Communicating Benefits from Vaccines Beyond Preventing Infectious Diseases

"[T]here is a growing lack of confidence in some vaccines. Improving communication about the direct benefits of vaccination as well as its benefits beyond preventing infectious diseases may help regain this lost confidence."

Confidence in vaccines and vaccination programmes has been negatively affected by well-publicised scares about vaccine safety, such as the debunked study linking autism and measles-mumps-rubella (MMR) vaccination. In the context of increasing global and specific vaccine hesitancy, the Fondation Mérieux organised a 2-day meeting in December 2017 to discuss strategies to help regain and maintain public trust in vaccination and to illustrate them through examples. The meeting brought together 44 experts from 12 countries who shared their experiences about the full benefits from vaccination, both direct and indirect, and methods for effective communication about vaccine benefits, including how digital initiatives could be effectively used in communication. This paper reports on the meeting presentations and ensuing discussion.

The 4 main themes included:

1. Indirect benefits of vaccines and vaccination - Examples of some of these benefits are summarised in Figure 1 and Table 1 in the paper. For example, it has been estimated that, for children born in the United States (US) during 1994-2013, vaccination will have prevented 322 million illnesses, 21 million hospitalisations, and 732,000 premature deaths, resulting in a saving of US$295 billion in direct medical costs and US$1.38 trillion in total societal costs. In short, "[t]here is a growing body of scientific evidence about indirect benefits, but these benefits and their impact are often underestimated and poorly communicated."
2. Improving vaccination uptake to increase benefits from vaccination - Conference attendees agreed that developing specific, strategic communication is a crucial element of vaccination policies to ensure high vaccine uptake. One avenue could be that created by the ADVANCE consortium, a European initiative funded by the Innovative Medicines Initiative. This group developed recommendations for strategies for the communication of the benefits and risk of marketed vaccines to inform decision-making. They recommend a step-wise approach, with, first, the definition of the goal and objectives of the communication; second, the mapping of stakeholders; third, the development of content and core components such as audience identity, communication channels and message, and engagement strategy; and finally, the development of an implementation and monitoring plan. They stress the need for transparency - both in the evidence generation process and the involvement and role of different partners, which is of particular importance when a public-private collaboration is involved. In addition, the communication dissemination route should be adapted to each audience, and - as the 2014 "Fluad crisis" in Italy illustrates - communication on vaccines should not only concentrate on safety but should also be accompanied by proactive communication on vaccine benefits, both direct and indirect.
3. Disease surveillance and epidemiological forecasting - Advances in internet tools can provide estimates of disease activity and vaccine effectiveness in near-real time. Examples of such systems include Break Dengue, which has been set up by a non-profit organisation to connect different initiatives addressing the issue of dengue around the world. The website's crowd surveillance, coupled with data from internet search engines and social media reports of new cases, provides "high-quality, close to real-time, disease surveillance....Although the website does not promote vaccination, it connects interdependent stakeholders, and raises disease awareness and the understanding that vaccination is the solution for prevention." The aforementioned ADVANCE consortium also stressed the importance of reinforcing credibility of vaccine-related information in order to build sustainable confidence in vaccines and vaccination for all stakeholders. "Transparency and independence are crucial characteristics for any information source for ensuring public trust."
4. Public health communication strategies - Examples include:
   • Using SMS (text) messages to remind parents and other individuals that their vaccination is due; educational messages that foster vaccine health literacy can also be transmitted via SMS by healthcare professionals.
   • Tailoring vaccination communication to suit school settings, which offer an opportunity to reach children - and their families - with health information and to promote positive behaviour change. A longer-term strategy involves teaching children, who are the future generations of parents, to be more aware of all the benefits of vaccines and vaccination, potentially making them more likely to accept vaccination and less prone to react negatively to vaccine safety scares. In fact, education about vaccines and vaccination could become part of the school curriculum. A game-based module on vaccines, designed to provide active, experienced-based learning, has the advantage of converting theoretical knowledge into practical knowledge - engaging and motivating students and creating an environment in which they can test their knowledge without fear of failure. The World Health Organization (WHO) European Regional Office is developing and pilot-testing a game-based education module on immunisation and vaccination for school children aged 10-11 years, with the aim of promoting durable positive behavioural changes in children and their families, and building population resilience against vaccine safety scares in Europe.

Thus, the conference highlighted the spectrum of indirect benefits of vaccination beyond the well-known direct benefits in vaccinated populations. These benefits are among the elements that participants stressed should be integrated within the design of transparent communication strategies that are designed to build mutual trust and understanding between public and private vaccine organisations and the lay public. Some recommendations going forward include:

• Improve our understanding of the various social behaviours of parents and other individuals that influence decision-making processes for vaccines and vaccination.
• Improve our understanding of healthcare professionals' motivation to provide impartial, credible information about vaccination and its full benefits, and build on this to train them to communicate to, and install an effective dialogue with, parents and other individuals.
• Rapidly communicate any safety issues to show that all organisations, both public and private, are actively collecting safety data using validated scientific methods. The overall aim of communicating this information is to promote informed decision-making using evidence-based benefit/risk ratios at all levels, including health authorities.
• Ensure that correct and pertinent information is delivered to the intended audience in a format they can readily access, understand, and use at the right time. Advances in communication technologies should be used to facilitate this - e.g., alert systems, such as SMS, can be used to remind individuals about their next vaccination and provide information about vaccines and vaccination.
• In addition to educating healthcare professionals and the general public (starting in schools), educate journalists about the importance of providing balanced reporting of vaccine safety concerns: that is, reporting not only on vaccine safety scares as they occur but the findings from the ensuing investigations so as to provide the full story to the public. The Fluad incident in Italy and the debunked link between MMR vaccination and autism, mentioned above, are examples in which reporting on the initial scare far outweighed reporting on the results from the subsequent investigations, which led to loss of public confidence and serious reductions in vaccination uptake.

In conclusion, workshop participants agreed that it is important to continue to share experiences about communicating the whole range of vaccine and vaccination benefits to increase their impact and to improve vaccination uptake. They called for continual efforts from all stakeholders to ensure effective, transparent communication of the full benefits and risks of vaccines and vaccination, with the aim of improving health for all individuals. To achieve this, all stakeholders, including the lay public, must continue to engage in dialogue and collaborate.