Transcript Slide 1

WAPOR Annual Congress (2015): Panel on
GLOBAL INDICES OF OPINIONS AND PERCEPTIONS
Vaccine Confidence Index
WAPOR Annual Congress (2015): Panel on
GLOBAL INDICES OF OPINIONS AND PERCEPTIONS
Vaccine Confidence Index
Panel Paper # 3
Authors Team:
Johnny Heald (Email: [email protected])
Dr Sara Gilani ([email protected])
(in collaboration with Professor Heidi Larson of London school of Hygiene and Tropical Medicine,
London University)
Presented at: WAPOR Annual Congress, 2015
(Buenos Aires, Argentina)
Note: Presentation is based on research in progress
WAPOR Annual Congress (2015): Panel on
GLOBAL INDICES OF OPINIONS AND PERCEPTIONS
Vaccine Confidence Index
This Presentation has 4 sections. Section # 1
provides the Background to the development
of Vaccine Confidence Index. Section # 2 lays
out and describes the Index. Section # 3 gives
and discusses the findings of pilot survey of the
Index in 5 Nations. Section # 4 provides
reflections by the Authors team on the Process
of developing a Global Index.
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WAPOR Annual Congress (2015): Panel on
GLOBAL INDICES OF OPINIONS AND PERCEPTIONS
Vaccine Confidence Index
Section # 1
Background
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WAPOR Annual Congress (2015): Panel on
GLOBAL INDICES OF OPINIONS AND PERCEPTIONS
Vaccine Confidence Index
The Vaccine Confidence Index has been put
together recently by a team led by Professor Heidi
Larson at LSHTM. This is part of a project to monitor
public confidence in Immunization programs. This
was launched in January, 2010 and is called
‘Vaccine Confidence Project’
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WAPOR Annual Congress (2015): Panel on
GLOBAL INDICES OF OPINIONS AND PERCEPTIONS
Vaccine Confidence Index
The project emerged because of a feeling that public
confidence in Vaccines is an important determinant
of the success of immunization programs. While local
efforts
and
interventions
in
each
country
are
important for their immunization programs, vaccine
confidence and related sentiments have the ability to
influence the immunization programs at a global level.
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WAPOR Annual Congress (2015): Panel on
GLOBAL INDICES OF OPINIONS AND PERCEPTIONS
Vaccine Confidence Index
Vaccine confidence is related to confidence in the
product/ vaccine (Vaccine producing companies),
administration capacity (healthcare providers and
health system) and vaccine policy makers (politicians or
administrators).
Vaccine Hesitancy is considered an indicator of waning
‘Vaccine Confidence’. WHO Strategic Advisory Group
of Experts (SAGE) on Immunisation have defined the
vaccine hesitancy issues into following three domains:
confidence (trust in the safety or efficacy of the
vaccine), convenience (ease of access), and
complacency (perception of the risk of disease and
importance of immunisation).
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WAPOR Annual Congress (2015): Panel on
GLOBAL INDICES OF OPINIONS AND PERCEPTIONS
Vaccine Confidence Index
“Measuring vaccine confidence is an emerging science. In developing Vaccine
Confidence Index (VCI), cues have been taken from other social science tools
that measure confidence more generally. The closest analogue to the VCI is the
Consumer Confidence Index (CCI), which measures consumer confidence,
defined as the degree of optimism about the state of the economy – deemed
important because consumers’ confidence is reflected in their spending and
saving behaviour, which in turn impacts the larger economy . The CCI is
dependent on larger social, national, and regional economic issues. The Vaccine
Confidence Index (VCI) is analogous to the CCI in that it too places a finger on
the pulse of a set of public sentiments, which influence vaccination behaviours,
with consequences for the whole population. In the case of the VCI, the
sentiments in question are confidence in vaccination and the entities with which it
is associated, and, like the sentiments measured by the CCI, vaccine sentiments
are influenced by broader social dynamics.”
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WAPOR Annual Congress (2015): Panel on
GLOBAL INDICES OF OPINIONS AND PERCEPTIONS
Vaccine Confidence Index
Section # 2
The Index
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WAPOR Annual Congress (2015): Panel on
GLOBAL INDICES OF OPINIONS AND PERCEPTIONS
Vaccine Confidence Index
THE INDEX
The Index is based on Simple Questions on Vaccine Confidence.
These include questions on following issues:
 Confidence in Vaccine programs as compared to other health
services (asked from all adult respondents)
 Hesitancy to immunize their children (asked from respondents
who were parents of young children)
 Ultimate decision of immunization or not (asked from those who
had ever hesitated)
 Reasons for Vaccine Hesitancy (asked from those who has ever
hesitated)
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WAPOR Annual Congress (2015): Panel on
GLOBAL INDICES OF OPINIONS AND PERCEPTIONS
Vaccine Confidence Index
Section # 3
PILOT SURVEY IN
5 COUNTRIES
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WAPOR Annual Congress (2015): Panel on
GLOBAL INDICES OF OPINIONS AND PERCEPTIONS
Vaccine Confidence Index
Survey Size and Prevalence of Hesitancy and Refusal
The five selected countries have all faced different vaccine confidence crisis that
have influenced their immunization programs as well as the global efforts against
preventable diseases.
The table shows a breakdown of respondents in each country by whether they
had children under 5, if so, whether they had ever hesitated to vaccinate their
child, and if so, whether they ultimately had the vaccine or did not have it.
Georgia shows the highest percentage (60%) of vaccine refusers, followed by UK
where 27.1% households reporting hesitancy refused vaccination. The proportion
of hesitants among parents was highest in the UK.
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WAPOR Annual Congress (2015): Panel on
GLOBAL INDICES OF OPINIONS AND PERCEPTIONS
Vaccine Confidence Index
Overview of Confidence Comparisons
In all 5 countries, overall confidence in immunisation was high; outside of the UK
where confidence in emergency services was higher than in immunisation
programmes, confidence in immunisation services was higher than confidence in
family planning services, in health workers and general health system.
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WAPOR Annual Congress (2015): Panel on
GLOBAL INDICES OF OPINIONS AND PERCEPTIONS
Vaccine Confidence Index
Relationship Between Vaccine Confidence & Vaccination Behavior
There is considerable variation between countries in the probability of hesitancy at a
given confidence level. Reporting no confidence at all in immunisation programmes
is associated with a 17% hesitancy rate in India, compared to 50% in Pakistan.
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WAPOR Annual Congress (2015): Panel on
GLOBAL INDICES OF OPINIONS AND PERCEPTIONS
Vaccine Confidence Index
Reasons for Hesitancy
Overall, the highest percentage of reasons for hesitancy was due to confidence
issues.
Source:
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WAPOR Annual Congress (2015): Panel on
GLOBAL INDICES OF OPINIONS AND PERCEPTIONS
Vaccine Confidence Index
COMPLEMENTARY SOCIAL MEDIA STUDY ON VCI
The Vaccine Confidence Group has been doing media and social
media monitoring of reports and issues related to vaccines and
immunization. The search is done through a specialized automated
software adapted from HealthMap. The reports are coded as
‘positive, negative or neutral’ and a typology of different types of
concerns regarding vaccines is also being developed. Moreover, a
diagnostic method is also being developed to prioritize reports that
need further investigation.
Some of the findings of this part of the project have been published
in scientific journals.
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WAPOR Annual Congress (2015): Panel on
GLOBAL INDICES OF OPINIONS AND PERCEPTIONS
Vaccine Confidence Index
DISCUSSION ON PILOT SURVEY FINDINGS
At present the findings are based on pilot in 5 countries only. There
were minor differences in the methodology of surveys in these
countries. But it has pointed out towards important trends:
 Vaccine confidence is generally high in most countries as
compared to other health services
 Vaccine confidence is correlated to confidence in the health
system and services
 Low vaccine confidence is associated with high vaccine hesitancy
 Vaccine Hesitancy can lead to varying level of Vaccine refusal
rates across countries
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WAPOR Annual Congress (2015): Panel on
GLOBAL INDICES OF OPINIONS AND PERCEPTIONS
Vaccine Confidence Index
More detailed analysis and research is needed in
understanding the relationship of vaccine confidence
with the background factors e.g. socio-demographic
characteristics of the respondents as well as the sociopolitical drivers at country, regional and global level.
As the survey gets coverage from other countries and
can get trend data across time on this issue from across
the globe and regions, it will be a useful tool to ‘monitor
vaccine confidence’ and thus influence vaccine policy.
It will be relevant to maintaining coverage of existing
immunization programs as well as new vaccine
programs.
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WAPOR Annual Congress (2015): Panel on
GLOBAL INDICES OF OPINIONS AND PERCEPTIONS
Vaccine Confidence Index
Section # 4
Reflections on Developing a
Global Index in Public Health
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WAPOR Annual Congress (2015): Panel on
GLOBAL INDICES OF OPINIONS AND PERCEPTIONS
Vaccine Confidence Index
Reflections on Developing a Global Index in Public Health
Our team is collaborating with the London School of Hygiene and Tropical
Medicine to develop and execute data gathering for this Index.
We conclude that the following 6 considerations hold the key to developing
a good Global Index:
1- SUBJECT DOMAIN EXPERTISE
The Index should emerge from experts and institutions with deep
knowledge of the subject domain, in this case Public Health and the issue
of Vaccination. This is to ensure a sound theoretical underpinning for the
entire exercise. Any Index is likely to undergo evolution, when put in
practice. A sound theoretical underpinning is necessary to shepherd the
refinement of the Index as it grows.
2- PARSIMONY: Fewest possible source questions
Considering that a Global Index is to be conducted across the world, it is
crucial (beyond the usual requirements of parsimony) to base itself on as
few sources questions as possible.
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WAPOR Annual Congress (2015): Panel on
GLOBAL INDICES OF OPINIONS AND PERCEPTIONS
Vaccine Confidence Index
Reflections on Developing a Global Index in Public Health
3- GLOBAL TRANSLABILITY: In terms of Concepts and Question wording
This subject has been widely discussed at WAPOR led forums specially
under the leadership of Tom Smith. It only needs to be constantly reemphasized.
4- DESIGN FOR GLOBAL APPLICATION AND TREND DATA:
Some Indices are handicapped because those were designed for
National Application, and subsequently extended to Global Space. We
have addressed this subject elsewhere, arguing that Global Surveys
require customized treatment at all stages of the Design. This needs to
be reiterated for global surveys which are being designed afresh.
Furthermore global indices must take into account issues which might
arise from trending the data over time. Issues pertaining to Sampled
Universe; Concept transformation on subjects under investigation;
changes in data gathering modes should all be at least highlighted, if not
resolved.
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WAPOR Annual Congress (2015): Panel on
GLOBAL INDICES OF OPINIONS AND PERCEPTIONS
Vaccine Confidence Index
Reflections on Developing a Global Index in Public Health
5- PRE-TESTING:
Pre-testing among a cross-section of nations and languages is helpful
and high recommended.
6- PILOT POLLS:
We find it extremely useful to pilot in a few nations representing a crosssection of circumstances and opening its data to an academic group for
public discourse.
7- OPEN ACADEMIC DISCOURSE:
We feel that open academic discourse through not for profit channels
enjoys a notable edge over developing new Indices through proprietary
corporate channels.
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WAPOR Annual Congress (2015): Panel on
GLOBAL INDICES OF OPINIONS AND PERCEPTIONS
Vaccine Confidence Index
Methodology for the Pilot Survey in 5 Nations
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WAPOR Annual Congress (2015): Panel on
GLOBAL INDICES OF OPINIONS AND PERCEPTIONS
Vaccine Confidence Index
References
Larson, H. J., Schulz, W. S., Tucker, J. D., & Smith, D. M. (2015).
Measuring Vaccine Confidence: Introducing a Global Vaccine
Confidence Index. PLoS currents, 7.
Larson, H. J., Jarrett, C., Schulz, W. S., Chaudhuri, M., Zhou, Y.,
Dube, E., ... & Wilson, R. (2015). Measuring vaccine hesitancy: the
development of a survey tool. Vaccine.
Larson, H. J., Smith, D. M., Paterson, P., Cumming, M.,
Eckersberger, E., Freifeld, C. C., ... & Madoff, L. C. (2013).
Measuring vaccine confidence: analysis of data obtained by a
media surveillance system used to analyse public concerns
about vaccines. The Lancet Infectious Diseases, 13(7), 606-613.
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