside the vaccination programme

The Vaccine Confidence Project (2015). The state of vaccine confidence 2015. London: LSHTM.

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www.vaccineconfidence.org

measuring and monitoring vaccine confidence - sabin vaccine … · 2017-02-08 · measuring and...

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