Vaccine hesitancy in health-care providers in Western countries: a narrative review

INTRODUCTION

Vaccine hesitancy (VH) is a leading cause of suboptimal vaccine uptake rates worldwide. The interaction between patients and health-care providers (HCPs) is the keystone in addressing VH. However, significant proportions of HCPs, including those who administer vaccines, are personally and professionally vaccine-hesitant.

AREAS COVERED

This narrative review sought to characterize the nature, extent, correlates, and consequences of VH among HCPs. We included 39 quantitative and qualitative studies conducted in Western countries, published since 2015, that assessed VH among HCPs in general, for several vaccines. Studies were reviewed using the WHO 3Cs model - (lack of) confidence, complacency, and (lack of) convenience.

EXPERT OPINION

Despite the lack of validated tools and substantial heterogeneity in the methods used to measure VH among HCPs, this review confirms its presence in this population, at frequencies that vary by country, profession type, setting, and level of medical education. Lack of knowledge and mistrust in health authorities/pharmaceutical industry/experts were among its principal drivers. Improving the content about vaccination in HCPs' training programs, facilitating access to reliable information for use during consultations, and developing and validating instruments to measure HCPs' VH and its determinants are key to addressing VH among HCPs.

"On the last day of the last month, I will go": A qualitative exploration of COVID-19 vaccine confidence among Ivoirian adults

The authorization of several high-efficacy vaccines for use against the novel SARS-CoV2 virus signals a transition in the global COVID-19 response. Vaccine acceptance is critical for pandemic control and has a variety of context- specific drivers that operate at the individual, group, and sociopolitical levels. Social and behavior change interventions can influence individual knowledge, attitudes, and intentions as well as community norms to facilitate widespread vaccine uptake. While considerable research has been done to explore vaccine confidence in high-income populations as well as with respect to childhood vaccinations, much work remains to be done in understanding attitudes and intentions in low and middle income countries for adult or novel vaccines. We conducted in-depth interviews with individuals who had recovered from COVID-19 (n = 8), people who had lost a family member to COVID-19 (n = 4), and health providers (n = 17). We also conducted focus group discussions with members of the general population (n = 24 groups) to explore social norms and community perceptions related to COVID-19, including prevention behaviors, stigma, and vaccines. Researchers collected data in Abidjan, Côte d’Ivoire, in November 2020. In considering whether to accept a future COVID-19 vaccine or not, individuals in the study weighed perceived risk of the vaccine against the severity of the disease. Perceived severity of rumored side effects or safety issues of vaccines were also a factor. Convenience was a secondary, albeit also important, consideration. While concerns about vaccine safety tended to produce an expressed intention to delay vaccination, conspiracy theories about those developing and promoting vaccines and their motives led people to say they would opt out entirely. Behavior change interventions must raise awareness and address misunderstandings about the purpose of vaccines, transparently communicate about vaccine safety and development processes, and engage trusted influencers to build an enabling environment for COVID-19 vaccine roll out.

Latent justice? A review of adversarial challenges to fingerprint evidence

This article provides an overview of recent research on latent fingerprint evidence featured in reported legal decisions from England and Wales, Australia and New Zealand. The research casts doubts on the effectiveness of adversarial criminal procedure. Rather, than engage with the methodological foundations - e.g. validity and reliability - and the actual abilities of fingerprint examiners, for more than a century, challenges were based on legal considerations and the meaning of categorical identification for the specific proceedings. Lawyers challenged fingerprint evidence based on the circumstances in which reference prints were collected, whether fingerprint records were hearsay, whether relying on a fingerprint record is unfair because it suggests prior criminality, whether the jurors could make their own comparison and so forth. There is no reported consideration of the validity and reliability of fingerprint comparison, and no requirement for fingerprint examiners to qualify the significance of a match decision, even after the abandonment of point standards and the appearance of critical reports from the United States and Scotland, and advice from the Forensic Science Regulator. To the extent that they considered the admissibility and probative value of this prominent forensic science evidence, lawyers and judges relied heavily on proxies such as training, experience and long use. In consequence, the article considers how we should understand adversarial legal practice, the performance of lawyers and judges, as well as the implications for forensic scientists and their evidence.

The reliability and transparency bases of trust in human-swarm interaction: principles and implications

Automation reliability and transparency are key factors for trust calibration and as such can have distinct effects on human reliance behaviour and mission performance. One question that remains unexplored is: what are the implications of reliability and transparency on trust calibration for human-swarm interaction? We investigate this research question in the context of human-swarm interaction, as swarm systems are becoming more popular for their robustness and versatility. Thirty-two participants performed swarm-based tasks under different reliability and transparency conditions. The results indicate that trust, whether it is reliability- or transparency-based, indicates high reliance rates and shorter response times. Reliability-based trust is negatively correlated with correct rejection rates while transparency-based trust is positively correlated with these rates. We conclude that reliability and transparency have distinct effects on trust calibration. Practitioner Summary: Reliability and transparency have distinct effects on trust calibration. Findings from our human experiments suggest that transparency is a necessary design requirement if and when humans need to be involved in the decision-loop of human-swarm systems, especially when swarm reliability is high. Abbreviations: HRI: human-robot interaction; IOS: inter-organisational systems; LMM: liner mixed models; MANOVA: multivariate analysis of variance; UxV: heterogeneous unmanned vehicles; UAV: unmanned aerial vehicle.

The use of adaptable automation: Effects of extended skill lay-off and changes in system reliability

This experiment aimed to examine how skill lay-off and system reliability would affect operator behaviour in a simulated work environment under wide-range and large-choice adaptable automation comprising six different levels. Twenty-four participants were tested twice during a 2-hr testing session, with the second session taking place 8 months after the first. In the middle of the second testing session, system reliability changed. The results showed that after the retention interval trust increased and self-confidence decreased. Complacency was unaffected by the lay-off period. Diagnostic speed slowed down after the retention interval but diagnostic accuracy was maintained. No difference between experimental conditions was found for automation management behaviour (i.e. level of automation chosen and frequency of switching between levels). There were few effects of system reliability. Overall, the findings showed that subjective measures were more sensitive to the impact of skill lay-off than objective behavioural measures.