Vaccine Acceptance: Science, Policy, and Practice in a 'Post-Fact' World

"A good communication strategy aimed at behavior change involves understanding people and the context in which they live, establishing a respectful partnership and helping them to change their behavior according to their willingness and capacity."

In September 2017, researchers and practitioners from around the world gathered in Veyrier-du-Lac, France, for the Fondation Mérieux's fifth annual meeting on vaccine acceptance to share their experiences in building and sustaining vaccine confidence and uptake. The organising committee chose to highlight the "post-fact world" in the meeting's title as the context for present and future work due to the polarisation and partisanship they see as beginning to distort perceptions about what is "real" and what isn't - something that can render the work of encouraging vaccine acceptance both challenging and ongoing. This conference report explores the main themes of the 3 days of deliberations.

Key meeting themes:

• The role of social marketing in improving vaccination acceptance and uptake - Participants recognised that when vaccination is voluntary, people need to be convinced of its value to them and their communities. Social marketing can facilitate this by understanding what people perceive as the barriers and benefits to vaccination and then working at the individual, environmental, and policy levels to make vaccination more desirable, accessible, and perceived to be the social norm. Specifically, based on robust contextual and audience insight analyses, social marketing aims to change modifiable determinants ethically and create demand and value for the desired behaviour (in this case, vaccination). The social marketing marketing mix comprises the 6 Ps: product, price, place, promotion, policy, and partnerships; they are each described here, and some examples of social marketing used to influence vaccination uptake are summarised in Table 1 in the paper.
• Enabling healthcare professionals (HCPs) to foster trust in vaccination - "[D]uring discussions about vaccination, the interaction is thus more likely to generate trust in vaccines if the person is spoken to in away that fosters receptivity rather than reactivity..." Motivational interviewing (MI) is a tool discussed during the meeting that uses simple, understandable language to encourage discussion and questions from parents rather than providing prescriptive, direct information. It has shown promising results (e.g., in the PromoVac intervention, implemented in Quebec, Canada). Another method for managing vaccination conversations is AIMS, which involves the following 4 steps: (i) Announce: Assume people are ready to be vaccinated or to vaccinate their children; (ii) Inquire: Use open-ended questions to understand the person's concern; (iii) Mirror: Reflect back what you have understood to make the person feel heard; (iv) Secure: Consolidate each conversation by securing trust. Participants stressed that, no matter which approach is used, it is important to remember that human relationships are at the heart of vaccine acceptance conversations.
• The role of mandates in promoting and sustaining vaccination acceptance and uptake - "While mandates may provide short-term boosting of vaccination uptake, for sustained uptake it is essential to address people's and HCPs' vaccine hesitancy and help them understand why vaccination matters. An effective vaccine communication strategy is required to do this, even when mandates are implemented."
• Alignment of research goals with public health needs - "One limitation in the current efforts to enhance vaccine acceptance and address vaccine hesitancy is the difficulty of integrating evidence-informed strategies into vaccination policies and programs.As discussed during one of the meeting workshops, if the knowledge gained from research is to be successfully translated into practice, key stakeholders (decision-makers and end-users, e.g., parents) should be involved from the very beginning of the research project development, thereby enabling them to have input into the research objectives and methods used. It is important to nurture collaboration and to develop trust between the individuals in different organizations."

On the latter point - the importance of collaboration - the authors note that an informal, interdisciplinary community of practice has grown out of the annual Fondation Mérieux meetings, resulting in the development of many projects. For example, community of practice members from Australia are employing learnings from trials in Canada testing the efficacy of vaccine communication interventions with parents of newborns.

In terms of take-home messages, participants stressed that:

1. Particularly in this "post-fact world", maintaining public confidence in vaccines and stimulating vaccine demand is work that must continue. It requires that vaccination communication is effective and sustained, that the media conversation is monitored, and that vaccine acceptance and uptake is assessed.
2. Relatedly, "securing acceptance and uptake should be addressed with the same rigor and resources as surveillance of vaccine safety, evaluating the incidence of vaccine-preventable diseases and measuring vaccine effectiveness."
3. Vaccine acceptance and uptake interventions should be evidence based, which requires "a clear and honest understanding of individual, social, political, and institutional aspects that determine vaccination acceptance and uptake."

Other resources:

• Click here to access presentations from each day of the meeting sessions.
• Click here to watch video recordings of the proceedings.