Vienna Vaccine Safety Initiative (ViVI)

Noting that vaccination can be a polarising topic, ViVI has deliberately chosen to step outside of the dichotomy of pro- versus anti-vaxxer and eschew the language and assumptions associated with it. ViVI has opted to avoid the visual language typical to the vaccination debate and instead incorporate a user-centred design based on the principles of Design Thinking – a human-centred approach to innovation that integrates people's needs and technological possibilities – within all of its materials. "We aim to establish a different line of communication that is professional and personal at the same time. We try to be inviting rather than confrontational," ViVI's Co-founder and Chair, Barbara Rath, explains.

Research is a core ViVI approach. For example, to understand where vaccine communication might be improved, ViVI conducted a number of survey projects addressing both parental perceptions of vaccine safety and the reporting of adverse events by healthcare providers. They learned that, for parents, the most important factor driving vaccine acceptance is an intact doctor-patient relationship. Healthcare providers may be unaware that they are holding a key position in vaccine safety communication. ViVI realised that an average paediatrician spends as much as one hour per eight-hour workday on vaccine consultations – yet few providers seem to have ever received any formal vaccine safety training. These findings led ViVI to a vaccine safety training initiative, where they developed a four-week teaching module, which has since been introduced into the reformed "Model Curriculum" at the Charité University Medical School in Berlin. The vaccinology elective consists of a 50-50 mix of formal teaching and hands-on experience in vaccine consultations with parents and children. During evidence-based medicine sessions, ViVI teaches medical students to critically review the scientific literature with a focus on vaccine safety and effectiveness. To this end, they make use of an e-learning tool developed by the Stanford School of Graduate Education through which they teach students to generate, rather than answer, multiple-choice questions.

ViVI pursues collaboration as part of this work, welcoming new members, including representatives of patient organisations, to their group. Comprising vaccine experts and organisation leaders from numerous different disciplines, backgrounds, and countries, diverse voices are key to the Initiative. They participate in collaborative projects and research consortia, both as individuals and as an NGO. For example, ViVI partnered with the School of Design Thinking at the Hasso Plattner Institute in Potsdam, Germany in order to investigate innovative and user-centred solutions to improve vaccine safety communication between patients, parents, and physicians. The result was the creation of the VAccApp™, an evidence-based digital vaccination record designed to help parents keep track of recommended immunisations for their children while integrating vaccine advice to help them understand the need for booster immunisations. (For further details, see Related Summaries, below). This and other m-health tools are currently being validated in different settings.

Another example of a ViVI project includes a systematic review of safety reporting in vaccine clinical trials that were carried out in developing countries. Looking at randomised clinical trials (RCTs) reporting safety outcomes published between 1989 and 2011, ViVI found that although 70% of RCTs mentioned definitions for at least one adverse event following immunisation (AEFI), they were not always consistent. Indeed, a total of 16 different definitions were used to describe fever, as well as seven different definitions of erythema. Predefined AEFI case definitions were used in just 4% of RCTs overall. This suggests there is significant room to improve the harmonisation of safety reporting and communication in developing country vaccine clinical trials, as well as the implementation of international vaccine safety standards across the globe.

Immunisation and Vaccines

ViVI points out that not everyone is experiencing the positive effects associated with vaccination. One reason for this is unequal immunisation service provision. In many non-industrialised and resource-poor nations, effective routine vaccination is neither widely available nor sufficiently supported. According to United Nations Children's Fund (UNICEF) statistics, of the 21.8 million children under the age of one worldwide who had not received the recommended three doses of the vaccine against diphtheria, tetanus, and pertussis (DTP) in 2013, 75% were concentrated in 15 countries. Further, in terms of experience, while AEFIs are extremely rare, ViVI argues that there is a need to work towards the accurate prediction of individual risks and a personalised vaccination strategy. There are patients - or, in the case of childhood vaccination, their parents - who choose to opt out of available vaccination programmes. This can be fuelled by any number of variables, from concerns about the safety and efficacy of vaccines to a mistrust of the medical sector and the science behind immunisation programmes. ViVI contends that it is in the interests of public health to promote medically appropriate vaccination and accompany each vaccination with individualised risk-benefit communication to encourage its uptake and allay fears.

Partners:
School of Design Thinking, Hasso Plattner Institute; International Association of Innovation Professionals; InnoLab Freie University Berlin; Robert Koch Institute; Peace Innovation Lab Berlin; Kapodistrias University of Athens; Hellenic Centre for Disease Control and Prevention; Clinical Data Interchange Standards Consortium; Stanford Graduate School of Education; Stanford Center for AIDS Research; University of Zimbabwe College of Health Sciences; University College of Medicine Malawi; Global Solutions for Infectious Diseases; Portable Cloud; Africa University, Zimbabwe; Amrita Institute of Health; Chalmers University of Technology, Sweden; Immunarray, Israel; Mahidol University, Thailand