[Vaccine hesitancy: discourse analysis of parents who have not fully or partially vaccinated their children]

[Public conversation on vaccines during the covid-19 pandemic in Argentina, 2021-2022]

In the face of declining vaccination coverage and the dissemination of health-related information, conversations in the public/mediatic digital sphere constitute a relevant study area for the field of health communication. Through a qualitative study based on the analysis of government publications, digital press, and social media, we characterize the public conversation on vaccines - in terms of topics, moments, axes, and framings in Argentina during the 2020-2021 period - marked by the debate on covid-19 vaccines. The results show that public conversation focused on covid-19 vaccination, structured in two distinct moments (vaccine production and vaccination campaign), and under moral framings grounded in vaccination as a care practice and science as an authoritative voice. Simultaneously, doubts about the safety and efficacy of vaccines shaped arguments of vaccine hesitancy, which we understand as part of extended practices associated with distrust towards institutions and reinterpretations of scientific knowledge and care.

The Need for Health Education and Vaccination-Importance of Teacher Training and Family Involvement

The health emergency due to COVID-19 has highlighted the importance of vaccination and its impact on social welfare. Inequalities have surfaced that affect the most vulnerable and those millions of children do not receive the necessary vaccines. Health education becomes a fundamental resource for citizens to access universal rights. One thousand people from 76 countries on five continents participated in this research in 2019–2020, from the health, education, and economic sectors. A descriptive cross-sectional study with a quantitative design was used. The instrument used was a correctly validated questionnaire: VACUNASEDUCA. The objectives were to reflect on the adequacy of teacher training and their awareness for the proper use of vaccines and to analyze the knowledge of parents about the consequences of vaccination. The results demonstrate the importance of teacher training and health education, with positive involvement of the family. The most favorable group is female, under 30 years, from the European continent, with a very high Human Development Index (HDI), and from the education sector. In conclusion, it is noted that, within the framework of the fourth industrial revolution, education must be configured with innovative approaches and tools, making it necessary to intervene in the context considering their cultural characteristics and promoting healthy lifestyle habits.

Inclusive Education for Health: Analysis of the Mandatory Nature of Vaccination and Its Regulation by Administrations, and Implications and Considerations for Vaccination against COVID

In the process of vaccination against COVID-19, the problem of parents who do not want to vaccinate their school-age children has been evident. A conflict arises between two fundamental rights: the right to ideological freedom, privacy, and physical integrity of parents and minors who do not opt for vaccination; and the right to health of the rest of the children who attend the same school, provoking a social debate on the need to introduce regulatory changes that favor the mandatory imposition of vaccination in certain cases. This research offers an observational study through a cross-sectional design of a quantitative nature, in which one thousand people belonging to the education, health, and economy sectors from seventy-six countries of five continents have participated. The instrument used was a previously validated questionnaire: VACUNASEDUCA. It was considered essential to know the awareness of vaccination processes of professionals from essential social sectors. Therefore, the objectives were: to reflect on the measures of mandatory vaccination, to know the importance of teachers being able to demand a regulated vaccination card from students, to study the need for regulation by administrations of compliance with vaccines, and to analyze the importance of health education. It has been shown that women and those under thirty years of age are the least in favor of compulsory vaccination, with the health sector being the most defending of their demand, and with Europe with the lowest means. It is concluded that mandatory vaccination could be an acceptable tactical option to prevent high-risk situations.

Health Education and Vaccination for the Construction of Inclusive Societies

Globalization has led to what has happened in a certain part of the world having a significant and rapid impact on other places, causing significant changes in health problems. In the last quarter of the 18th century, the history of vaccination began, becoming an effective tool to prevent and control communicable diseases. This paper proposes an observational research with a cross-sectional design to study the importance of health education and vaccination in building inclusive societies. With a sample of 1000 participants from 76 countries, vaccine awareness and regulation were analyzed, considering the following variables: gender, age, sector, Human Development Index (HDI), and continent. The instrument used was a questionnaire (VACUNASEDUCA) developed for this research and timely validated. As a result, it is highlighted that the profiles of women, people under 30 years of age, education sector, high Human Development Index, and European continent are those that most value the importance of raising awareness in society and the regulation of actions for vaccination compliance. The consequences of "vaccine reluctance" are of concern in every country on the planet. Therefore, it is concluded that effective and evidence-based communication is key to allaying fears and promoting acceptance of vaccination around the world, building inclusive societies in which all citizens enjoy the health benefits.

Vaccine hesitancy in Argentina: Validation of WHO scale for parents

BACKGROUND

The WHO SAGE Working Group on Vaccine Hesitancy developed the Vaccine Hesitancy Scale (VHS) to identify and compare hesitancy in different global settings. The objectives of the study were to describe and analyze vaccine hesitancy and to validate the VHS in a group of parents in Buenos Aires city, Argentina.

METHODS

A cross-sectional survey was conducted in parents of 1-3 and 12-15 year-old children at three health centres in Buenos Aires City, between June 2018 and May 2019. Sociodemographic data were collected together with history of refusal and/or delay in children's vaccination (defined as hesitancy). The 10-item VHS using 5-point Likert-scale (higher scores indicating lower hesitancy) was administered and children's immunization record cards were verified. Link between hesitancy and socio-demographic variables, and hesitancy and vaccination status was analyzed for five specific vaccines. Cronbach's α was used to determine internal consistency reliability and factor analysis to confirm survey subdomains. Simple and multiple regression analysis was used to examine associations between VHS scores and hesitancy, and VHS scores and vaccination status.

RESULTS

Six hundred parents were surveyed and 469 immunization cards verified; 11.5% (n = 69) parents were hesitant. High maternal educational level showed significant association with hesitancy (OR 2.66 95% CI: 1.20-5.9) in the adjusted model. Hesitancy was significantly associated with incomplete MMR vaccination in children (OR 4.43 95% CI: 1.08-8.20) and HPV vaccination in adolescents (OR 3.75 95% CI: 1.54-9.12). Cronbach's α was 0.66 and factor analysis identified three underlying constructs: "Benefits", "Harms" and "Confidence in healthcare system". High scores in VHS were associated with lack of hesitancy (OR 1.2 95% CI: 1.13-1.27) and complete vaccination status (OR 1.07 95% CI: 1.02-1.12).

CONCLUSIONS

Hesitancy was associated with high maternal educational level, and incomplete MMR and HPV immunization status in children and adolescents. VHS was a reliable and valid tool in this population.

Contribution of rationality to vaccine attitudes: Testing two hypotheses

Although previous studies have demonstrated an association between vaccine attitudes and cognitive biases, often resulting in vaccination hesitancy, the exact contribution of rationality has not been fully clarified. We tested two hypotheses regarding the impact of rationality on vaccine attitudes stemming from bounded and expressive rationality. We focused on parental vaccine attitudes operationalized by the affective, behavioral, and cognitive attitude components and investigated how these are influenced by disillusionment toward authorities and ability to engage in rational thinking operationalized using cognitive reflection and heuristics and biases tasks. The study was of a cross‐sectional correlational design with a non‐probabilistic sample of 823 volunteer participants surveyed online in April and May 2018 in Croatia. The results identified disillusionment toward authorities as a predictor of all components. Furthermore, performance on heuristics and biases tasks also predicted the affective and cognitive, but not the behavioral component, whereas cognitive reflection had no impact on vaccine attitudes. Next, a moderation effect of disillusionment toward authorities on the association between the omission bias task and all attitude components was identified. Parents with low disillusionment demonstrated positive vaccine attitudes regardless of their rationality, whereas for parents with high disillusionment a significant positive correlation between performance on the omission bias task as assessed with a vaccination vignette and attitudes was identified. This suggests that the ability to resist vaccine specific omission bias, that is, higher rationality, can decrease the negative effects of disillusionment, which supports the bounded rationality hypothesis.

Tasas de cobertura vacunal contra el virus del papiloma humano en adolescentes andaluzas y su relación con el riesgo social y la estrategia vacunal

Objetivo: conocer las tasas de vacunación contra el virus del papiloma humano (VPH) y su relación con la estrategia vacunal y la pertenencia a zonas necesitadas de transformación social (ZNTS). Diseño: estudio descriptivo, auditoría de historias clínicas. Emplazamiento: cuatro centros de salud urbanos (2015-2018). Participantes: adolescentes susceptibles de vacunación contra el VPH. Mediciones principales: tasas vacunales de acceso, cobertura y deserción. Resultados: 366 adolescentes (12-16 años). Tasas: acceso 85,5%; cobertura 77,6%; deserción 9,3%. A mayor edad, mejores tasas de acceso (odds ratio [OR]: 6,1) y cobertura (OR: 1,4). La vacunación en el centro de salud se relaciona con una mejor tasa de cobertura (OR: 12,7), pero aumenta significativamente la tasa de deserción (OR: 75,6). Vivir en ZNTS disminuye la tasa de deserción (OR: 0,6). Conclusiones: la vacunación en centros de salud mejora la tasa de cobertura, pero con mayor riesgo de no completar la vacunación. La tasa de deserción es menor en ZNTS. Palabras clave: vacunas contra papilomavirus, cobertura de vacunación, áreas de pobreza.

Carrasco M, Pinós L, Picchio CA, Rius C, Diez E. Vaccine hesitancy among paediatric nurses: Prevalence and associated factors

Objective

This study describes the prevalence of vaccine hesitancy associated with the Catalan systematic childhood vaccination calendar and some related psychosocial determinants among paediatric primary care nurses in Barcelona (Spain).

Methods

Cross-sectional descriptive study. In 2017 we invited the paediatric nurses (N = 165) working in Barcelona public primary health centres with paediatric departments (N = 41) to participate. They answered a questionnaire with sociodemographic and behavioural variables: severity and perceived probability of contracting the diseases of the vaccines in the vaccination schedule; safety and protection offered by each vaccine; and beliefs, social norms, and knowledge about vaccines. Outcome variable was vaccine hesitancy, dichotomized into not hesitant (nurses who would vaccinate their own offspring), and hesitant (including those who would not vaccinate them, those who had doubts and those who would delay the administration of one or more vaccines). We performed bivariate analysis and adjusted logistic regression models.

Results

83% of paediatric nurses (N = 137) agreed to participate. 67.9% had the intention to vaccinate their children of all the vaccines in the systematic schedule. 32.1% of nurses experienced vaccine hesitancy, especially about the HPV (21.9%) and varicella (17.5%) vaccines. The multivariate analysis suggests associations between hesitancy and low perception of the severity of whooping cough (aOR: 3.88; 95%CI:1.32–11.4), low perception of safety of the HPV vaccine (aOR:8.5;95%CI:1.24–57.8), the belief that vaccines are administered too early (aOR:6.09;95%CI:1.98–18.8), and not having children (aOR:4.05;95%CI:1.22–13.3).

Conclusions

Although most paediatric nurses had the intention to vaccinate their own children, almost one-third reported some kind of vaccine hesitancy, mainly related to doubts about HPV and varicella vaccines, as well as some misconceptions. These factors should be addressed to enhance nurses’ fundamental role in promoting vaccination to families.

Decision making processes underlying avoidance of mandatory child vaccination in Croatia - a qualitative study

Despite extensive research evidencing child vaccination is safe and effective, we are witnessing a trend of increasing vaccine hesitancy which is listed among the top ten global health threats. Although some countries incorporate mandatory vaccination programs, no particularly efficient strategies for addressing vaccine avoidance have so far been identified. Within this study we investigated perceptions and reasoning of vaccine hesitant parents from Croatia where child vaccination is mandatory. The aims were to reveal different strategies by which they avoid mandatory vaccination schedules and hypothetical situations in which they would reconsider vaccinating, as well as to identify features of related decision-making. We conducted 25 semi-structured interviews with vaccine hesitant parents and analyzed the data using the framework of thematic analyses. The identified themes were related to the parents’ decision-making process, reflection as well as justification of their decision, avoidance behavior of mandatory vaccination schedules and related consequences, dealing with outcomes of the decision and reconsidering vaccinating. The results support and extend previous findings regarding vaccine reasoning, linking hesitancy with the experientially intuitive thinking style and social intuitionist model of moral reasoning. The findings provide important insights into vaccination avoidance and potential for reconsideration, as well as dealing with related risks. Furthermore, we offer a general framework as well as practical guidelines that may help the development of strategies aimed at increasing vaccination rates.

Preciso mesmo tomar vacina? Informação e conhecimentosobre vacinasno adolescer

Objetivo: descrever o conhecimento de adolescentes do 9o ano do ensino fundamental de escolas públicas sobre vacinas, as doenças imunopreveníveis e as doenças transmissíveis.Métodos: Estudo epidemiológico transversal, descritivo, desenvolvido com 605 adolescentes de 22 escolas públicas de um município de grande porte do Estado de Minas Gerais, Brasil.Resultados: as fontes de informação mais citadas pelos adolescentes sobre infecções transmissíveis e formas de prevenção foram a escola (65,1%), comunicação de massa (48,4%), e pai e mãe (29,9%). Sobre o conhecimento de infecções/doenças imunopreveníveis, 61,5% dos adolescentes citaram a febre amarela (FA) e 5,6% o papilomavírus humano (HPV). Ademais, 60,7% relataram serem vacinado contra a paralisia infantil, 56% contra a FA, e 5% contra o HPV. A cobertura vacinal média identificada na coleta de dados foi de 45,1%, aumentando para 91% após a vacinação. Considerando as respostas dos adolescentes sobre as vacinas presentes no cartão e qual imunobiológico já tivesse vacinado, a análise de Kappa evidenciou concordância substancial em relação à vacina contra FA e concordância moderada entre as demais vacinas.Conclusão: Evidenciou-se: (des)informação dos adolescentes sobre vacinas, doenças transmissíveis e as imunopreveníveis; baixa cobertura vacinal (41%); a comunicação/informação em saúde foram efetivas na decisão dos adolescentes de se vacinarem, aumentando a cobertura vacinal (91%).