Measuring vaccine hesitancy: The development of a survey tool

Abstract

In March 2012, the SAGE Working Group on Vaccine Hesitancy was convened to define the term "vaccine hesitancy", as well as to map the determinants of vaccine hesitancy and develop tools to measure and address the nature and scale of hesitancy in settings where it is becoming more evident. The definition of vaccine hesitancy and a matrix of determinants guided the development of a survey tool to assess the nature and scale of hesitancy issues. Additionally, vaccine hesitancy questions were piloted in the annual WHO-UNICEF joint reporting form, completed by National Immunization Managers globally. The objective of characterizing the nature and scale of vaccine hesitancy issues is to better inform the development of appropriate strategies and policies to address the concerns expressed, and to sustain confidence in vaccination. The Working Group developed a matrix of the determinants of vaccine hesitancy informed by a systematic review of peer reviewed and grey literature, and by the expertise of the working group. The matrix mapped the key factors influencing the decision to accept, delay or reject some or all vaccines under three categories: contextual, individual and group, and vaccine-specific. These categories framed the menu of survey questions presented in this paper to help diagnose and address vaccine hesitancy.

Strategies intended to address vaccine hesitancy: Review of published reviews

“…Determinants of hesitancy in mass campaigns vary and include convenience, confidence and complacency factors, as also seen with routine programmes [62]. While neither the systematic review of strategies [63] nor the reviews examined in this article have focused on interventional research in the context of mass campaigns, the Working Group did note that successful mass campaigns had a number of common features; these include the polio elimination campaign in India [64] (although the reaction to the mass polio campaign approach has also provoked distrust in some countries), [65] polio virus containment in Israel in 2013, [66] meningococcal A campaigns in several countries in the African meningitis belt [67,68] and meningococcal C outbreak control campaigns in high-income countries, [69]. In each case, the vaccine-preventable disease was well known and feared.…”

Review of vaccine hesitancy: Rationale, remit and methods

“…Two in-person meetings in October 2012 and February 2013, in addition to the monthly teleconferences, facilitated the development of a definition of vaccine hesitancy, a workable model of factors impacting vaccine hesitancy [10] and indicators of vaccine hesitancy [11], which were pilot tested in the WHO Region of the Americas and the European Region in the 2013 JRF. By April 2013, the commissioned systematic review on vaccine hesitancy [12] had been finalized, and based on the retrieved evidence, the systematic review on interventions to address vaccine hesitancy had been initiated.…”

“…Based on the matrix of determinants of vaccine hesitancy, in response to requests from countries, a standard list of survey questions was prepared by the Working Group with questions developed de novo or retrieved from published literature, acknowledging that few of these questions have been validated, and that none of the questions had been validated in settings other than high-income countries [11]. The systematic review on strategies was finalized prior to the October 2014 SAGE meeting [15].…”

How to deal with vaccine hesitancy?

“…WHO member states are encouraged to incorporate a plan to measure [13] and address vaccine hesitancy into their country's immunization programme as part of good programme practices. Health-care workers should be educated and trained to deal with vaccine hesitancy in patients and parents.…”

“…One of the main difficulties identified by the Working Group was the lack of validated and standardized tools to assess and measure vaccine hesitancy rates and underlying hesitancy determinants across settings and between population groups, and for monitoring trends over time [13]. A list of general hesitancy survey questions was developed by the Working Group but these need to be validated in different countries, as well as tested in different health-care systems, socio-cultural contexts, and vaccine programmes, at the national, sub-national and local subgroup level.…”