Public health practitioner perspectives on dealing with measles outbreaks if high anti-vaccination sentiment is present

Evidence gaps and challenges in maintaining and increasing vaccine uptake: A Delphi survey with Australian stakeholders

ISSUE ADDRESSED

Increasing and maintaining vaccination uptake is crucial for preventing and managing infectious diseases. In the context of the post-coronavirus disease 2019 (COVID-19) pandemic landscape, this paper examines the perceptions of immunisation implementers and policymakers to uncover the challenges and evidence gaps in routine immunisation efforts.

METHODS

We conducted an online two-round modified Delphi survey with immunisation experts, senior public servants, policymakers, policy advisory groups, and representatives from peak bodies from across Australia. We asked respondents to outline what they see as the greatest challenges to increasing and maintaining uptake of recommended vaccines in Australia; the most difficult aspects of their work in vaccination; the largest evidence gaps in vaccine uptake; and the kinds of social and behavioural research they would like to see prioritised.

RESULTS

The two most important challenges for increasing and maintaining vaccine uptake were effectively communicating the benefits of vaccines to parents and the public and ensuring accessible and affordable vaccination services. Participants strongly agreed that 'communication about the importance of vaccination' was the most difficult aspect of their work. Consistently important was the need to better engage specific population groups, such as culturally and linguistically diverse people, pregnant people, at risk cohorts, and health care providers. Social and behavioural research about 'how to effectively address hesitancy' was ranked highly among participants.

CONCLUSIONS

Findings from this project help provide an understanding of the behavioural, social, ethical, and policy knowledge needs for immunisation policy and implementation in Australia. To respond to vaccine challenges, increase coverage and build public trust in vaccination, policymakers and governments should incorporate social research into vaccination programmes. SO WHAT?: Australia is preparing to launch a Centre for Disease Control. This study demonstrates the importance of integrating social, behavioural, ethical, and policy research into the fabric of this new enterprise. It underlines the need to capacity-build a workforce able to deliver high-quality research in these areas, address the needs of immunisation implementers and policymakers, and achieve good outcomes for Australians.

Climate change, vaccines, GMO: The N400 effect as a marker of attitudes toward scientific issues

While the psychological predictors of antiscience beliefs have been extensively studied, neural underpinnings of the antiscience beliefs have received relatively little interest. The aim of the current study is to investigate whether attitudes towards the scientific issues are reflected in the N400 potential. Thirty-one individuals were asked to judge whether six different issues presented as primes (vaccines, medicines, nuclear energy, solar energy, genetically-modified organisms (GMO), natural farming) are well-described by ten positive and ten negative target words. EEG was recorded during the task. Furthermore, participants were asked to rate their own expertise in each of the six topics. Both positive and negative target words related to GMO elicited larger N400, than targets associated with vaccines and natural farming. The results of the current study show that N400 may be an indicator of the ambiguous attitude toward scientific issues.

'Get your own house in order': Qualitative dialogue groups with nonvaccinating parents on how measles outbreaks in their community should be managed

Objective

Communities with high levels of vaccine rejection present unique challenges to vaccine‐preventable disease outbreak management. We sought perspectives of nonvaccinating parents to inform public health responses in such communities.

Methods

Nineteen purposively sampled nonvaccinating Australian parents participated in one of seven online dialogue groups. We asked what they thought parents, school principals and public health professionals should do in a hypothetical school measles outbreak and used a framework approach to data analysis.

Results

Parents' views were grounded in strong beliefs in parental responsibility and the belief that vaccines are not effective, thus unvaccinated children do not therefore pose a threat. They then reasoned that the forced exclusion of unvaccinated children from school in a measles outbreak was disproportionate to the risk they pose, and their child's right to education should not be overridden. Nonvaccinating parents judged that all parents should keep sick children at home regardless of disease or vaccination status; that school principals should communicate directly with parents and avoid using social media; that public health professionals should provide information to parents so they can decide for themselves about excluding their children from school; that public health responses should avoid accidental identification of unvaccinated children and that mainstream media should be avoided as a communication tool.

Conclusion

Nonvaccinating parents do not always agree with current Australian approaches to measles outbreak management. Their perspectives can inform approaches to outbreak responses in communities with high levels of vaccine rejection.

Patient or Public Contribution

We sought input from individuals who did and did not vaccinate on study design in its early phases. Individual conversations were used deliberately as we felt the group advisory situation may have felt less safe for nonvaccinating parents, given the divisive and often hostile nature of the topic.