In February, Sabin convened 70 immunization managers from 30 countries to discuss an issue of increasing concern to public health experts around the world: vaccine acceptance and demand.

Immunization managers facilitate every aspect of an immunization program, from cost-effective procurement of vaccines to the vigilant monitoring of vaccine safety and efficacy. A peer network like the one Sabin provides through the International Association of Immunization Managers (IAIM) creates opportunities for immunization managers to come together to address the most pressing topics challenging immunization programs. The IAIM Joint Regional Meeting for the Americas and Europe was organized by the Sabin Vaccine Institute in collaboration with the World Health Organization Regional Office for Europe as a forum to share experiences countering vaccine hesitancy and ensure the continued success of immunization programs.

Defining Vaccine Hesitancy

Dr. Noni MacDonald of the Canadian Center for Vaccinology defined vaccine hesitancy as the delay in acceptance or refusal of vaccines despite the availability of vaccine services. Such hesitancy poses a danger both to the unvaccinated child and to public health by leaving the child vulnerable to serious diseases like polio, measles and diphtheria, and by reducing “community immunity,” which is essential to keep such diseases out of a population.

According to Dr. MacDonald, the reasons for delaying or refusing vaccines vary widely depending on the place, demographic and vaccine in question. Recent data from the WHO/UNICEF Joint Reporting Form indicates that the three most common reasons cited for vaccine hesitancy are concerns about the relative risks and benefits of vaccination, a lack of knowledge or awareness of issues surrounding vaccines, and religious, cultural, gender or socioeconomic issues.

A key focus of the meeting was to help immunization managers effectively address these barriers to vaccination within their populations in order to foster trust. The efforts included identifying best practices to accurately measure behaviors, attitudes, knowledge and perceptions of vaccination, and integrating lessons learned from those experiences into effective communication strategies to build immunization program resilience and encourage vaccine confidence within a community.

Measuring Vaccine Confidence

As with any public health intervention, an important part of addressing vaccine hesitancy is ensuring sufficient data is collected to be able to identify where and why this problem exists. Dr. Douglas Opel’s group at the University of Washington has been developing tools to do just that, including a survey tool that accurately predicts how a parent’s attitudes on vaccination will influence their child’s ultimate vaccine uptake. This 15-question survey, called the “Parent’s Attitudes about Childhood Vaccines” tool, or PACV, is helping researchers accurately measure the attitudes influencing vaccine confidence and identify the most important reasons underlying vaccine refusal. Questions such as, “All things considered, how much do you trust your child’s doctor?” reveal parents’ levels of trust in information provided by healthcare professionals and their value judgments on the risks and benefits associated with vaccines.

Understanding Barriers to Immunization

Researchers involved in developing the WHO Guide to Tailoring Immunization Programs (TIP), presented communication strategies for addressing the specific reasons for refusing or delaying childhood immunizations. The TIP approach stresses the need for tailored strategies informed by behavioral science to communicate with susceptible populations. It emphasizes the need to consider and comprehensively address these groups’ specific concerns and barriers to immunization.

Robb Butler of the WHO Regional Office for Europe also highlighted the value of behavioral insight into addressing vaccine acceptance and demand during an interactive exercise. By asking attendees to compare their beliefs on the benefits of exercise to how often they actually go to the gym, Butler showed them first-hand that knowing a behavior is important does not necessarily mean a person will perform that behavior. He noted that understanding why people do not perform a behavior they know to be beneficial – for example, exercising regularly or receiving a flu vaccine – can help improve vaccine uptake by helping managers design campaigns that address the most common serious neurological illness that were subsequently demonstrated not to be caused by the vaccine. Bolette Søborg of the Danish Health Authority and Brenda Corcoran of the Irish HSE National Immunization Office presented their experiences counteracting the spread of misinformation through social and traditional media. They advised that the best way to prevent misinformation from causing major setbacks to a national immunization program was to get ahead of such misinformation before it takes hold.

Inoculating Against Misinformation

Proactively sharing accurate information about the vaccine through social media and traditional media outlets is one method Søborg and Corcoran proposed to counteract anti-vaccine propaganda. This so-called “inoculation against misinformation” helps support parents who are already vaccinating their children, reinforcing their decision. It also prepares a community to be more skeptical of misinformation when they encounter it by making them much more familiar with the truth. Actively disseminating information about a vaccination campaign from the beginning, rather than in response to a crisis, makes it much less likely the population as a whole will be influenced by anti-vaccine propaganda.

Since 2013, Sabin has helped advance global vaccination efforts by bringing together immunization managers from more than 100 countries to share the latest leadership, management and technical skills to help them strengthen their immunization programs. The focus of this year’s meeting stemmed from increased recognition that in order to address dropping vaccine uptake, immunization managers and other public health experts need to make a concerted effort to understand the populations they serve and the values guiding their decision to vaccinate. This meeting served as a valuable opportunity for immunization managers to share their experiences with peers from other countries and leverage their collective knowledge to increase global vaccine confidence.

The IAIM Joint Regional Meeting for the Americas and Europe was held from February 1-2, 2017 in Madrid, Spain. Presentations from the meeting are available online.