Dramatic change in public attitudes towards vaccination during the 2009 influenza A(H1N1) pandemic in France

Do boys have the same intentions to get the HPV vaccine as girls? Knowledge, attitudes, and intentions in France

BACKGROUND

The vaccine coverage against human papillomavirus (HPV) vaccination remains low in France. The objective of this study was to study adolescent perceptions by comparing boys and girls, in order to build effective school-based interventions.

METHODS

This paper presents a cross-sectional study in French middle school pupils. They completed online questionnaires on their knowledge and attitudes toward the HPV vaccine, HPV vaccination status, their intention, reasons to vaccinate or not to vaccinate, and psychological antecedents of vaccination. A structural equation modeling (SEM) analysis was used to test the hypothesized model.

RESULTS

The participants are 818 pupils aged from 12 to 16 years (Mage = 13.78). Most pupils were in the pre-contemplative stage (62.7 % of boys and 40.8 % of girls). SEM analysis indicated that the relationship between the level of HPV knowledge, the representations of vaccines in general, and vaccine intention was mediated by attitudes towards the HPV vaccine among both boys and girls.

CONCLUSIONS

These findings reveal a high percentage of boys who do not feel concerned by the HPV vaccine and highlight the need to consider the psychological antecedents of vaccination in general in addition to the specific attitudes to the HPV vaccine.

COVID-19 vaccine acceptance: A comparative longitudinal analysis of the association between risk perception, confidence, and the acceptance of a COVID-19 vaccine

Following the outbreak of COVID-19, scientists rushed to develop vaccines to protect individuals and ferry the world out of the pandemic. Unfortunately, vaccine hesitancy is a major threat to the success of vaccination campaigns. Research on previous pandemics highlighted the centrality of perceived risk and confidence as core determinants of vaccine acceptance. Research on COVID-19 is less conclusive, and frequently it relies on one-country, cross-sectional data, thus making it hard to generalize results across contexts and observe these relationships over time. To bridge these gaps, in this article, we analyzed the association between perceived risk, confidence, and vaccine acceptance cross-sectionally at individual and country levels. Then, we longitudinally explored whether a within-country variation in perceived risk and confidence was correlated with a variation in vaccine acceptance. We used data from a large-scale survey of individuals in 23 countries and 19 time-points between June 2020 and March 2021 and comparative longitudinal multilevel models to estimate the associations at different levels of analysis simultaneously. Results show the existence of cross-sectional relationships at the individual and country levels but no significant associations within countries over time. This article contributes to our understanding of the roles of risk perception and confidence in COVID-19 vaccines' acceptance by underlining that these relationships might differ at diverse levels of analysis. To foster vaccine uptake, it might be important to address individual concerns and persisting contextual characteristics, but increasing levels of perceived risk and confidence might not be a sufficient strategy to increase vaccine acceptance rates.

Effect of influenza vaccine subsidies for older adults on vaccination coverage and mortality before and during the COVID-19 pandemic: an ecological study in Japan

OBJECTIVE

We aimed to determine how municipal subsidies for seasonal influenza vaccines for the elderly affected vaccination coverage and health outcomes and how responses to vaccine prices changed during the COVID-19 pandemic.

STUDY DESIGN AND METHODS

This ecological study includes 1245 municipalities in Japan between 2019 and 2020. Fixed-effects regression analysis was performed to evaluate the effect of influenza vaccine cost subsidy for people aged 65 years or older on vaccination coverage, all-cause mortality, and influenza-related mortality.

RESULTS

The vaccination rate increased when patients' copayments decreased, and reducing the copayment by 1000 Japanese Yen (JPY) was estimated to increase the vaccination rate by 6.3% (95% confidence interval [CI] 4.5-8.2%) in the adjusted model. When examining the additional effect of a zero price compared to a nearly zero price, we found that a zero price increased the immunization rate by 6.4% (95% CI 1.4-11.5%). The effect of copayment on the increase in vaccination coverage was significantly lower during the pandemic than in the pre-pandemic period. The municipal and prefectural analyses found no association between influenza vaccine copayments and all-cause, influenza, or pneumonia mortality.

CONCLUSION

Cost subsidies and the zero-price effect were shown to increase vaccination coverage but were not associated with relevant mortality measures. Although the impact was attenuated under pandemic conditions, cost subsidy effectively increases the vaccination rate.

Vaccination acceptability in the French general population and related determinants, 2000-2021

BACKGROUND

This study describes the evolution of vaccination acceptability and associated determinants in the French general population between 2000 and 2021, and vaccinations with the highest vaccine hesitancy between 2010 and 2021.

METHODS

Data were collected from the nine national 'Health Barometer' cross-sectional surveys conducted between 2000 and 2021. These surveys included French-speaking individuals aged 18-75 years old who were selected through randomly generated landline and mobile phone numbers. Participants were asked about their acceptability of vaccination in general and their vaccine hesitancy toward any particular vaccinations. Determinants of vaccination acceptability were studied using univariate and multivariate Poisson regressions.

RESULTS

The proportion of persons who found vaccination acceptable in general (i.e., answering "very" or "somewhat" favourable in the survey interview) decreased from 91.1% in 2000 to 61.2% in 2010 (the latter year coinciding with the 2009 H1N1 influenza pandemic), increased in 2014 (78.8%), slightly fluctuated until 2019 (74.2%), and increased again in both 2020 (80.0%) and 2021 (82.5%) during the COVID-19 pandemic. Irrespective of the year, acceptability was higher among persons with higher incomes, those with a higher education level, and individuals not living alone. In 2021, for the first time, vaccination acceptability was higher among persons over 44 years old (versus 18-24 year-olds) and among retired persons (versus workers). The highest hesitancy rate for a vaccine was for the 2009 H1N1 influenza virus in 2010 (41% answering "somewhat" or "very" unfavourable). In 2021, the highest rate was for the COVID-19 vaccine (21%).

DISCUSSION

Unlike the experience of the 2009 AH1N1 influenza pandemic, which led to a collapse in vaccination acceptability among the French general population, acceptability continued to increase during the COVID-19 pandemic. However, the pre-2010 level was not reached. Our results show a tendency towards a widening social and economic gap in terms of vaccine acceptability over time.

Implications for COVID-19 vaccine uptake: A systematic review

BACKGROUND

Globally, increasing coronavirus disease (COVID-19) vaccination coverage remains a major public health concern in the face of high rates of COVID-19 hesitancy among the general population. We must understand the impact of the determinants of COVID-19 vaccine uptake when designing national vaccination programmes. We aimed to synthesise nationwide evidence regarding COVID-19 infodemics and the demographic, psychological, and social predictors of COVID-19 vaccination uptake.

METHODS

We systematically searched seven databases between July 2021 and March 2022 to retrieve relevant articles published since COVID-19 was first reported on 31 December 2019 in Wuhan, China. Of the 12,502 peer-reviewed articles retrieved from the databases, 57 met the selection criteria and were included in this systematic review. We explored COVID-19 vaccine uptake determinants before and after the first COVID-19 vaccine roll-out by the Food and Drug Authority (FDA).

RESULTS

Increased COVID-19 vaccine uptake rates were associated with decreased hesitancy. Concerns about COVID-19 vaccine safety, negative side effects, rapid development of the COVID-19 vaccine, and uncertainty about vaccine effectiveness were associated with reluctance to be vaccinated. After the US FDA approval of COVID-19 vaccines, phobia of medical procedures such as vaccine injection and inadequate information about vaccines were the main determinants of COVID-19 vaccine hesitancy.

CONCLUSION

Addressing effectiveness and safety concerns regarding COVID-19 vaccines, as well as providing adequate information about vaccines and the impacts of pandemics, should be considered before implementation of any vaccination programme. Reassuring people about the safety of medical vaccination and using alternative procedures such as needle-free vaccination may help further increase vaccination uptake.

A Discrete Choice Analysis Comparing COVID-19 Vaccination Decisions for Children and Adults

IMPORTANCE

COVID-19 vaccination rates in the US remain below optimal levels. Patient preferences for different attributes of vaccine products and the vaccination experience can be important in determining vaccine uptake decisions.

OBJECTIVE

To assess preferences for attributes of adult and pediatric COVID-19 vaccination among US adults.

DESIGN, SETTING, AND PARTICIPANTS

An online survey of a national panel of 1040 US adults was conducted in May and June 2021. A discrete choice analysis was used to measure the relative value of each attribute in the decision to choose a COVID-19 vaccination option for adults or children. Six attributes were used to described hypothetical vaccination options: vaccine effectiveness, mild side effects, rare adverse events, number of doses, time required for vaccination, and regulatory approval. Respondents chose between hypothetical vaccination profiles or no vaccination. Additional survey questions asked about vaccination beliefs, COVID-19 illness experience, COVID-19 risk factors, vaccination status, and opinions about the risk of COVID-19.

EXPOSURES

Respondents chose which vaccine profile they would prefer to receive for themselves (or no vaccination). Respondents then considered an identical set of profiles for a hypothetical child aged 0 to 17 years.

MAIN OUTCOMES AND MEASURES

Relative value of vaccination-related attributes were estimated using Bayesian logit regression. Preference profiles for subgroups were estimated using latent class analyses.

RESULTS

A total of 1040 adults (610 [59%] female; 379 participants [36%] with an age of 55 years and older years) responded to the survey. When asked about vaccination choices for themselves, participants indicated that vaccine effectiveness (95% vs 60%) was a significant attribute (β, 9.59 [95% CrI, 9.20-10.00] vs β, 0.41 [95% CrI, 0-0.80]). Respondents also preferred fewer rare adverse events (β, 6.35 [95% CrI, 5.74-6.86), fewer mild side effects (β, 5.49; 95% CrI, 5.12-5.87), 1 dose (β, 5.41; 95% CrI, 5.04-5.78), FDA approval (β, 6.01; 95% CrI, 5.64-6.41), and shorter waiting times (β, 5.67; 95% CrI, 4.87-6.48). Results were very similar when framing the question as adult or child vaccination, with slightly stronger preference for fewer rare adverse events for children. Latent class analysis revealed 4 groups of respondents: (1) individuals sensitive to safety and regulatory status, (2) individuals sensitive to convenience, (3) individuals who carefully considered all attributes in making their choices, and (4) individuals who rejected the vaccine.

CONCLUSIONS AND RELEVANCE

In this survey study of US adults, the identification of 4 distinct preference groups provides new information to guide communications to support vaccine decision making. In particular, the group that prioritize convenience (less time required for vaccination and fewer doses) may present an opportunity to create actionable strategies to increase vaccination uptake for both adult and pediatric populations.

A national platform for Covid-19 vaccine studies recruitment in France: Covireivac volunteer's characteristics

During the Covid-19 pandemic, the urgent need for safe and effective vaccines has led to many vaccine trials, implying fast and extensive recruitment of volunteers. In France, until 2020, vaccine clinical research participants were usually recruited locally, through center-based pools of volunteers, and local communication plans. Covireivac is a French public online platform launched on 10/01/2020 that enables national, large-scale recruitment of volunteers for Covid-19 vaccine studies. On the Covireivac website, all adult participants registered online, gave their informed consent, and filled out two online forms with information on their identity, health status (comorbidities, treatments), and known exposure to SARS-CoV-2. Since July 2021, volunteers could mention if their children are interested in participating in a Covid-19 vaccine trial. The objective of this work is to describe Covireivac's volunteer characteristics registered from 10/01/2020 to 11/02/2022. To identify independent volunteer characteristics associated with a period of registration we performed a multivariate logistic regression. Among 54,424 registrations, 52,391 (96%) were analysed; 61% were male (n = 31,893), median age was 50 y; 13% (n = 6586) were healthcare workers. At registration, 15,879 volunteers (33%) reported at least one comorbidity, among whom 16% (n = 7349) were obese and 17% (n = 8346) had hypertension. Most volunteers registered during the first month (n = 35,876, 66%). The Covireivac platform allowed quick and large recruitment of potential volunteers for Covid-19 vaccine trials and could be used on a larger scale for vaccine trials in France. It could facilitate recruitment in vaccine trials and provide sponsors with better visibility of the recruitment capacities of clinical research centers.

Vaccine confidence, public understanding and probity: time for a shift in focus?

Lack of vaccine confidence can contribute to drops in vaccination coverage and subsequent outbreaks of diseases like measles and polio. Low trust in vaccines is attributed to a combination of factors, including lack of understanding, vaccine scares, flawed policies, social media and mistrust of vaccine manufacturers, scientists and decision-makers. The COVID-19 crisis has laid bare societies' vulnerability to new pathogens and the critical role of vaccines (and their acceptability) in containing this and future pandemics. It has also put science at the forefront of the response, with several governments relying on academics to help shape policy and communicate with the public. Against this backdrop, protecting public trust in scientists and scientific output is arguably more important than ever. Yet, conflicts of interest (CoI) in biomedical research remain ubiquitous and harmful, and measures to curb them have had limited success. There is also evidence of bias in industry-sponsored vaccine studies and academics are voicing concerns about the risks of working in a CoI prevalent research area. Here, we set out to challenge established thinking with regard to vaccine confidence, by shifting the gaze from a deficit in public understanding towards probity in research relationships and suggesting an alternative and perhaps complementary strategy for addressing vaccine mistrust. We argue that a concerted effort needs to be made to revisit the norms that undergird contemporary vaccine research, coupled with a willingness of all stakeholders to reimagine those relationships with an emphasis on demonstrating trustworthiness and probity.

Vaccination conspiracy beliefs among social science & humanities and STEM educated people-An analysis of the mediation paths

Understanding vaccine hesitancy is becoming increasingly important, especially after the global outbreak of COVID-19. The main goal of this study was to explore the differences in vaccination conspiracy beliefs between people with a university degree coming from different scientific fields—Social Sciences & Humanities (SH) and Science, Technology, Engineering and Mathematics (STEM). The study was conducted on an online convenience sample of respondents with college and university degrees in Croatia (N = 577). The results revealed that respondents educated in SH proved to be more prone to vaccination conspiracy beliefs. The indirect effect through science literacy was confirmed, while this was not the case for the indirect effects through health beliefs (natural immunity beliefs) and trust in the healthcare system. However, all three variables were important direct predictors of vaccination conspiracy beliefs. Female gender and religiosity were positively correlated with vaccination conspiracy beliefs, while age was not a statistically significant predictor. The authors concluded by emphasizing the necessity of the more theoretically elaborated approaches to the study of the educational and other socio-demographic differences in vaccine hesitancy.

COVID-19 vaccine intention among young adults: Comparative results from a cross-sectional study in Canada and France

Background

High rates of COVID-19 vaccination uptake are required to attain community immunity. This study aims to identify factors associated with COVID-19 vaccine uncertainty and refusal among young adults, an underexplored population with regards to vaccine intention generally, in two high-income settings: Canada and France.

Methods

A cross-sectional online survey was conducted from October to December 2020 among young adults ages 18–29 years (n = 6663) living in Canada (51.9%) and France (48.1%). Multinomial logistic regression analyses were performed to identify the sociodemographic and COVID-19-related measures (e.g., prevention behavior and perspectives, health-related concerns) associated with vaccine uncertainty and refusal. We conducted weighted analyses by age, gender and province/region of residence.

Results

Intention to accept vaccination was reported by 84.3% and 59.7% of the sample in Canada and France, respectively. Higher levels of vaccine uncertainty and refusal were observed in France compared to Canada (30.1% versus 11%, 10.2% versus 4.7%). In both countries, we found higher levels of vaccine acceptance among young adults who reported COVID-19 prevention actions. Vaccine uncertainty and refusal were associated with living in a rural area, having lower levels of educational attainment, not looking for information about COVID-19, not wearing a face mask, and reporting a lower level of concern for COVID-19′s impact on family. Participants who had been tested for COVID-19 were less likely to intend to refuse a vaccine.

Conclusions

COVID-19 vaccine acceptance was high among young adults in Canada and France during a time in which vaccines were approved for use. Targeted interventions to build confidence in demographic groups with greater hesitance (e.g., rural and with less personal experience with COVID-19) may further boost acceptance and improve equity as vaccine efforts continue to unfold.

Determinants of COVID-19 Vaccine Acceptance and Hesitancy: A Health Care Student-Based Online Survey in Northwest China

Background: With the spread of COVID-19 around the world, herd immunity through vaccination became a key measure to control the pandemic, but high uptake of vaccine is not guaranteed. Moreover, the actual acceptance of COVID-19 vaccination and associated factors remain uncertain among health care students in Northwest China. Methods: A cross-sectional survey of a sample of 631 health care students was performed using a questionnaire developed through Wen Juan Xing survey platform to collect information regarding their attitudes, beliefs, and acceptance of COVID-19 vaccination. Binary logistic regression analyses were performed to identify the association between vaccination willingness and demographics, attitudes, and beliefs to determine the factors that actually effect acceptance and hesitancy of COVID-19 vaccine among health care students. Results: Overall, 491 (77.81%) students actually received the COVID-19 vaccine, and of the 140 unvaccinated, 69 were hesitant and 71 rejected. Binary logistic regression analysis showed that the actually vaccinated individuals were those who mostly believed in the effectiveness of the COVID-19 vaccine (OR = 2.94, 95%CI: 1.37, 6.29), those who mostly felt it is their responsibility to receive the vaccine to protect others from infection (OR = 2.75, 95%CI: 1.45, 5.23), with less previous experience about other vaccines (OR = 1.70, 95%CI: 1.06, 2.72), students who mostly thought COVID-19 to be very severe (OR = 1.77, 95%CI: 1.07, 2.93), and students who mostly thought the COVID-19 vaccine was one of the best protection measures (OR = 1.68, 95%CI: 1.03, 2.76). Concerns about side effects of vaccines (OR = 0.30, 95%CI: 0.18, 0.51) and the use of personal protective behavior as an alternative to the COVID-19 vaccination (OR = 0.16, 95%CI: 0.06, 0.39) hindered the vaccine acceptance. Conclusions: Our study showed higher COVID-19 vaccine acceptance among healthcare students. However, the individuals with vaccine hesitancy and rejection were still worrying. Vaccine safety and effectiveness issues continue to be a major factor affecting students' acceptance. To expand vaccine coverage in response to the COVID-19 pandemic, appropriate vaccination strategies and immunization programs are essential, especially for those with negative attitudes and beliefs.

Vaccine Hesitancy and Rejection of a Vaccine for the Novel Coronavirus in the United States

The arrival of the COVID-19 vaccine has been accompanied by increased discussion of vaccine hesitancy. However, it is unclear if there are shared patterns between general vaccine hesitancy and COVID-19 vaccine rejection, or if these are two different concepts. This study characterized rejection of a hypothetical COVID-19 vaccine, and compared patterns of association between general vaccine hesitancy and COVID-19 vaccine rejection. The survey was conducted online March 20-22, 2020. Participants answered questions on vaccine hesitancy and responded if they would accept the vaccine given different safety and effectiveness profiles. We assessed differences in COVID-19 rejection and general vaccine hesitancy through logistic regressions. Among 713 participants, 33.0% were vaccine hesitant, and 18.4% would reject a COVID-19 vaccine. Acceptance varied by effectiveness profile: 10.2% would reject a 95% effective COVID-19 vaccine, but 32.4% would reject a 50% effective vaccine. Those vaccine hesitant were significantly more likely to reject COVID-19 vaccination [odds ratio (OR): 5.56, 95% confidence interval (CI): 3.39, 9.11]. In multivariable logistic regression models, there were similar patterns for vaccine hesitancy and COVID-19 vaccine rejection by gender, race/ethnicity, family income, and political affiliation. But the direction of association flipped by urbanicity (P=0.0146, with rural dwellers less likely to be COVID-19 vaccine rejecters but more likely to be vaccine hesitant in general), and age (P=0.0037, with fewer pronounced differences across age for COVID-19 vaccine rejection, but a gradient of stronger vaccine hesitancy in general among younger ages). During the COVID-19 epidemic’s early phase, patterns of vaccine hesitancy and COVID-19 vaccine rejection were relatively similar. A significant minority would reject a COVID-19 vaccine, especially one with less-than-ideal effectiveness. Preparations for introducing the COVID-19 vaccine should anticipate substantial hesitation and target concerns, especially among younger adults.

No Such Thing as a Free-Rider? Understanding Drivers of Childhood and Adult Vaccination through a Multicountry Discrete Choice Experiment

Increased vaccine hesitancy and refusal negatively affects vaccine uptake, leading to the reemergence of vaccine preventable diseases. We aim to quantify the relative importance of factors people consider when making vaccine decisions for themselves, or for their child, with specific attention for underlying motives arising from context, such as required effort (accessibility) and opportunism (free riding on herd immunity). We documented attitudes towards vaccination and performed a discrete choice experiment in 4802 respondents in The United Kingdom, France and Belgium, eliciting preferences for six attributes: (1) vaccine effectiveness, (2) vaccine preventable disease burden, (3) vaccine accessibility in terms of copayment, vaccinator and administrative requirements, (4) frequency of mild vaccine-related side-effects, (5) vaccination coverage in the country’s population and (6) local vaccination coverage in personal networks. We distinguished adults deciding on vaccination for themselves from parents deciding for their youngest child. While all attributes were found to be significant, vaccine effectiveness and accessibility stood out in all (sub)samples, followed by vaccine preventable disease burden. We confirmed that people attach more value to severity of disease compared to its frequency, and discovered that peer influence dominates free-rider motives, especially for the vaccination of children. These behavioral data are insightful for policy and are essential to parameterize dynamic vaccination behavior in simulation models. In contrast to what most game theoretical models assume, social norms dominate free-rider incentives. Policy-makers and healthcare workers should actively communicate on high vaccination coverage, and draw attention to the effectiveness of vaccines while optimizing their practical accessibility.

Attitudes of hospital physicians toward childhood mandatory vaccines in France: A cross-sectional survey

Background

Due to a decades-long crisis of confidence in vaccination, in 2017 France extended the number of mandatory early childhood vaccines from 3 to 11.

Aims

To describe the opinions of hospital staff physicians (HSPs) regarding this measure, quantify the proportion who would have preferred measures based on education, and study the factors associated with the latter opinion.

Methods

Cross-sectional nationwide survey with a standardized questionnaire in 2018–2019 among HSPs in 14 French public hospitals. The factors associated with HSPs’ preference for education and persuasion over mandatory vaccination were analyzed with simple and multiple Poisson regressions.

Results

The analyses included 1,795 HSPs (participation rate of 86%). Among them, 84% considered the extension of mandatory childhood vaccination essential given the epidemiological context at the time; in a later question, 40% would have preferred education and persuasion. Multiple regressions showed that the latter tended to be younger and less trustful of sources of information about vaccination. They were more likely to think that information on the rationale behind the national vaccination policy lacked clarity and that the extension of mandatory vaccines was not essential, even in the current epidemiologic situation.

Conclusion

Although most HSPs agreed that the extension of mandatory childhood vaccines was essential, some were ambivalent about its coercive philosophy. Further research is necessary to better understand the reasons of this ambivalence. A fraction did not understand the French vaccination strategy well. Efforts to explain its details to HSPs and an overhaul of their initial training on vaccination are still needed.

How French adolescents use images to represent HPV vaccination (during school-based workshops) adolescents and HPV vaccination

OBJECTIVE

In this study we investigated adolescent students' (13-15 years old) social representations of the vaccination against human papillomavirus (HPV) by analysing their iconographic productions of the vaccination.

DESIGN

A qualitative study with workshops was set up in three volunteer schools. Student groups created a total of 27 posters about the vaccination.

RESULTS

Two types of messages emerged: the first presented vaccination as a means of preventing cancer, while the second presented it as a means of promoting sexual health.

CONCLUSION

The choice between using one message type or the other seemed to stem from the fact that students appropriated the subject of the workshops differently.

Demographics of Vaccine Hesitancy in Chandigarh, India

The impact of vaccine hesitancy on childhood immunization in low- and middle-income countries remains largely uncharacterized. This study describes the sociodemographic patterns of vaccine hesitancy in Chandigarh, India. Mothers of children <5 years old were sampled from a two-stage cluster, systematic sample based on Anganwadi child care centers in Chandigarh. Vaccine hesitancy was measured using a 10-item Vaccine Hesitancy Scale, which was dichotomized. A multivariable logistic regression assessed the association between socioeconomic factors and vaccine hesitancy score. Among 305 mothers, >97% of mothers thought childhood vaccines were important, effective, and were a good way to protect against disease. However, many preferred their child to receive fewer co-administered vaccines (69%), and were concerned about side effects (39%). Compared to the “other caste” group, scheduled castes or scheduled tribes had 3.48 times greater odds of vaccine hesitancy (95% CI: 1.52, 7.99). Those with a high school education had 0.10 times the odds of vaccine hesitancy compared to those with less education (95% CI: 0.02, 0.61). Finally, those having more antenatal care visits were less vaccine hesitant (≥4 vs. <4 visits OR: 0.028, 95% CI: 0.1, 0.76). As India adds more vaccines to its Universal Immunization Program, consideration should be given to addressing maternal concerns about vaccination, in particular about adverse events and co-administration of multiple vaccines.

Social distancing in response to the novel coronavirus (COVID-19) in the United States

In order to reduce the spread of SARS-CoV-2, much of the US was placed under social distancing guidelines during March 2020. We characterized risk perceptions and adherence to social distancing recommendations in March 2020 among US adults aged 18+ in an online survey with age and gender quotas to match the general US population (N = 713). We used multivariable logistic and linear regression to estimate associations between age (by generational cohort) and these outcomes. The median perceived risk of infection with COVID-19 within the next month was 32%, and 65% of individuals were practicing more social distancing than before the outbreak. Baby Boomers had lower perceived risk than Millennials (-10.6%, 95% CI: -16.2%, -5.0%), yet were more frequently social distancing (OR = 1.64; 95% CI: 1.05, 2.56). Public health outreach should focus on raising compliance with social distancing recommendations, especially among high risk groups. Efforts to address risk perceptions alone may be inadequate.

Postponing vaccination in children with an infection: a qualitative study among general practitioners and pediatricians

BACKGROUND

Vaccination postponement is an important contributing factor to low vaccination coverage. The causes of vaccine postponement are numerous, but the presence of viral infection, whether febrile or not, is the most frequent cause.

OBJECTIVE

The objective was to explore the factors motivating the practice of vaccination postponement in a child with an infection by general practitioners (GPs) and paediatricians.

METHODS

An exploratory qualitative study using semi-directive individual interviews was carried out among GPs and paediatricians in a French region between November 2015 and January 2018. After the interviews were fully transcribed, an analysis of the data was performed using an inductive method derived from the grounded theory.

RESULTS

Fourteen GPs and four paediatricians participated in the study. Vaccination postponement during infection in children is rooted in doctors' practices; it is considered a low-risk habit that is shared with parents, and vaccine hesitancy reinforces this practice. In children presenting with an infection, the presence of uncertainty about vaccine safety and effectiveness seems to justify postponing vaccination. The organization of a consultation dedicated to vaccination catch-up was cited as the best tool to limit the effects of vaccination delay on vaccination coverage.

DISCUSSION

In children presenting with an infection, vaccination postponement is widely used by GPs and paediatricians. Simplification of the vaccination catch-up process and clear and consistent recommendations on the indications and modalities for vaccination postponement would be useful.

Vaccine confidence in China after the Changsheng vaccine incident: a cross-sectional study

BACKGROUND

China's achievements in immunization are being threatened by a vaccine crisis. This paper aims to investigate vaccine confidence in China after the Changsheng vaccine incident and attempts to identify the factors contributing to it.

METHODS

An online cross-sectional investigation was conducted from 1 to 25 September 2018. Descriptive analysis and logistic regression were performed to examine the associations between socio-demographic factors, cognition and attitudes towards the Changsheng vaccine incident and vaccine confidence.

RESULTS

We included 1115 respondents in the final analysis, and found that approximately 70% (783) of the respondents did not have vaccine confidence. More than half of the respondents (54.53%) were dissatisfied with the government's response measures to the Changsheng vaccine incident. The logistic regression model indicated that vaccine confidence was positively associated with the degree of satisfaction with the government's response measures (OR = 1.621, 95% CI = 1.215-2.163), attitudes towards the risks and benefits of vaccination (OR = 1.501, 95% CI = 1.119-2.013), concerns about vaccine safety (OR = 0.480, 95% CI = 0.317-0.726), and vaccine efficacy (OR = 0.594, 95% CI = 0.394-0.895).

CONCLUSIONS

A majority of the respondents held negative attitudes towards vaccines after the Changsheng vaccine incident. A coordinated effort is required to restore public confidence in vaccines, especially in China, where a nationwide mandatory immunization policy is implemented. To end dissent towards inoculation, a series of actions is crucial and multiple parties should work together to advance efforts and explore the possibility of establishing an open and transparent regulatory system.

Image of the new vaccination obligation through the media

INTRODUCTION

Vaccination campaigns always go hand by hand with controversies about their safety and usefulness. The widespread perception of vaccines as dangerous induces a decrease in the population immunization coverage, which led The French Ministry of Health to add 8 new mandatory vaccines to the 3 existing ones. The objective of this study is to analyze the information conveyed by the media and received by the French population about this new legislation.

METHOD

The newspaper articles and television and radio programs were selected from the media with the highest audience rate from January 2016 to May 2018. They were analyzed according to the grounded theory, up to data saturation, with double coding.

RESULTS

The qualitative analysis included 38 written press articles, 18 radio programs and 18 television programs. After coding, several themes emerged. Discussions about the usefulness of vaccination, trust in vaccines, vaccination coverage, and the cost of measure were controversial in the media. Questions about ethics were also mentioned. The description of anti-vaccines by journalists and some doctors conveyed a negative image while reminding their strong mobilization through social media. The law and its implementation details were frequently reminded across the different media.

DISCUSSION-CONCLUSION

Traditional media give opposing views on immunization obligations. Vaccination is supported by a majority of doctors. Parents share their fears and concerns about vaccination and its adverse effects. An effort regarding public communication seems necessary in order to reassure the population. The study of other media, such as the Internet, could help to deepen this study.

Vaccine hesitancy in the French population in 2016, and its association with vaccine uptake and perceived vaccine risk-benefit balance

Vaccine hesitancy (VH) is prominent in France. Objectives: This study aimed to estimate the prevalence and socio-demographic correlates of VH in sub-groups of the French population and to investigate the association of VH with both vaccine uptake and perceived risk–benefit balance (RBB) for four vaccines. Methods: During the 2016 Health Barometer – a national cross-sectional telephone survey in a representative sample of the French population – parents of 1–15 year-old children, parents of 11–15 year-old girls and elderly people aged 65–75 years were asked about VH (using three questions adapted from the World Health Organization definition), vaccine uptake and perceived RBB for measles and hepatitis B (children’s parents), human papillomavirus (girls’ parents) and seasonal influenza (elderly people) vaccines. Results: A total of 3,938 parents including 959 girls' parents – and 2,418 elderly people were interviewed. VH prevalence estimates were 46% (95% confidence interval (CI): 44–48) among parents, 48% (95%CI: 45–51) among girls’ parents and 35% (95% CI: 33–36) among elderly people, with higher estimates associated with high education level, children’s age (10–15 years), and, for the elderly, poor perception of health status. VH was associated with uncertainty about and/or an unfavourable perception of vaccines’ RBB for the four vaccines and with lower self-reported vaccine uptake, except for human papillomavirus vaccine in girls. Results were confirmed by multivariable analysis. Conclusion: Further research is needed to study the association between VH and vaccine uptake for other vaccines, and to design and validate measurement tools to monitor VH over time.

Extension of French vaccination mandates: from the recommendation of the Steering Committee of the Citizen Consultation on Vaccination to the law

On 4 December 2017, French parliamentarians passed a law extending the vaccination mandates for children up to 2 years of age from three vaccinations (against diphtheria, tetanus and poliomyelitis) to 11 by adding vaccinations against pertussis, Haemophilus influenza b (Hib), hepatitis B, pneumococcal diseases, meningococcal C diseases, measles, mumps and rubella. This vote follows a recommendation made by the Steering Committee of the Citizen Consultation on Vaccination that took place in 2016. The law applies to all children born after 1 January 2018. Parents who do not fulfil the mandate will not be fined but non-vaccinated children will not be admitted to any collective child services such as nurseries or schools. No exemption other than for medical reasons will be considered. Here we describe the historical background of this evolution and its main epidemiological, sociological and policy drivers. They mainly refer to insufficient vaccine coverage, persistence of a preventable burden for some diseases and growing vaccine hesitancy in the French population. We also discuss some of the challenges and conditions of success.

Patients' high acceptability of a future therapeutic HIV vaccine in France: a French paradox?

Background

France is the European country with the lowest level of confidence in vaccines. Measurement of patients’ acceptability towards a future therapeutic HIV vaccine is critically important. Thus, the aim of this study was to evaluate patients’ acceptability of a future therapeutic HIV vaccine in a representative cohort of French patients living with HIV-AIDS (PLWHs).

Methods

This multicentre study used quantitative and qualitative methods to assess PLWHs’ opinions and their potential acceptance of a future therapeutic HIV vaccine. Cross-sectional study on 220 HIV-1 infected outpatients, aged 18–75 years.

Results

The participants’ characteristics were similar to those of the overall French PLWH population. Responses from the questionnaires showed high indices of acceptance: the mean score for acceptability on the Visual Analog Scale VAS was 8.4 of 10, and 92% of patients agreed to be vaccinated if a therapeutic vaccine became available. Acceptability depended on the expected characteristics of the vaccine, notably the duration of its effectiveness: 44% of participants expected it to be effective for life. This acceptance was not associated with socio-demographic, clinical (mode of contamination, duration of disease), quality of life, or illness-perception parameters. Acceptability was also strongly correlated with confidence in the treating physician.

Conclusion

The PLWHs within our cohort had high indices of acceptance to a future therapeutic HIV vaccine.

Trial registration

This study was retroactively registered on ClinicalTrials.gov with ID: NCT02077101 in February 21, 2014.

Influenza vaccination among children with idiopathic nephrotic syndrome: an investigation of practices

Background

Annual influenza vaccination is recommended for all children with idiopathic nephrotic syndrome (INS) in France. Consequently, the Social Security automatically sends prescriptions to all patients suffering from a chronic disease. The aim of this study was to evaluate the follow-up to these recommendations.

Methods

We conducted a monocentric retrospective investigation of practices. We included all children with steroid-sensitive INS in remission who attended our clinics from January 1st 2015 to January 1st 2017, resided in France and had a valid phone number. Data were collected from May 2017 to June 2017 through a phone interview and review of clinical charts.

Results

75 patients met the inclusion criteria. The parents of 57 children could be reached by phone and agreed to participate to the survey. 35/57 (61.4%) declared having received a prescription during the 2016–2017 campaign. Only 14 children (24.6%) were vaccinated. 17/43 (39.5%) parents of unvaccinated children had concerns about the safety of the vaccine, 16/43 (37.2%) were not aware of the recommendations, 5/43 (11.6%) had been recommended by their physician not to vaccinate their child, 3/43 (7%) forgot to have them vaccinated and 2/43 (4.6%) reported no reason. 13/43 (30%) unvaccinated children presented a relapse during the flu season - 2/13 during an influenza-like illness - whereas 1/14 (7%) immunized children presented a relapse during the six months of post-vaccination follow-up. Relapse rates were not increased in vaccinated children compared to unvaccinated children (p = 0.15), nor in the 6 months following vaccination compared to the 6 months prior (1/14 vs 5/14, p = 0.20).

Conclusions

1) < 2/3 patients were properly prescribed the recommended yearly influenza vaccination at our center 2) only 1/4 were vaccinated and most of their parents were misinformed. Physicians must be aware of this and should make every effort to better inform their patients on the risks of flu illness and the benefits and safety of the vaccination.

Electronic supplementary material

The online version of this article (10.1186/s12882-019-1240-2) contains supplementary material, which is available to authorized users.

A preliminary prospective study: Could the labeling of a health-care message on a consumer product limit forgetfulness in parents confronted with immunization?

BACKGROUND

Parental hesitancy in immunization is an emerging and concerning problem owing to the serious consequences of a lack of vaccination. Few tools are available to combat this phenomenon.

AIMS

To evaluate the interest of parents in recording the vaccine schedule on a common consumer product as a solution to prevent immunization oversight.

METHOD

We conducted a preliminary prospective and monocentric study, in a parental population, using surveys to evaluate interest in this solution, and to define the sociodemographic characteristics of our population. Our population was clustered into three groups: against immunization, hesitant/negligent, and pro-immunization. This solution was evaluated using a univariate model between fearful and confident populations in respect of immunization, associated with a descriptive analysis of the population against immunization.

RESULTS

Of 825 surveys distributed, 709 were analyzed. There were 47 parents against immunization (6.6%), 284 hesitant/negligent parents (40%), and 378 pro-immunization parents (53.3%). We showed that the hesitant/negligent population reported more difficulties in remembering the immunization schedule (P<0.001; OR=0.36; 95% CI [0.25-0.51]), and was interested in discussions on immunization (P<0.001; OR=0.41; 95% CI [0.29-0.58]). This population prone to oversight was interested in the labeling of an everyday consumer product with the immunization schedule (P=0.03; OR=0.68; 95% CI [1.02-2.11]) to limit the number of missed injections.

CONCLUSION

There is no single or perfect solution to combat the current anti-immunization problem, although communication through everyday consumer products seems to be an interesting tool for raising parental awareness of the importance of immunization. Further studies are required to evaluate the effectiveness of this tool.

HPV vaccination rate in French adolescent girls: an example of vaccine distrust

OBJECTIVES

To explore the clinical issues of human papillomavirus (HPV) vaccination to develop explanatory hypotheses for the low level of vaccination among adolescent girls in France where the full course coverage is low (<15%).

DESIGN

We used semistructured interviews. Our qualitative and phenomenological procedure applied interpretative phenomenological analysis.

PARTICIPANTS

16 physicians regularly faced with the prescription of HPV vaccine, represented several medical specialties (paediatrics, general practice, internal medicine, gynaecology), with hospitalist or private practices.

MAIN OUTCOME MEASURES

The results connect three superordinate themes grouping three concentric levels: within society, during the consultation and in the individual doctor's feelings.

RESULTS

The modalities and contents of the information about HPV vaccination raise questions about the limitations of the information doctors receive. The ineluctable association between sexuality and HPV vaccination explains their reluctance to raise topics considered to be private. The reasons for HPV vaccination illustrate the difficulty of arguing in favour of it. In view of the frequent parental reluctance, which weakens the parent-physician alliance, physicians must take responsibility for defending the benefits of vaccination. They nonetheless remain citizens whose opinions may implicitly echo the general reluctance, promoted by disinformation. In delaying or avoiding the subject of vaccination, they involuntarily become an instrument of anti-vaccination discourse.

CONCLUSIONS

It is imperative to improve the distribution of credible information about vaccination, unbiased and scientifically supported by a strong institutional position and to rethink the place of the clinician in the system of adolescent health and disease prevention in France.

Strategies implemented to address vaccine hesitancy in France: A review article

Vaccination has been identified many decades ago as an effective means to prevent several diseases. However, in France, there is an emergence of vaccine hesitancy, that has caused a reduction of vaccination coverage rates. This issue reduces the effectiveness of the immunization process, and represents a real threat to public health that should be urgently addressed. The purpose of this review is to present actions that have been taken to fight against vaccine hesitancy and thus enhance vaccine uptake. The results indicate that different strategies have been proposed to reach this goal, mainly by vaccination campaigns. These findings highlight the strong implication of national health authorities and the medical staff of hospitals and health-care centers. However, actions implemented should be part of a long-term approach, and further studies are required to identify the most effective strategies to address vaccine hesitancy.

Pneumococcal and influenza vaccine uptake in adults with inflammatory bowel disease in France: Results from a web-based study

BACKGROUND

Despite specific immunization guidelines for immunocompromised patients, there is a dearth of studies on inflammatory bowel disease (IBD) population in France.

AIMS

To estimate the prevalence and predictors of influenza and pneumococcal vaccination rates in a sample of French IBD adults.

METHODS

An anonymous online survey was submitted to members of several French immunocompromised patients' associations during the winter 2016.

RESULTS

Overall, there were 199/1625 (12%) participants with an IBD. Among these, 32% were <30 years old, 85% were male, and 62% were treated with immunosuppressive therapy. Self-reported influenza vaccine uptake was 34% (95% CI [28-41]) and 38% (95% CI [31-44]) for pneumococcal vaccines. Healthcare provider's (HCP) recommendation for vaccination (adjusted OR 12.7 95% CI [5.6-28.8]), immunosuppressive therapy (aOR 2.3 [1.1-5.3]), better knowledge of vaccination (aOR 3.2 [1.1-9.2]) and favorable attitudes towards vaccination (aOR 3.4 [1.2-9.5]) were positively associated with influenza vaccine uptake. Vaccine recommendation by HCPs was the only independently associated factor with pneumococcal vaccines uptake (OR 187.7 [24.8-1422.5]).

CONCLUSION

Immunization rates in our sample do not reach recommended levels. Factors associated with vaccination included high knowledge, favorable attitudes towards vaccination and recommendation for vaccination. This underlines the role of health care providers in contact with IBD patients.

Flu vaccination among patients with diabetes: motives, perceptions, trust, and risk culture - a qualitative survey

Background

Vaccination against seasonal influenza (SIV) is recommended for patients with diabetes, but their vaccination coverage is unsatisfactory in France and elsewhere. This qualitative survey of people with diabetes sought to explore 1) the extent to which SIV-related behaviour is more or less automatic; 2) reasons they choose/reject SIV; 3) their trust/distrust in authorities, science, and medicine.

Methods

We conducted semi-structured in-depth interviews of 19 adults with diabetes in 2014. We recruited them through physicians or patient associations and implemented an analysis of thematic content.

Results

Eight patients were vaccinated against flu in the preceding flu season and 11 were not. SIV uptake and refusal were stable over time and justified by multiple arguments. Coupons for free vaccines and regular doctor visits contributed to the habit of vaccination. Vaccination decisions were frequently anchored in past experiences of influenza and its vaccine. Patients often justified non-vaccination with attitudes of trivialisation/relativisation of influenza-associated risks and the perception that these can be controlled by means other than vaccination (e.g., through the avoidance of exposure). Some misbeliefs (e.g., SIV causes influenza) and doubts about SIV effectiveness and safety also existed. Several patients reported increased mistrust of SIV since the A/H1N1 pandemic in 2009. Patients trusted their doctors strongly regardless of their SIV behaviour, but unvaccinated patients had little trust in the government and pharmaceutical companies. Some discordances were found between perceptions and behaviour (e.g., remaining vaccinated despite doubts about SIV effectiveness or remaining unvaccinated despite feelings of vulnerability towards influenza complication), suggesting the existence of some vaccine hesitancy among patients.

Conclusion

This study among patients with diabetes suggest that SIV uptake is stable, thanks to a favourable environment. Nonetheless, SIV refusal is also stable over time. Unvaccinated patients used multiple arguments to justify SIV refusal, including compensatory health beliefs. Physicians should take every opportunity to recommend SIV. The necessary individualised patient education regarding SIV requires better physician training in patients priorities. While almost all patients strongly trust their doctors, unvaccinated patients distrust distal stakeholders: it is absolutely essential to restore trust in them and to develop new more effective influenza vaccines.

Individual decisions to vaccinate one's child or oneself: A discrete choice experiment rejecting free-riding motives

It is essential for public health to understand what drives people's hesitance towards vaccination. Theoretical models of vaccination decisions are ubiquitous, often incorporating herd immunity, perceptions of vaccine-related side-effects (VRSE) and of vaccine-preventable burden of disease, but with little to no empirical exploration. Herd immunity is a (usually) positive externality where vaccinated individuals influence others' risks by their reduced capability to transmit an infectious disease to them. It is often assumed that (rational) individuals incorporate this externality in their strategic vaccination decision, from which free-riding behavior arises. We performed a Bayesian D-efficient discrete choice experiment in February-March 2017 to study vaccination behavior in 1919 Belgian respondents. Choice sets with vaccine profiles were constructed using six attributes: vaccine effectiveness, VRSE, accessibility (in terms of convenience and reimbursement), vaccine-preventable burden of disease, local (respondents' network of contacts) vaccination coverage, and population (the population at large) vaccination coverage. VRSE and accessibility are the most influential attributes, followed by vaccine effectiveness and burden of disease. Both population and local coverage are less important than the other attributes, but show a significant direct linear relationship with vaccine utility. This supports the existence of peer influence (more incentivized as more and more vaccinate), rather than free-riding on herd immunity. These findings were independent of whether respondents made vaccine choices for themselves or for their child. Around 40% of the respondents indicated accepting vaccination with little or no questioning. These 'acceptors' were less sensitive to changes in the vaccine-preventable burden of disease for their child's vaccination choices (but not for themselves). Public health institutions are critical in stimulating vaccine uptake by making vaccines conveniently available at an affordable price and by communicating pro-actively on perceived VRSEs. The free-riding assumption as a driver of individual vaccine decisions, seems inappropriate, but this observation needs confirming in other populations.

Patient's behaviors and missed opportunities for vaccination against seasonal epidemic influenza and evaluation of their impact on patient's influenza vaccine uptake

Objectives

Influenza vaccination (IV) coverage remains low in France. Objectives were to assess patient knowledge and behaviors and missed opportunities for vaccination (MO) and their impact on vaccine uptake.

Methods

This is a prospective-observational study, including emergency department patients at risk for severe influenza. Patients were interviewed about their knowledge and behaviors. We evaluated the health-care voucher scheme (HCVS) and MO.

Results

868 patients were included. Vaccine uptake was 33.2%, 42% of patients knew about the possible severity of influenza, 23% thought that they were not at risk for severe influenza, 39% knew that they have an indication for the vaccine, and 4.3% to 11.5% expressed reservations concerning IV side effects and effectiveness. HCVS was used by 44.3% of patients, but only 14.8% had been vaccinated. MO were reported by 484 patients (69.4%) declaring 1104 consultations and 148 IV propositions (86.6%). Predictors of vaccine uptake (p<0.0001) were: knowledge of serious and fatal influenza forms [OR 0.36 (CI95% 0.25–0.5)]; confidence in influenza vaccine effectiveness [0.38 (0.2–0.7)]; opposition to vaccines [0.22 (0.1–0.48)]; visit to general practitioner [4.53 (2.9–7.1)]; general practitioner proposed IV [2.1 (1.2–3.4)].

Conclusion

Our results indicate that high rate of missed opportunities, some patient behaviors and general practitioner visits may explain low influenza vaccine uptake, and that HCVS use is a complex process. Of interest, we found that the patient’s knowledge of the potential severity of influenza is not sufficient to promote vaccine, suggesting that the information strategy must be adapted to each patient behavior.

Vaccine criticism: Presence and arguments on French-speaking websites

OBJECTIVE

To evaluate the presence of vaccine criticism on the French Web and to analyze strategies and arguments used by opponents of vaccination.

METHODS

The most frequently used keywords associated with the terms "vaccination" and "vaccine" on Google.fr in September 2013 were identified and searched for individually on Google.fr. The links presented in the first three pages of results were reviewed to identify the most frequent providers of information. The proportion of critical content was determined by website type and a content analysis was performed.

RESULTS

The main preoccupations about vaccination were general concerns; <1% of searches were guided by negative keywords. Institutional websites, healthcare websites, news websites and anti-vaccine websites were the most frequent providers of results. The proportion of anti-vaccine websites among the results was 11% for a neutral search and 24% for a search guided by negative keywords. Critical content was observed in other types of website. Six major strategies and categories of arguments used by opponents of vaccination were identified: the manipulation of science, the use of shocking images and an appeal to emotions via testimonies, a general vaccination conspiracy, the individual's freedom of choice not respected, an unnatural act and a negative benefit/risk balance.

CONCLUSION

It seems important to monitor online vaccination debates, to develop an institutional presence that meets the needs of Internet users and to help them develop a critical view.

Socioeconomic differences in childhood vaccination in developed countries: a systematic review of quantitative studies

INTRODUCTION

The reasons for vaccine hesitancy and its relation to individual socioeconomic status (SES) must be better understood. Areas covered: This review focused on developed countries with programs addressing major financial barriers to vaccination access. We systematically reviewed differences by SES in uptake of publicly funded childhood vaccines and in cognitive determinants (beliefs, attitudes) of parental decisions about vaccinating their children. Using the PRISMA statement to guide this review, we searched three electronic databases from January 2000 through April 2016. We retained 43 articles; 34 analyzed SES differences in childhood vaccine uptake, 7 examined differences in its cognitive determinants, and 2 both outcomes. Expert commentary: Results suggest that barriers to vaccination access persist among low-SES children in several settings. Vaccination programs could be improved to provide all mandatory and recommended vaccines 100% free of charge, in both public organizations and private practices, and to reimburse vaccine administration. Multicomponent interventions adapted to the context could also be effective in reducing these inequalities. For specific vaccines (notably for measles, mumps, and rubella), in UK and Germany, uptake was lowest among the most affluent. Interventions carefully tailored to respond to specific concerns of vaccine-hesitant parents, without reinforcing hesitancy, are needed.

Seasonal influenza vaccine uptake among people with disabilities: A nationwide population study of disparities by type of disability and socioeconomic status in France

People with disabilities use various preventive health services less frequently than others, notably because of a lower socioeconomic status (SES). We examined variations of seasonal influenza vaccine uptake according to type/severity of disability and SES. We analyzed (in 2016) data from the 2008 French national cross-sectional survey on health and disability (n=12,396 adults living in the community and belonging to target groups for seasonal influenza vaccination). We defined seasonal influenza vaccine uptake during the 2007-2008 season by the self-reporting of a flu shot between September 2007 and March 2008. We built scores of mobility, cognitive, and sensory limitations, and an SES score based on education, occupation, and income. We performed bivariate analyses and then multiple log-binomial regressions. The prevalence of vaccine uptake was 23% in the 18-64 group and 63% in the ≥65 group. In bivariate analyses, it was higher among people in both age groups who had mobility and/or cognitive limitations and in the ≥65 group among those with sensory limitations. In the multiple regression analyses, only the presence of major mobility limitations in the18-64 group remained significant. The probability of vaccine uptake was higher in the highest SES category than in the lowest. Among at-risk groups, people with disabilities were more frequently vaccinated than others, mainly because of their higher levels of morbidity and healthcare use. Socioeconomic inequalities in access to vaccination persist in France. Future research is needed to monitor the trend in vaccine uptake in institutions.

Prevalence and correlates of vaccine hesitancy among general practitioners: a cross-sectional telephone survey in France, April to July 2014

This article sought to estimate the prevalence of vaccine hesitancy (VH) among French general practitioners (GPs) and to study its demographic, professional and personal correlates. We conducted a cross-sectional telephone survey about GPs' vaccination-related attitudes and practices in 2014 in a national panel of 1,712 GPs in private practice, randomly selected from an exhaustive database of health professionals in France. A cluster analysis of various dimensions of VH (self-reported vaccine recommendations, perceptions of vaccine risks and usefulness) identified three clusters: 86% of GPs (95% confidence interval (CI): 84-88) were not or only slightly vaccine-hesitant, 11% (95% CI: 9-12) moderately hesitant and 3% (95% CI: 3-4) highly hesitant or opposed to vaccination. GPs in the latter two clusters were less frequently vaccinated and reported occasional practice of alternative medicine more often than those in the first cluster; they also described less experience with vaccine-preventable diseases and more experience with patients who they considered had serious adverse effects from vaccination. This study confirms the presence of VH among French GPs but also suggests that its prevalence is moderate. Given GPs' central role in vaccination, these results nevertheless call for a mobilisation of stakeholders to address VH among GPs.

Barriers and motivations to volunteers' participation in preventive vaccine trials: a systematic review

INTRODUCTION

The recruitment of volunteers in preventive vaccine trials (PVT) is a challenge, since vaccine hesitancy and debates on vaccines are combined to usual difficulties of enrollment in clinical trials. Areas covered: Current knowledge of the reasons leading to the volunteers' participation or non-participation in PVT mainly focuses on data from preventive HIV vaccine trials. A systematic PubMed search was conducted using PRISMA guidelines to identify articles or reviews that reported barriers and motivations to participation in PVT regardless of the targeted disease or population. Expert commentary: In view of the barriers and motivations reviewed here, improvements in recruitment could be made through a better explanation of the prevented disease, of the expected individual and collective benefit and of all ethical protective principles associated to the trials. Use of decision aids as well as patient and public involvement may improve given information and may enhance comprehension of participants and their participation in PVT. Further prospective and interventional studies are needed to analyze if these leads may improve acceptation level in PVT.

Barriers of Influenza Vaccination Intention and Behavior - A Systematic Review of Influenza Vaccine Hesitancy, 2005 - 2016

BACKGROUND

Influenza vaccine hesitancy is a significant threat to global efforts to reduce the burden of seasonal and pandemic influenza. Potential barriers of influenza vaccination need to be identified to inform interventions to raise awareness, influenza vaccine acceptance and uptake.

OBJECTIVE

This review aims to (1) identify relevant studies and extract individual barriers of seasonal and pandemic influenza vaccination for risk groups and the general public; and (2) map knowledge gaps in understanding influenza vaccine hesitancy to derive directions for further research and inform interventions in this area.

METHODS

Thirteen databases covering the areas of Medicine, Bioscience, Psychology, Sociology and Public Health were searched for peer-reviewed articles published between the years 2005 and 2016. Following the PRISMA approach, 470 articles were selected and analyzed for significant barriers to influenza vaccine uptake or intention. The barriers for different risk groups and flu types were clustered according to a conceptual framework based on the Theory of Planned Behavior and discussed using the 4C model of reasons for non-vaccination.

RESULTS

Most studies were conducted in the American and European region. Health care personnel (HCP) and the general public were the most studied populations, while parental decisions for children at high risk were under-represented. This study also identifies understudied concepts. A lack of confidence, inconvenience, calculation and complacency were identified to different extents as barriers to influenza vaccine uptake in risk groups.

CONCLUSION

Many different psychological, contextual, sociodemographic and physical barriers that are specific to certain risk groups were identified. While most sociodemographic and physical variables may be significantly related to influenza vaccine hesitancy, they cannot be used to explain its emergence or intensity. Psychological determinants were meaningfully related to uptake and should therefore be measured in a valid and comparable way. A compendium of measurements for future use is suggested as supporting information.

Negative perceptions of hepatitis B vaccination among attendees of an urban free testing center for sexually transmitted infections in France

BACKGROUND

Official French health care policy recommends vaccinations against hepatitis B for all infants and at-risk adults. Attendees at our free testing center for sexually transmitted infections (FTC-STI) routinely express hepatitis B vaccine hesitancy. We aimed in this exposed population to explore the extent of knowledge concerning HBV infection, to quantify HBV vaccine refusal, and to identify the reasons for this refusal.

METHODS

During a 3-month period in 2013, all attendees at the Grenoble FTC-STI were given an anonymous questionnaire exploring their knowledge of hepatitis B, perception of the hepatitis B vaccine, acceptance of free same-day hepatitis B vaccination, and reasons for refusing this offer (where applicable).

RESULTS

The questionnaire was completed by 735 attendees (64.7% of those attending during the study period)(59.9% men; age 27.9 ± 9.2). Most respondents identified hepatitis B as a potentially severe, potentially lifelong illness existing in France. Concerning the hepatitis B vaccine, less than 50% totally or mostly agreed that it is safe; when asked whether the vaccine is dangerous, 44.2% answered "I don't know" and 14.0% agreed; when asked whether the vaccine is "not well characterized," 45.0%, answered "I don't know" and 26.5% agreed. When asked whether they mistrust the hepatitis B vaccine or all vaccines in general, 39.0% and 28.9% of those unvaccinated agreed, respectively. Two thirds refused to get vaccinated on the same day. When asked whether they were afraid of the adverse effects of this vaccine, only 18.7% disagreed.

CONCLUSION

Negative perceptions of the hepatitis B vaccine are widespread in this at-risk population. Consequently, a successful communication strategy must reassure this at-risk population of the vaccine's innocuous nature.

Scoring and psychometric validation of the 'Determinants of Intentions to Vaccinate' (DIVA©) questionnaire

Background

Primary care physicians (PCPs) play a key role regarding vaccination in France. The aims of the present study were to define the scoring rules and to assess the measurement properties of the ‘Determinants of Intentions to Vaccinate’ (DIVA^©) questionnaire that aims to assess PCPs’ attitudes and beliefs toward vaccination.

Methods

The DIVA questionnaire was derived from a literature review and PCPs focus groups. Scoring and early validation of the DIVA questionnaire were determined during a cross-sectional study conducted in France. During the study, PCPs had to complete the DIVA questionnaire for any of the six vaccine-preventable diseases (VPDs) to which they were randomly assigned (measles, pertussis, pneumococcus infection, seasonal influenza, human papillomavirus -HPV- infection and tetanus). Descriptive analyses of items and the analysis of the grouping of items into domains were conducted. Internal consistency reliability and construct validity was assessed according to each VPD.

Results

The DIVA questionnaire was completed by 1,069 PCPs and was well accepted. The ‘Commitment of the PCP to the vaccination approach’ score showed very good internal consistency reliability (Cronbach’s alpha >0.70 overall and for each VPD). The construct validity of the DIVA questionnaire was confirmed.

Conclusions

The DIVA questionnaire is a valid and reliable measure of PCPs’ attitudes and beliefs toward vaccination.

Electronic supplementary material

The online version of this article (doi:10.1186/s12875-016-0539-3) contains supplementary material, which is available to authorized users.

Adolescent confidence in immunisation: Assessing and comparing attitudes of adolescents and adults

INTRODUCTION

There is limited knowledge of adolescent views and attitudes towards immunisation. Our study investigated adolescent attitudes to immunisation and compared differences in vaccination attitudes between adolescents and adults.

METHODS

This study was a cross-sectional, national online survey. Recruitment was stratified by state and gender to ensure findings were nationally representative. Regression analyses were performed to assess and compare adolescent and adult views on vaccine benefits, community protection, risks, side effects, sources of information, and decision-making preference.

RESULTS

In 2013, 502 adolescents and 2003 adults completed the online survey. Lower levels of vaccine confidence were observed in adolescents with adolescents less likely to believe vaccines are beneficial and/or safe compared to adults (p=0.043). Compared to females, males were less confident of vaccine benefits (p<0.05) but less concern about vaccine side effects (p<0.05). Adolescents were more concerned about vaccine side effects than adults for pain (p<0.001), redness or swelling (p<0.001), and fever (p=0.006). Adolescents were less likely than adults to consider health professionals (p<0.001) and the media (e.g. internet) (p=0.010) as important sources of information, and were more likely to seek information from social networks (p<0.001) including families and schools. Although 62.0% of adolescents agreed that parents should make the decision about vaccination for them, adolescents were more likely to prefer a joint decision with parents (p<0.001) or by themselves (p=0.007) compared with adults.

CONCLUSION

Adolescents have a lesser understanding of vaccine safety and benefits than adults and have higher concerns about potential vaccine reactions. Improving adolescent awareness and knowledge of the benefits and risks of vaccination through school-based educational programs may improve confidence in and uptake of vaccines for adolescents and increase vaccine confidence in the next generation of parents.

The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey

Background

Public trust in immunization is an increasingly important global health issue. Losses in confidence in vaccines and immunization programmes can lead to vaccine reluctance and refusal, risking disease outbreaks and challenging immunization goals in high- and low-income settings. National and international immunization stakeholders have called for better monitoring of vaccine confidence to identify emerging concerns before they evolve into vaccine confidence crises.

Methods

We perform a large-scale, data-driven study on worldwide attitudes to immunizations. This survey – which we believe represents the largest survey on confidence in immunization to date – examines perceptions of vaccine importance, safety, effectiveness, and religious compatibility among 65,819 individuals across 67 countries. Hierarchical models are employed to probe relationships between individual- and country-level socio-economic factors and vaccine attitudes obtained through the four-question, Likert-scale survey.

Findings

Overall sentiment towards vaccinations is positive across all 67 countries, however there is wide variability between countries and across world regions. Vaccine-safety related sentiment is particularly negative in the European region, which has seven of the ten least confident countries, with 41% of respondents in France and 36% of respondents in Bosnia & Herzegovina reporting that they disagree that vaccines are safe (compared to a global average of 13%). The oldest age group (65+) and Roman Catholics (amongst all faiths surveyed) are associated with positive views on vaccine sentiment, while the Western Pacific region reported the highest level of religious incompatibility with vaccines. Countries with high levels of schooling and good access to health services are associated with lower rates of positive sentiment, pointing to an emerging inverse relationship between vaccine sentiments and socio-economic status.

Conclusions

Regular monitoring of vaccine attitudes – coupled with monitoring of local immunization rates – at the national and sub-national levels can identify populations with declining confidence and acceptance. These populations should be prioritized to further investigate the drivers of negative sentiment and to inform appropriate interventions to prevent adverse public health outcomes.

•

Overall vaccine confidence is positive, though responses differ between countries.

•

The European region has the lowest confidence in vaccine safety with France the least confident globally.

•

Bangladesh, Ecuador, and Iran reported highest agreement that vaccines are important.

•

Azerbaijan, Russia, and Italy reported most skepticism around vaccine importance.

•

Education increases confidence in vaccine importance and effectiveness but not safety.

This global survey builds on previous studies of vaccines' perceived importance, safety, effectiveness, and religious compatibility. The worldwide survey investigates attitudes towards vaccines on an unprecedented scale, interviewing 65,819 respondents across 67 countries. This can help inform public health agendas by highlighting national and regional variations in attitudes towards vaccines; for example, that the European region is the least confident region towards vaccine safety. One pattern shared by diverse countries worldwide is a worrying gap between high confidence in vaccine importance yet lower confidence in safety, identifying at-risk countries whose vaccine acceptance may be more precarious than previously thought. Meanwhile, factors such as religion, which past research shows to be crucial in some sub-populations, display no consistent pattern at the global scale, emphasizing the importance for future research of understanding the local drivers of vaccine confidence in more detail.

[Vaccination coverage and socioeconomic determinants of BCG vaccination in children before 3 months: Results of the Elfe cohort study, 2011]

BACKGROUND

In 2007, French authorities changed mandatory BCG vaccination for all children into a strong recommendation to vaccinate only children considered at high risk of tuberculosis. Vaccination coverage (VC) data are insufficient in France. We estimated VC at approximately two months of age and identified socioeconomic factors associated with BCG vaccination.

METHODS

The Elfe study (Étude Longitudinale Française depuis l'Enfance) included a random sample of about 18 000 children born in 2011 selected at birth from 320 maternity wards from mainland France. Information was collected through questionnaires and telephone interviews conducted approximately two months after delivery. Because BCG recommendations are different in the Paris region (Île-de-France [IDF]) and outside this region, VC was estimated separately in these two regions. We estimated VC for different levels of tuberculosis risk, approached by the geographical origin of the parents. Poisson regression was performed to analyze the association between socioeconomic factors and BCG vaccination status, and results expressed by prevalence ratios (PR).

RESULTS

CV was higher in IDF (59.5%) compared to at-risk children outside IDF (46.7%) (p<0.001). VC in children with two parents from a tuberculosis highly endemic country was 80.5% in IDF and 60.4% outside IDF. In the multivariable model, having one or two parents from a tuberculosis highly endemic country (PR around 1.40) or consulting a private pediatrician (PR around 1.15) or a maternal and child health (MCH) center (PR around 1.40) after leaving the maternity ward were associated with a higher VC, whereas a university educational level in mothers was associated with a lower VC (PR=0.80).

CONCLUSION

In France, BCG vaccination in infants is performed early after discharge from the maternity ward. A first consultation with a pediatrician or in a MCH center is associated with better vaccination coverage. Children at higher risk are probably well identified by physicians and better vaccinated.

Opening the 'Vaccine Hesitancy' black box: how trust in institutions affects French GPs' vaccination practices

BACKGROUND

In recent years, vaccine hesitancy among health professionals has emerged as an important issue on public health agendas. However, we do not yet know very much about whether, and if so how, trust in institutions affects their practices.

METHODS

A path analysis model explaining the influence of trust on GPs' vaccine hesitancy was applied to a cross-sectional survey of 1,582 French GPs performed in 2014. We hypothesized that distrust in public health institutions influences GPs' concerns about the safety of various vaccines, their perceptions about the importance of vaccination, their self-efficacy in the doctor-patient relationship, and ultimately their vaccination recommendations to patients.

RESULTS

GPs' trust in institutions was found to be significantly associated with lower vaccine hesitancy, an association mediated to a large extent by the vaccine's perceived safety (β = 0.09, P < 0.01) and the importance of vaccination (β = 0.46, P < 0.001).

CONCLUSION

These results suggest that restoration of high vaccination coverage may require the re-establishment of a significant degree of trust in the public health system among health professionals.