How can vaccination levels be improved through better public dialogue? Heidi J Larson, PhD Director, The Vaccine Confidence Project “Vaccination challenges and EU cooperation. What is the way forward?” FEAM 19 November 2018 Brussels [email protected] Better “public dialogue” or dialogue with the public? WHO? Dialogue implies two (“dia”) or more sides WHICH Public? Publics are highly polarized Who is talking to Who? Dialogue will be different with Health Care WHERE? Dialogue is needed at multiple levels Professionals than with, for instance, the media, citizens or patient groups WHAT? Knowing what to talk about means listening in order to understand the issues – Need evidence to inform conversations HOW? Dialogue is happening in multiple channels: face-to-face, social media, community meetings, GP practices, formal/informal [email protected] The “dialogue” challenge FRANCE DENMARK [email protected] IRELAND Emotions are strong ITALY ROMANIA “Vaccines are NOT safe!...Know the risks!” http://www.feedler.ro/feed/7208497--cluj-reactie-raed-arafat-despre-panourile-antivaccin-uitati-va-la-ce-s-a-intamplat- cu-copiii-afectati-de-rujeola-lipsa-vaccinarii-a-fost [email protected] Need to understand the issues What is driving perceptions and anxieties? [email protected] [email protected] Do you believe vaccines are safe? agree Strongly disagree http://www.lemonde.fr/sante/article/2016/09/09/plus-de-quatre-francais-sur-dix-estiment-que-les-vaccins-ne-sont-pas-surs_4994856_1651302.html [email protected] Vaccine confidence in the EU Most confident countries Importance: Portugal (98%), Finland (98%), Spain (96%) Safety: Portugal (95%), Denmark (94%), Spain (92%) Effectiveness: Portugal (97%), Denmark (95%), Spain (94%) Least confident countries Importance: Poland (76%), Bulgaria (78%), Slovakia (86%) Safety: Bulgaria (66%), Latvia (68%), France (70%) Effectiveness: Latvia (71%), Bulgaria (73%), Poland (75%) [email protected] GPs vaccine recommendations [email protected] Changes in public confidence between 2015-2018 Countries with increase in confidence in safety, Countries with decrease in confidence in safety, importance, effectiveness and religious compatibility importance, effectiveness and religious compatibility 20% 20% 10% 10% 0% 0% -10% -10% Slovenia Greece Italy The UK Poland Countries with increase in confidence in safety Countries with decrease in confidence in safety 20% 20% 10% 10% 0% 0% -10% -10% France Netherlands Romania Demark Czech Republic Finland Sweden Vaccines are important for Vaccines are safe Vaccines are effective Vaccines are compatible with my children to have religious beliefs [email protected] What drives low confidence in Europe? Vaccine safety 107 Low risk of contracting VPD 51 VPD not severe 36 Vaccines don't work 32 Lack information, misunderstandings 31 Vaccines not necessary 24 Not enough evidence, testing 21 Not offered, recommended against 20 Low risk of Fear of side Strong immune system 20 VPDs not Do not qualify 15 contracting effects Vaccines too new 12 severe Too young 12 VPDs Risks > benefits 11 Not priority 11 Negative media reports 11 Against vaccination in general 9 Natural alternatives 9 Mistrust pharmaceutical companies 8 Mistrust health authorities 8 Vaccine cause the disease they prevent 7 Mistrust governments 7 Influenced by family/friends 7 Frequency of concerns: number of VPD have benefits 7 Promiscuity, STI vaccine 6 qualitative studies where concerns were Concerns about injections 6 Mistrust doctors 6 mentioned + number of quantitative studies Never had/get VPD 6 Too many vaccines 5 where more than 20% of participants Negative experience (personal) 5 Conflicting messages 5 mentioned those concerns Immune system too weak 5 0 20 40 60 80 100 120 [email protected] [email protected] [email protected] The Netherlands Credit: L. Mollema, National Institute for Public Health, The Netherlands [email protected] Need to better understand the user-perspective [email protected] www.vaccineconfidence.org [email protected].