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  1. A short reflection on moral notions in immunisation in the context EIW 2018 European Immunization Week 2018 raises awareness on vaccination as an individual right and a collective responsibility. Highlighting the importance of everyone’s role in protecting their community from dangerous, infectious diseases by choosing to get fully vaccinated is as relevant as ever with outbreaks of measles still occurring throughout the WHO European Region to this day. Immunisation with its enormous success story has been a pathfinder for universal health coverage. Examining immunisation from an ethical lense is detrimental because virtually every individual in this world is – or ought to be – reached by vaccination programmes and their health benefits. However, vaccine hesitancy, misinformation and the influence of anti-vaxxers is a real threat to achieving elimination. It is therefore extremely relevant to observe the roles of all stakeholders involved in immunisation processes and to evaluate how immunisation services can be as equitable, inclusive, acceptable and beneficial as possible - from a normative and ethics perspective, as moral underpinnings have been identified as a relevant element of vaccine hesitancy (Amin et al 2017). Herd immunity is a building block of disease prevention through vaccination. This year’s EIW reflects the importance of this concept and reminds individuals of their responsibility in protecting not only themselves, but also their community. The decision not to get fully vaccinated can have severe consequences to those who cannot get vaccinated themselves. Responsibility can indicate taking on a moral obligation. This indirect moral power of one party can be defined as a “person or institution contributing to a system without necessarily receiving direct individual benefit or observing others receiving benefit“. However in the context of immunisation, both service receivers and providers share burdens and risks as well as paramount individual and collective benefits. This relates closely to the concept of reciprocity, which in short is “the practice of exchanging things with others for mutual benefit”. An immunisation programme provides vaccinations as a part of disease prevention for the public and requires the participation and cooperation of the public to achieve better health for all. Acting upon this principle is based on a more general normative value of social cooperation for the public good. Reciprocity can generate strong bonds of solidarity among groups. Thus, immunisation is not just a moral obligation by one side. If services are well functioning (meaning equitable), it is a win-win situation for all involved, as vaccination risks are relatively low (especially compared to those of other health interventions and to those diseases vaccination prevents) and the burden of participating is also relatively small (of course, this is arguable depending on your standpoint), yet it brings about very immediate and long-term benefits for the individual and collectively. According to the conception of reciprocity for public health ethics, reciprocity “demands an appropriate balancing of the benefits and burdens of social cooperation necessary to obtain the good of public health. (…)” (Dawson, Upshur 2016). In the context of immunisation, reciprocity can be formulated as the following: First, that the vaccinee (A) “complies to active participation in the programme with the aim of disease prevention and (i.e., contribution to public good). Second, the authorities organising the vaccination (B) have an obligation to provide evidence-based information and free and safe vaccines for the participation in the immunisation programme and provide care for any potential adverse events following the vaccination. This may include, among other things, explanation of the procedure, explanation of risks, and providing accessible treatment” (Beeres et al 2018). A chain of health systems/authorities providing evidence-based, tailored and easily accessible information creates trust, which creates cooperation and collective action in a society. Results of a Swedish study on generalised trust and collective action in immunisation (Rönnerstrand 2015) supports the theoretical claim that trust stimulates cooperation in large-scale collective action. Also, the empirical investigation indicates that high trusting individuals are unconditional cooperators in collective action. This implies that trust may give rise to a willingness to vaccinate to protect others, even in the absence of obvious reciprocity. In the face of continuing measles outbreaks in the European Region, it is highly relevant that EIW 2018 stresses rights and responsibilities as key determinants in immunisation. I would like to encourage members of this forum to join a broader discussion on what role ethics, morals and justice play in this field and the implications on policies and policy makers this perspective can bring about. When people understand the importance and the benefits of immunisation, i.e. “are on board”, they can pass on this knowledge in their community. Here it is crucial that those providing the services take on their own responsibility and make vaccination and vaccination services as available, acceptable and accessible as possible. This goes especially for the provision of evidence-based and tailored information. Immunisation must be provided in an equitable manner to achieve better participation and compliance, and thus high immunisation coverage. Reciprocity not only requires that individuals should not be overly burdened by measures to protect public health, but also that individuals are supported in a way that allows them to fulfil their obligations” (Viens, Bensimon, Upshur 2009). References: Amin AB, Bednarczyk RA, Ray CE, Melchiori KJ, Graham J, Huntsinger JR, et al. Association of moral values with vaccine hesitancy. Nat Hum Behav. 2017;1(12):873–80. Available from: https://doi.org/10.1038/s41562-017-0256-5 Beeres, Dorien T., et al. "Screening for infectious diseases of asylum seekers upon arrival: the necessity of the moral principle of reciprocity." BMC medical ethics 19.1 (2018): 16. Rönnerstrand, Björn. Generalized trust and the collective action dilemma of immunization. Göteborg Studies in Politics 139, edited by Bo Rothstein, Department of Political Science, University of Gothenburg, Box 711, 405 30 Göteborg, Sweden. 142 pages. Salmon, D.A., Omer, S.B. Individual freedoms versus collective responsibility: Immunization decision making in the face of occasionally repeating values. Emerging Themes in Epidemiology. 2006;3:1-3. World Health Organization. "Ethical considerations in developing a public health response to pandemic influenza." (2007).
  2. Measles outbreaks continue to occur in a number of EU/EEA countries, and there is a risk of spread and sustained transmission in areas with susceptible populations. Since the beginning of 2016, 48 deaths due to measles were reported in the EU. New data published today by ECDC in the Communicable Disease Threat Report (CDTR) show that the highest number of measles cases in 2017 were reported in Romania (7 977), Italy (4 854) and Germany (904). Greece is currently experiencing a measles outbreak, with 690 cases including two deaths, reported since May 2017; most cases were unvaccinated or incompletely vaccinated. The monthly measles and rubella surveillance monitoring report is also published today and provides more in-depth analysis of the situation. The spread of measles across Europe is due to suboptimal vaccination coverage in many EU/EEA countries: of all measles cases reported during the one-year period 1 November 2016‒31 October 2017 with known vaccination status, 87% were not vaccinated. Measles increasingly affects all age groups across Europe and in 2017, 45% of measles cases with known age were aged 15 years or older. Romania, Italy, Germany and Greece were the countries most affected by measles during 2016 and 2017 and each shows different trends: Romania saw a sharp increase in cases from October 2016, and the trend has continued throughout 2017; in Italy, the increasing trend started in January 2017, while in Germany it began in February 2017; Greece has seen a measles outbreak starting in the second half of 2017, with 167 cases reported in October. This data is based on analysis of the cases notified to ECDC and included in the monthly and biannual monitoring reports. The latest available figures on vaccination coverage collected by WHO (2016) show that the vaccination coverage for the first dose of measles was below 95% in 18 of 30 EU/EEA countries; for the second dose of measles, it was below 95% in 20 of 27 EU/EEA countries reporting second dose coverage data. In order to achieve the measles elimination goal, the vaccination coverage rates for children targeted by routine vaccination programmes should increase in a number of countries, as the vaccination coverage of the second dose must be at least 95% to interrupt measles circulation and achieve herd immunity. This is particularly important to protect children below one year of age, who are particularly vulnerable to complications of measles but are too young to have received the first dose of vaccine. Read more ECDC collects measles data on a monthly basis via The European Surveillance System (TESSy). In addition, ECDC monitors measles and rubella epidemiology and outbreaks via epidemic intelligence. For a complete overview of data regarding measles outbreaks in the EU/EEA in 2016 and 2017, the following outputs are available and regularly updated: Communicable Disease Threat Report “Measles and Rubella, Monitoring European and worldwide outbreaks” (Epidemic intelligence data) Monthly measles and rubella monitoring report (a concise report with TESSy data from 1 November 2016 – 31 October 2017) Bi-annual measles and rubella monitoring report (an extensive report, TESSy and epidemic intelligence data presented, with data from 1 January 2016 – 30 June 2017) ECDC Atlas of Infectious Diseases (TESSy data) Monthly-Measles-Rubella-monitoring-report-December-2017_0.pdf
  3. The Confederation of Meningitis Organisations (CoMO) are pleased to share the new: Vaccines Question & Answer Resource! This resource answers many of the more challenging questions surrounding vaccines including the topics of: Vaccine Manufacture and Availability Vaccine Protection Vaccine Safety View online>> Download PDF>> Please share this resource as far and wide as you consider appropriate within your professional and personal networks alike. Use the link: http://bit.ly/VaxQandA and the hashtag: #VaccinesWork CoMO's Vaccines Q&A Resource.pdf
  4. I conducted a small study in one rural area in the USA where patients have no-to-low science literacy. Among the elders, neither videos nor texts essays succeeded in withdrawing their interest to learn about viral diseases. BUT a comic book did that and more! To my knowledge, this is the first report on improving health education among old patients using comics. I’d love to see if such results are reproducible elsewhere in EU or the USA …. If someone is interested in making our small sample size bigger, that would be awesome!
  5. WHO: Vaccination and trust (2017) This document presents the scientific evidence behind WHO’s recommendations on building and restoring confidence in vaccines and vaccination, both in ongoing work and during crises. The evidence draws on a vast reserve of laboratory research and fieldwork within psychology and communication. It examines how people make decisions about vaccination; why some people are hesitant about vaccination; and the factors that drive a crisis, covering how building trust, listening to and understanding people, building relations, communicating risk and shaping messages to the audiences may mitigate crises. This background document is part of the Vaccination and trust library, which includes a series of support documents with practical guidance for specific situations.
  6. CAN YOU DESCRIBE THIS MAP IN ONE WORD? I have been asking this over the Social Media on Tiwtter - LinkedIn ...etc. Answers came as: DISTRUST - DEPRESSING - NO! - .... I'm curious to have more answers for this increasing vaccine hesitancy problem. Thank you, Susan
  7. The European Commission is dedicating this year’s EU Health Award to initiatives of non-governmental organisations (NGOs) that contributed or are contributing to high standards of public health in the European Union through vaccination. This is great recognition of the importance of vaccination. Previous EU Health Awards were for initiatives to fight Ebola and anti-microbial resistance. The prizes are substantial: €20,000, €15,000 and €10,000. Read more here The European Commission is also hosting a workshop on vaccination in Brussels later this month, including a session on vaccine hesitancy and communication (to which I will contribute). It feels like there is a lot of momentum behind vaccination at the moment.
  8. The importance of vaccination throughout life is a key message at the heart of this year’s World Immunisation Week and the #VaccinesWork campaign. As an organisation whose main focus is meningitis and septicaemia, we at the Confederation of Meningitis Organisations (CoMO), know only too well the consequences of a common misconception that vaccinations are just for babies. We know only too well the consequences of a common misconception that vaccinations are just for babies We are first to agree that infant vaccination is one of the most important and highly successful areas of protection but other ages are also at risk. Teenagers are an essential piece of the puzzle when it comes to raising awareness of the importance of vaccines. This is not only because they are the adults, and parents, of tomorrow but also because it is at this point that many who have been in the education system will move into the world of work, meaning they are harder to reach to talk about recommended vaccines. We conducted a survey through ComRes of 3,026 14-18 year olds across the UK, France, Germany, Poland, Italy and Sweden to gain a better understanding of their levels of awareness around vaccines and how best to communicate these essential messages to them. We surveyed 3,026 14-18 year olds across the UK, France, Germany, Poland, Italy and Sweden We were pleased to find that there was a very positive attitude to receiving information about vaccines, with only 9% saying that they did not want to receive information. There was also a positive response to the need for vaccines throughout life. Young people in France and Germany were the most well-informed on this topic, with around three quarters indicating that vaccines are needed at all stages of life (74% and 73% respectively). In the other countries surveyed awareness was lower, in Poland and the UK in particular, there was a greater belief that vaccines are needed as a baby or toddler (41% in both the UK and Poland) or at school or university (33% in the UK, 23% in Poland) - not at other stages of life. This may indicate a need for greater education in these areas and it would be interesting to compare these findings with the figures for vaccine uptake over the course of life to examine whether a greater awareness of need for vaccines results in a greater level of uptake. Interestingly, this awareness does not seem to correlate with the general attitude towards the safety of vaccines. One in five (18%) of those surveyed say they are afraid of having a vaccination because they don’t trust them, and a worrying 32% responded that they think vaccines can be dangerous. In France especially this concern over the safety of vaccines was most prevalent, with 41% of adolescents agreeing that they can be dangerous and 20% saying that they are afraid of vaccines because they don’t trust them. A study published in EBioMedicine last year found that the same proportion of the general population in France disagreed with the statement that vaccines are safe, so it may be that adolescent opinion is representative of the general population on the subject of vaccination. A worrying 32% responded that they think vaccines can be dangerous In France 61% of adolescents report seeing or hearing about vaccines through their doctors. A study published in Eurosurveillance in November of last year found that 14% of French GPs are moderately vaccine-hesitant. It is possible that this hesitancy reported in adolescents stems from the attitudes of their GPs towards vaccination, a concerning thought. In the other countries surveyed, adolescents reported learning about vaccination predominantly through their parents or guardians, with doctors coming in second place and school or teachers following behind. A finding of note is that there were marked differences between the individual countries and where they report hearing about vaccines and importantly, where they would like to hear about vaccines in future, indicating that an approach to awareness raising on the safety of vaccines and the importance of vaccines across the life course must be tailored to the needs of adolescents on a more country-specific basis. We were also surprised to learn that young people express less of an interest in learning about vaccination via digital media. This source was considered less trustworthy and traditional means were clearly favoured. There were marked differences between the individual countries and where they report hearing about vaccines Overall the results are promising. Attitudes towards vaccination and its necessity throughout life are generally good and methods of communication have clearly been identified. There is certainly more work to be done, particularly with regard to addressing vaccine hesitancy as an important part of education about the role vaccines have to play throughout life. The information from this survey will provide us with an important steer towards the best methods to use to communicate with young people and to move further towards a universal understanding of the need for vaccines at all stages of life.
  9. The ECDC catalogue of interventions to address vaccine hesitancy offers a collection of 40 interventions developed in various countries around the world in order to measure and address vaccine hesitancy. It showcases examples of practices that can serve as a bank of ideas and be adapted according to national and local needs and strategies. The catalogue is divided into two parts. First, it lists relevant interventions that focus on developing tools to measure the scope and scale of vaccine hesitancy in various populations. These diagnostic tools can then be used by public health professionals to inform the development of targeted interventions to address vaccine hesitancy. Second, it focuses on interventions designed to address or respond to vaccine hesitancy. This part is subdivided into three categories: individual-level interventions focusing on parents; individual-level interventions focusing on improving healthcare workers’ confidence and communication skills to respond to hesitant patients; and interventions focusing on responding to hesitancy at a community level. Examples of interventions measuring the scope and scale of hesitancy Global vaccine confidence index The aim of the Global Vaccine Confidence Index is to measure vaccine hesitancy and provide information about hesitant populations and the nature of their concerns. Information is gathered through a survey administered globally through a joint collaboration between Gallup International and the London School of Hygiene and Tropical Medicine Vaccine Confidence Project. It gives a comparable indication about populations’ trust in vaccines and what their concerns are. Questionnaire measuring vaccine hesitancy among general practitioners The aim of the questionnaire is to measure, and to some extent quantify, vaccine hesitancy among general practitioners (GPs). The questionnaire assesses perceptions about vaccines (risk, utility), recommended behaviours towards patients, personal vaccination behaviours, and confidence in various sources of information about the benefits and risks of vaccines. It was administered by telephone interviews. Examples of interventions addressing or responding to vaccine hesitancy Web-based MMR decision aid The aim of the web based decision aid is to empower parents to make informed decisions about vaccination against measles, mumps and rubella. It consists of a step-by-step guide including frequently asked questions and answers, numerical and graphic data comparing the potential risks of the MMR vaccine with the potential risks of contracting disease and clarifies options available. It also includes a clarifying values exercise where the user reviews the importance they place on advantages and disadvantages of vaccination. Framework for communicating with vaccine hesitant parents This communication framework aims to improve communication between clinicians and vaccine hesitant parents. It helps clinicians to tailor their conversations with patients and avoid confrontational arguments. It uses the principles of motivational interviewing, thereby guiding patients rather than directing them and focusing on developing an empathic relationship. This respectful, non-judgemental approach aims to build trust between vaccine-providers and their patients. The intervention has two different communication approaches for different types of vaccine hesitant parents. Catalogue-interventions-vaccine-hesitancy.pdf
  10. The European Medicines Agency supports the European Immunization Week 2017. As part of our Annual Report 2016 to be published in May this year, a doctor, a researcher, and a regulatory body’s representative shared their thoughts on vaccine hesitancy. Their main quotes are encompassed in a set of images published under Gallery -> 'EIW 2017 materials'. The .pdf version of the interview is attached to this topic. vaccines interview final.pdf
  11. The European Medicines Agency supports the European Immunization Week 2017. As part of our Annual Report 2016 to be published in May this year, a doctor, a researcher and a regulatory body’s representative shared their thoughts on vaccine hesitancy.
  12. Hi everyone, Many of you will have read Dr Heidi Larson's latest Vaccine Confidence Survey of 67 countries. The big story is France where 41% of respondents disagreed that vaccines are safe. France! It is truly remarkable given that many vaccines are actually developed and produced there. This is a new 'French Paradox'. Louis Pasteur must be turning in his grave... What is going on in France? Why are their results different to Denmark and Portugal and the rest of their near-neighbours? We (Vaccines Today) ran an article earlier this year about a revision of France's vaccination policy and a public consultation that was due to begin in March. It must be time for an update on that now. Would anyone like to comment here (for publication on Vaccines Today - or not) or to be interviewed on this topic? The questions are simple: - Why is France 'different'? - How is the public consultation going? - What can be done to reverse this negative sentiment? Thanks, Gary
  13. Free Resource @YouTube Anti-Vax = Anti-Facts ( Playlist ) https://www.youtube.com/playlist?list=PLefPh1XlGcqNQmRfAAziO7kyfqP2TO4xT
  14. Request Your Copy Read More About Us At Vaccines Today Blog: http://www.vaccinestoday.eu/vaccines/meet-the-scientist-using-comics-to-save-lives/
  15. I’m a Senior Expert in Capacity Building and Communication, working at the European Centre for Disease Prevention and Control (ECDC). The postings on this site are my own and don't necessarily represent ECDC’s positions or opinions. The other day I was at a crossroad in the beautiful city of Stockholm and the traffic light was red; I was wondering if I should cross or not as no cars were coming. And by the way crossing a street on red seems acceptable in Sweden. While I had this debate with myself I also used the wording – why am I so hesitant? And that was the trigger to the next thought – I am hesitant myself. I was actually concerned with the potential consequences of crossing the street on red light. Wouldn’t you be too? It is fair to say that we all have our concerns, are hesitant at some point in time. For me though hesitancy related to vaccination represents something more than these “little concerns” we have in our lives everyday, it is about when people have a deeper concern might hamper their positive attitude and stop them to vaccinate. This is of course my own interpretation of the definition provided by the Strategic Advisory Group of Experts (SAGE) on Immunisation1. In the context of an ECDC project, the London School of Hygiene and Tropical Medicine (LSHTM) carried out a small qualitative study to look at the opinions of healthcare workers to vaccination. The study addressed primary healthcare practitioners in four countries of the European Union, working in areas with low vaccine coverage. Although clearly not representative, a key conclusion is that physicians do have concerns, some of them being hesitant to vaccination because, among other reasons, they feel responsible if something happens to their patients. As a person who made the Hippocratic Oath when graduating from the Faculty of Medicine I would share the feeling of being responsible and wanting the best for my patients. So what can we, the public health community, do in order to better equip our fellow colleagues in dealing with their concerns and serving better their patients? I would say inform, inform, inform. In these times when the Internet and social media are widely used as sources of information (and not always the correct information) for everybody, I consider we have the responsibility to engage and inform, inform, inform – correct information, from trustworthy sources. ECDC has recently published relevant documents including communication tools in this area aimed at primary healthcare and public health professionals. You can read more about the ECDC work at: Technical reports: Vaccination motivating hesistant populations europe literature review Vaccine hesitancy among healthcare workers Communication guides: Lets talk about protection vaccination guide Lets talk about hesitancy vaccination guide Translation is not enough 1 Vaccine hesitancy is defined as ‘a behaviour, influenced by a number of factors including issues of confidence (level of trust in vaccine or provider), complacency (do not perceive a need for a vaccine, do not value the vaccine), and convenience (access). Vaccine-hesitant individuals are a heterogeneous group that are indecisive in varying degrees about specific vaccines or vaccination in general. Vaccine-hesitant individuals may accept all vaccines but remain concerned about vaccines, some may refuse or delay some vaccines, but accept others, and some individuals may refuse all vaccines’.
  16. POLITICO.eu - This is the latest in a POLITICO special report on vaccines: the accomplishments, history, controversy and business challenges. While France is one of the world’s rich countries with the highest immunization rates for diphtheria and tetanus — for which the government has made vaccination mandatory — it’s one of the worst performers when it comes to vaccinating babies against measles and hepatitis B, according to OECD data. Read the full feature
  17. "Talkshow" with different experts and vaccine opponents performed by junior high school students in Ludwigsburg, Germany. The 35min play was followed by a discussion forum in front of approximately 150 students and several teachers.
  18. Seeing as the topic of vaccine hesitancy (its definition and the means of addressing and measuring it) is the subject of a significant amount of enquiry by immunization community members, the media and the public, I thought I would draw attention to a late-2015 Journal Of Vaccine supplement that some of us had the pleasure to work on and publish. Most of you will be familiar with this but for those of you who have not seen it: http://www.sciencedirect.com/science/journal/0264410X/33/34 In the near future, the Immunize Europe Forum will provide a space for research papers, articles, and reports on specific topics of interest to the forum participants.
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