Under-vaccinated Groups in Europe: Who are they and how to communicate with them in outbreak situations? Work Package 6 - EU project Effective communication in Outbreak management Development of an evidence-based tool for Europe E-com@EU is coordinated by Prof. dr. Jan Hendrik Richardus, Erasmus University Rotterdam. This EU project is directed at development of an evidence-based behavioural and communication package to respond to major epidemic outbreaks. Seite 1 von 87 Writing of the report: Part I: Identification and description of under-vaccinated groups in three European countries and their beliefs regarding vaccination Nelly Fournet - Epidemiology and Surveillance Unit, Centre for Infectious Diseases Control, National Institute for Public Health and the Environment (RIVM), the Netherlands. - European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden (Parts on UVGs in Romania and Portugal were written by collaborators, see list page 3) Part II - Communication and behavioural influence tactics recommendations Jeff French Strategic Social Marketing Ltd. Hampshire, United Kingdom Corresponding authors: Part I: Jim van Steenbergen Preparedness and Response Unit National Institute for Public Health and the Environment (RIVM) P.O. Box 1, 3720 BA Bilthoven, The Netherlands Tel: +31 (0)30 274 2528 - Fax: +31 (0)30 274 2528 or 7000 (secr) Email: [email protected] Part II: Jeff French Strategic Social Marketing Strategic Social Marketing Ltd Attabara, Conford, Hants, GU307QW United Kingdom Tel: +44 (0)1428 751 475 www.strategic-social-marketing.org Seite 2 von 87 Collaborators who contributed to the report (alphabetical order): • Franklin Apfel, World Health Communication Associates, United Kingdom • Gratiana Chicin, National Institute for Public Health, Romania Chapter on NIP in Romania (Part I, Appendixe 15.1) • Jean-Yves Durand, Instituto de Ciências Sociais - Universidade do Minho, CRIA, Portugal Chapter on Roma communities, macrobiotics and critical citizens in Portugal (Part I, chapter 5.5.) • Nelly Fournet, Epidemiology and Surveillance Unit, RIVM, the Netherlands • Jeff French. Strategic Social Marketing, United Kingdom • Irene Harmsen, Epidemiology and Surveillance Unit, RIVM, the Netherlands Review methodology, Anthroposophists, determinants and matrix parts (Part I) • Manuela Ivone Cunha, Instituto de Ciências Sociais - Universidade do Minho, CRIA, Portugal Chapter on Roma communities, macrobiotics and critical citizens in Portugal (Part I, chapter 5.5.) • Frederic Keck, Sociology and anthropology department - Centre National de la Recherche Scientifique, France • Aileen Kitching, Immunisation Department, Centre for Infectious Disease Surveillance & Control (CIDSC), Public Health England, United Kingdom Review report (Part I) • Liesbeth Mollema, Epidemiology and Surveillance Unit, RIVM, the Netherlands Supervision of Part I of the report • Ria Reis, Sociology and anthropology department from the University of Amsterdam, the Netherlands • Helma Ruijs, Preparedness and Response Unit, RIVM, the Netherlands Review of the Orthodox Protestants and determinants parts (Part I) • Edith Smith, Persuasive communication Department - University of Amsterdam & Leiden Medical University Center the Netherlands • Jim van Steenbergen, Preparedness and Response Unit, RIVM, the Netherlands Project leader • Paula Valente, Direcção-Geral da Saúde, Portugal Chapter on NIP in Portugal (Part I, Appendixe 15.1) • Marius Wamsiedel, Romani CRISS, Romania Chapter on Roma population in Romania (Part I, chapter 5.4.) • Piotr Wysocki, European Centre for Disease Prevention and Control (ECDC) Sweden Seite 3 von 87 Table of contents Writing of the report: ................................................................................................................ 2 Collaborators who contributed to the report (alphabetical order): ............................................. 3 Table of contents ..................................................................................................................... 4 Abbreviations ........................................................................................................................... 6 Foreword ................................................................................................................................. 7 Executive Summary ................................................................................................................. 8 1. Introduction ......................................................................................................................10 1.1 Designing communication strategies for under-vaccinated groups ................................10 1.2 Aim of this Work Package..............................................................................................10 1.3 Case definition of an Under-Vaccinated Group (UVG) ...................................................10 2. Introduction and objectives ..............................................................................................13 3. Methodology ....................................................................................................................14 3.1 Selection of the three countries .....................................................................................14 3.2 First two steps of the Intervention Mapping approach ....................................................14 3.2.1 The needs assessment: identification and description of the UVGs, and of the determinants of poor vaccine uptake among those groups.............................................. 14 3.2.2 Definition of performance and programme objectives ............................................ 15 4. Results: Identified under-vaccinated groups in the three selected European countries ....16 4.1 Identified UVGs .............................................................................................................16 4.2 UVGs in Europe ............................................................................................................16 4.3 The Orthodox Protestant Denominations (The Netherlands) .........................................17 4.3.1 Background ........................................................................................................... 17 4.3.2. Beliefs about vaccination ...................................................................................... 18 4.3.3 Vaccination coverage ............................................................................................ 19 4.3.4 Community Outbreaks .......................................................................................... 19 4.4 The Anthroposophists (The Netherlands) ......................................................................19 4.4.1 Background ........................................................................................................... 20 4.4.2 Beliefs about vaccination ....................................................................................... 20 4.4.3 Vaccination coverage ............................................................................................ 23 4.4.4 Outbreaks in their community............................................................................... 23 4.5 The Dutch Association for critical vaccination (NVKP) (The Netherlands) ......................23 4.5.1 Background ........................................................................................................... 24 4.5.2 Beliefs about vaccination ....................................................................................... 24 4.5.3 Vaccination coverage ............................................................................................ 25 4.5.4 Outbreaks ............................................................................................................. 25 4.6 Roma population (central/eastern/south-eastern Europe and Portugal) .........................25 4.6.1 Background ........................................................................................................... 26 4.6.2 Vaccination – attitudes and behaviour .................................................................. 26 4.6.3 Vaccination coverage ............................................................................................ 29 4.6.4 Outbreaks in Roma community ............................................................................. 29 4.7 Macrobiotics and critical citizens (Portugal) ...................................................................29 4.7.1 Alternative dietary systems: macrobiotics .............................................................. 30 4.7.2 Critical citizens (critical vaccine acceptors or vaccine refusers) .............................. 31 5. Determinants of non-vaccination by UVG ........................................................................35 6. Theoretical vaccination behaviour model .........................................................................37 6.1 Existing theoretical vaccination behavior model for the general population in the Netherlands .........................................................................................................................37 7. Determinants and performance objectives .......................................................................39 7.1 Selection of determinants of poor vaccine uptake ..........................................................39