From package to protection: how do we close global coverage gaps to optimize the impact of vaccination?

Vaccination coverage in both developed and developing world is still far from the expected/recommended rates. Suboptimal vaccination uptake increases not only individual risk but could also precipitate epidemics in communities and hospitals. Vaccination programs face two major challenges: coverage gaps and coverage erosion.

Access and affordability are major determinants of the former while the latter is rather influenced by awareness and acceptance. Individual attitude towards vaccination is a complex combination of several determinants, such as beliefs, perceived severity of the disease, understanding of vaccine effectiveness, socioeconomic status, past experience, etc. which together converge to subjective judgement. The attitude of physicians with regard to vaccination and the role of media could also influence individual attitudes. A better understanding of social and cognitive determinants of vaccination would allow the set-up of intervention strategies to optimize vaccine coverage.

Fondation Mérieux organized from September 22-24, 2014, the conference entitled: ’From package to protection- How do we close global coverage gaps to optimize the impact of vaccination’ in Annecy-France (hosted at “Les Pensières” Conference Center). A multi-disciplinary group of experts drawn from academia, industry, international organizations and national public health institutes, gather to explore the best options to address coverage gaps and erosion in vaccination.

The panel expert has reviewed and discussed various issues including:

• The psychology of risk perception, decision making and emotional barriers and drivers of vaccine acceptance;

• Ongoing studies of tools that aim at identifying drivers and barriers of vaccination:

  • The MOTIV (Motors of Trust in Vaccination) tool, a collaborative, patient centric project

  • The MoVac and MoVAds scales for vaccination motivation and vaccination advocacy among health care professionals (HCPs)

  • The PACV (Parent Attitudes about Childhood Vaccine) survey that aim at identifying, understanding and talking to hesitant parents

  • The V-ABC (Vaccine Attitudes Beliefs and Concerns) framework to measure parental vaccine acceptance

  • The 5A vaccination coverage framework that started to lay out a structured approach to a complex program with an evidence base.

• Intervention strategies that could influence vaccine coverage such as motivational interviews between HCPs and patients, vaccine advocacy campaigns, the RED (Reaching Every District) strategy developed by the WHO;

• Evidence-based approaches to effective communication on vaccine risk and benefits.

After the review of the current situation, the expert panel identified the following lessons learnt and the main challenges to be addressed with high priority:

Lessons learnt

• Drivers and barriers are vaccine-dependant and should be therefore addressed by vaccine and population to tailor responses.

• Connection with HCPs and public to meet their needs is crucial:

  • HCPs are still key to decision-making;

  • The public ask for being active partners in their decisions to be vaccinated and/or to vaccinate their children. To ensure actions that guarantee better vaccination acceptance, dialogue needs to be tailored according to the public’s needs and expectations.

• Public health is communication.

Effective and well-oriented communication could improve awareness and vaccine acceptance. HCPs should be trained to have appropriate and essential communication skills. The public is dramatically unmoved by data; adequate communication frame is therefore important for successful understanding. Reporting numbers when communicating on benefices and risks of vaccines are necessary, but they should be few, consistent, in an adapted format with emotion.

Challenges

• Foster a dynamic, multidisciplinary and better connected community of practice;

• Establish vaccination acceptance as a legitimate discipline for theoretical and applied research;

• Ensure adoption of standardized and validated tools to measure barriers and drivers of vaccine acceptance and the impact of intervention;

• Bring all tools and manuals to ’the Matrix’;

• Grow rigorous qualitative, quantitative, culturally and geographically balanced evidence-based on i) drivers and barriers to coverage and acceptance; ii) intervention options and iii) measuring impact of interventions;

• Develop better communication strategies and improve communication frame.