Vaccine Hesitancy and Confidence - PDF

CENTRUM VOOR VACCINOLOGIE ISABEL LEROUX-ROELS (COURTESY OF KOEN VAN HERCK) 4.2. VACCINE HESITANCY VACCINE HESITANCY ̶ What? ̶ Information sources ̶ Three mechanisms ̶ A continuüm ̶ Some examples Thanks to Prof. Koen Van Herck 2 VACCINE HESITANCY ̶ What? ̶ Information sources ̶ Three mechanism...

CENTRUM VOOR VACCINOLOGIE ISABEL LEROUX-ROELS (COURTESY OF KOEN VAN HERCK) 4.2. VACCINE HESITANCY VACCINE HESITANCY ̶ What? ̶ Information sources ̶ Three mechanisms ̶ A continuüm ̶ Some examples Thanks to Prof. Koen Van Herck 2 VACCINE HESITANCY ̶ What? ̶ Information sources ̶ Three mechanisms ̶ A continuüm ̶ Some examples Thanks to Prof. Koen Van Herck 3 NOTHING NEW UNDER THE SUN… 4 OR MAYBE THERE IS? 5 WHO –VACCINE HESITANCY ̶ ̶ ̶ Vaccine hesitancy - the reluctance or refusal to vaccine despite the availability of vaccines – threatens to reverse progress made in tackling vaccine-preventable infectious diseases. Vaccination is one of the most effective ways of avoiding disease – it currently prevents 2-3 million deaths* and a further 1,5 million could be avoided if global coverage of vaccinations improved. Measles, for example, has seen a 30% increase in cases globally. The reasons for this rise are complex, and not all of these cases are due to vaccine hesitancy. However, some countries that were close to eliminating the disease have seen a resurgence. The reasons why people choose not to vaccinate are complex; a vaccines advisory group to WHO identified complacency, inconvenience in accessing vaccines, and lack of confidence are key reasons underlying hesitancy. Health workers, especially those in communities, remain the most trusted advisor and influencer of vaccination decisions, and they must be supported to provide trusted, credible information on vaccines. 6 VACCINE HESITANCY ̶ What? ̶ Information sources ̶ Three mechanisms ̶ A continuüm ̶ Some examples Thanks to Prof. Koen Van Herck 7 MANY INFORMATION SOURCES ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ World Health Organization (Dr. Katrine Bach Habersaat) : Tailoring immunization programmes https://apps.who.int/iris/bitstream/handle/10665/329448/9789289054492-eng.pdf European Centre for Disease Prevention and Control: www.ecdc.europa.eu/en/immunisationvaccines/vaccine-hesitancy The Vaccine Confidence Project (Prof. Heidi Larson) www.vaccineconfidence.org/research/vaccinehesitancy/ Scientic papers, e.g. editorial 05/2019 in Lancet Child and Adolescent Health Information for vaccinators: VaxInfo pro https://www.vaxinfopro.be/spip.php?article1915&lang=fr (in dutch) ̶UAntwerp: Valentijn Vaccinatiesymposium: https://www.uantwerpen.be/nl/congressen/valentijnvaccinatie-symposium/vorige-edities/live-opnames/ UAntwerp: Summer School in Vaccinology (SumVax): https://www.uantwerpen.be/en/summer-winterschools/vaccinology/ Webinars and podcast from e.g. Heidi Larson, Katrine Bach Habersaat 8 VACCINE HESITANCY ̶ What? ̶ Information sources ̶ Three mechanisms (3 C’s) ̶ A continuüm ̶ Some examples Thanks to Prof. Koen Van Herck 9 MECHANISM: THE 3 C’S 10 COMPLACENCY ̶ Self-satisfied, taking no action (NL: “gemakzucht”, “zelfgenoegzaamheid”) ̶ Vaccination is not useful ̶ Doubts on the actual danger of infectious diseases ̶ Other, more important health priorities ̶ Paradox: this mechanism is strengthened by the success of the vaccination programmes (cfr. Lecture on vaccine safety) 11 CONVENIENCE ̶ Comfort, ease of vaccination ̶ Vaccination can be inconvenient if (mainly organisational aspects) ̶ Availability is restricted ̶ Price is too high (CAVE: for free = without value?) ̶ Accessibility of vaccinators, vaccination moments ̶ Respect for cultural, religious, …. Elements ̶ Resources for the promotion of vaccination 12 CONFIDENCE ̶ Trust in vaccination ̶ Trust/Belief in ̶ Efficacy/effectiveness and safety ̶ Expertise (and motivation) of vaccinators/HCW, scientists ̶ (Evidence-based) decisions of the government “Misinformation is a symptom, not the cause of vaccine hesitancy” Heidi Larson Vaccine Confidence Project 13 14 From Jo Yarwood, EPI Programme manager 15 From Jo Yarwood, EPI Programme manager Alternative framework used by WHO is the COM-B model https://apps.who.int/iris/bitstream/handle/10665/329448/9789289054492-eng.pdf 16 VACCINE HESITANCY ̶ What? ̶ Information sources ̶ Three mechanisms (3 C’s) ̶ A continuüm … which necessitate appropriate communication strategies ̶ Some examples Thanks to Prof. Koen Van Herck 17 18 19 20 21 22 23 24 25 26 27 VACCINE HESITANCY ̶ What? ̶ Information sources ̶ Three mechanisms (3 C’s) ̶ A continuüm ̶ Some examples Thanks to Prof. Koen Van Herck 28 HYPOTHETICAL, UNPROVEN ASSOCIATIONS BETWEEN SOME VACCINES AND HEALTH CONDITIONS Andre FE. Vaccine 2003; 21: 593-5 RECENT SURGES OF ANTI-VACCINE CRITICISM? ̶ The Wakefield incident (1998) ̶ ̶ ̶ Measles vaccination is responsible for autism Dramatic impact on uptake of MMR vaccines and reappearance of measles infections HPV vaccine (since +/- 10 years) ̶ ̶ Vaccines are poisonous Vaccines are not effective Vaccines cause cancer ̶ ̶ Pandemic influenza vaccine (2009) ̶ Pandemic vaccines were ‒ Useless ‒ Not adequately tested ‒ Adjuvants were toxic ̶ ̶ Pandemic was a creation of industry-WHO ̶ Dramatic change in media coverage COVID-19 vaccines (2020) Michele Bachmann – Long term side effects – Infertility – Genetic modifications (RNA, DNA vaccine) – Weakening of the immune system – …. 32 Dr. Andrew Wakefield 2010 The Lancet 1998 351:637 - 641 EFFECT OF THE WAKEFIELD INCIDENCE ON MMR UPTAKE AND THE NUMBER OF MEASLES CASES IN THE UK ̶ ̶ ̶ 2019: LARGEST MEASLES OUTBREAK WORLDWIDE Multifactorial: ̶ Political instability, corruption ̶ Healthcare organisation ̶ Migration ̶ Refusal of the vaccine EU: ̶ Outbreak in Ukraine has incited the epidemic in Europe ̶ Highest numbers of cases in Eastern European countries, France and Italy USA: ̶ Had reached the elimination status since 2000 ̶ Recent large outbreaks in NYC and other states (‘pockets’ of unimmunized people) 36 ̶ ̶ EUROPE Bi-annual measurement of confidence in various vaccines (e.g. MMR, HPV, seasonal flu, COVID-19) and the influence of socio-demographic determinants, in both the general population and the group of healthcare workers Some results: https://www.vaccineconfidence.org/our-work/reports/state-of-vaccine-confidence-in-eu-2022/ 37 USA “Measles parties” Interesting viewpoint from an US-based pediatrician on how to deal with VHP’s (vaccine hesitant parents): https://edition.cnn.com/2019/09/14/opinions/vaccine-hesitancy-opinion-parikh/index.html https://outride.rs/en/vaccines-fake-news/vaccine-skepticism-and-populism 39 Directed by….. 40 A WORRIED MOTHER SAYS:“I READ ON THE INTERNET THAT THE HPV VACCINE CONTAINS RAT POISON. I HONESTLY DON’T KNOW IF I WANT MY DAUGHTER TO BE VACCINATED” ̶ Fact or myth? ̶ It concerns the substance sodiumborate, present in many products such as rat poison and cockroach poin, but also in (ecological) cosmetics and detergents www.bcfi – SKP (summary of product characteristics) 6.1 List of excipients Gardasil contains sodium borate Cervarix doesn’t contain sodium borate Does this pose a health risk? 41 / USEFUL INFORMATION SOURCES ON VACCINE COMPOSITION 1. Children’s Hospital of Philadelphia. Vaccine Education Center. Dr. Paul Offit http://www.chop.edu/centers-programs/vaccine-education-center/vaccineingredients 2. Oxford Vaccine Group – Vaccine Knowledge Project http://vk.ovg.ox.ac.uk/vaccine-ingredients 3. CDC – Vaccine Excipient and Media Summary https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/excipienttable-2.pdf 42 / MYTH! The quantity of borax present in Gardasil is too small to pose any health risk Only toxic if ingested in very large quantities MSDS (material safety data sheet): risk class 1 (idem als Nabicarbonaat en zout) 43 / Karafillakis E et al. Hum Vaccine Immunother 2019; 15: 1615-27 44 DO CHILDREN RECEIVE TOO MANY VACCINES? “Is the immune system of young children not being overloaded by administering so many vaccines at a young age?” “And doesn’t that increase the susceptibility of children to infections?” “I only want my child to be vaccinated against tetanus, I do not want him/her to receive a combination vaccine” https://www.zorg-en-gezondheid.be/basisvaccinatieschema DO CHILDREN RECEIVE TOO MANY VACCINES? 1900 1960 1980 2009 Vaccine proteins Vaccine proteins Vaccine proteins Vaccine proteins Smallpox ± 200 Smallpox ± 200 Diphteria 1 Diphteria 1 TOTAL ± 200 Diphteria 1 Tetanus 1 Tetanus 1 Tetanus 1 Pertussis ± 3000 Pertussis 3 Pertussis ± 3000 Polio 15 Polio 15 Polio 15 Measles 10 Measles 10 TOTAL ± 3217 Mumps 9 Mumps 9 Rubella 5 Rubella 5 TOTAL ± 3041 Hib 2 Hepatitis 1 Men C 2 TOTAL < 50 Anno 2022: + rota and 13-PCV Microorganisms are ubiquitous at very high densities on and in our bodies Our immune system has a huge capacity to react towards different antigens. We have about 109 antigen-specific T and B cells. Studies have demonstrated that there is no increased incidence of other infections in vaccinated children (e.g. Glanz et al. JAMA 2018) 47