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Vaccine confidence: innovations and threats to the future

In this video, Dr Heidi Larson explains vaccine confidence and the causes of vaccine hesitancy, and how this information
HEIDI LARSON: Good morning, or good afternoon, depending on where in the world you’re watching from. My name is Heidi Larson. And I’m a professor of anthropology and risk and decision science at the London School of Hygiene and Tropical Medicine. And I lead the Vaccine Confidence Project. Today, I’m going to say a few things about vaccines in the context of child health.
This year we had a big review of what’s called the Global Vaccine Action Plan. It is looking at overall progress in vaccines for children in particular. And the verdict is we’re doing good, but not great. We haven’t managed to reach the 90% threshold that we need globally. So to keep the world’s children healthy, we really need to do an extra boost around immunisation. And one thing about immunisation is it touches every child’s life around the world. So it hits a number of different cultures, religions, geographies, economies. And looking at vaccines and vaccine confidence in the context of child health is a window on a lot of different health situations.
And, in the case of vaccine uptake, the reasons that we don’t do as well in some places than other are a mix of access regions and reasons. You can’t reach there. You don’t have time. You don’t have transport. Or sometimes, it’s not so far away, but you just don’t trust the vaccine. Or you don’t think it’s safe. And it’s created what WHO has framed as vaccine hesitancy. Why aren’t people coming for their vaccines? It’s such a fantastic health intervention. It saves so many lives. Why are people questioning vaccination? We at the Vaccine Conference Project have developed what we call a Vaccine Confidence Index. It’s a global index where we measure what are people thinking about vaccines. Are they important?
Are they safe? Are they effective? And are they compatible with your religious or other beliefs? And that’s a really important part of public confidence in vaccines. Do they fit in a mother’s life, in a family’s life outside of what we think from a public health perspective? Well, the biggest concern that people had was, are they really safe? They’ve been demonstrated to be very safe. Historically, you don’t see a vaccine in a clinic before it goes through years of trials and tests and ensuring that it’s safe and that it has the immune strength that it needs to protect the life and health of a child.
But that’s not what everybody sees, especially these days with the internet, with social media, with alternative people who want to sometimes disrupt a programme for political reasons. Sometimes they actually just believe in another way, another alternative health or natural health or for religious reasons. And sometimes they just don’t have accurate information. It’s accidental misinformation versus intentional misinformation. Well, it varies differently, as you can see from the map. But in addition to safety there’s a number of different reasons. And in an advisory group to the World Health Organisation, we assessed different types of concerns. And we also did it with the European Centres for Disease Control and had similar clusters of reasons why people don’t take vaccine.
Because one of the first things you want to do if in your programme or if in your country some people are not taking vaccines, before you say we need to give them more information or it’s just about access, we need to talk to people. We need to listen what their perspective is, understand what their feelings as well as knowledge and information levels are, as well as their logistical access situation. Maybe it’s just a matter of not being able to get to the vaccine. Maybe they didn’t know that it was given on that day. But maybe it’s something else, and we need to understand what that is.
In the advisory group to WHO’s Strategic Advisory Group on Vaccines more generally, there was a working group specifically to understand what were these drivers of hesitancy. And we came up with three clusters. Confidence. Do we think they’re safe? Do we trust them? Do we believe in them. Convenience. Those are those access reasons. And complacency. I don’t really need it. I don’t see anybody with those diseases. And sometimes you don’t see them just because we’ve done a good job with vaccines, but we need to keep doing a good job with vaccines. There’s a range of these reasons.
And only until you know what those reasons are can you develop the kind of intervention you need to make sure that people get their vaccines. So I’m going to end my short intervention for this MOOC with a couple different creative ways that people can build confidence and can engage. We’ve had issues– the first thing you tend to see in the news is the damage that social media can play in spreading misinformation. But there’s also very creative things that communities and countries are doing with social media and other types of interventions, including the basic face-to-face listening and conversation. That is very important.
HPV in Ireland and Denmark and some other countries involved young girls, girls who were the ones who would be getting the teenage vaccine to prevent HPV and cervical cancer. By their involvement, we made the campaign relevant to the population. In India, Mission Indradhanush used very creative ways of engaging communities and reaching out. And just let’s talk about and listen to your concerns as a mother, as a community, are absolutely important. So thank you very much. I think building confidence is extremely important to address the global vaccine hesitancy. But we also need the usual quantitative measures and anticipate where the issues are and make sure we’re listening carefully to the public. Thank you very much.

Vaccination is an issue that affects every child around the world and has resulted in massive reductions in child mortality from vaccine preventable diseases like measles.

However, vaccine coverage is still low in some regions that continue to have poor access to vaccination, and progress has slowed or even reversed in regions with good access but low levels of trust. In this step, Professor Heidi Larson, Director of the Vaccine Confidence Project at LSHTM, will explain what is vaccine confidence, the causes of vaccine hesitancy, and how this information can be used to improve vaccine confidence and uptake.

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