Vaccine acceptance, hesitancy and refusal in Canada: Challenges and potential approaches

Dubé, Ève; Bettinger, Julie A.; Fisher, William A.; Naus, Monika; Mahmud, Simeen; Hilderman, Tim

doi:10.14745/ccdr.v42i12a02

Cited by 57 publications

(46 citation statements)

References 55 publications

(66 reference statements)

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“…Many factors influence vaccine noncompliance or hesitancy; however, the role of the internet due to the abundance of online antivaccination sentiment and activists has been reported as an important concern [ 8 - 13 ]. A significant association was established between using the internet to search for vaccine information and negative parental perception of the risk of childhood immunizations [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

User-Driven Comments on a Facebook Advertisement Recruiting Canadian Parents in a Study on Immunization: Content Analysis

Tustin¹,

Crowcroft²,

Gesink³

et al. 2018

JMIR Public Health Surveill

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BackgroundMore people are searching for immunization information online and potentially being exposed to misinformation and antivaccination sentiment in content and discussions on social media platforms. As vaccination coverage rates remain suboptimal in several developed countries, and outbreaks of vaccine-preventable diseases become more prevalent, it is important that we build on previous research by analyzing themes in online vaccination discussions, including those that individuals may see without actively searching for information on immunization.ObjectiveThe study aimed to explore the sentiments and themes behind an unsolicited debate on immunization in order to better inform public health interventions countering antivaccination sentiment.MethodsWe analyzed and quantified 117 user-driven open-ended comments on immunization posted in the Comments section of a Facebook advertisement that targeted Canadian parents for recruitment into a larger study on immunization. Then, 2 raters coded all comments using content analysis.ResultsOf 117 comments, 85 were posted by unique commentators, with most being female (65/85, 77%). The largest proportion of the immunization comments were positive (51/117, 43.6%), followed by negative (41/117, 35.0%), ambiguous (20/117, 17.1%), and hesitant (5/117, 4.3%). Inaccurate knowledge (27/130, 20.8%) and misperceptions of risk (23/130, 17.7%) were most prevalent in the 130 nonpositive comments. Other claims included distrust of pharmaceutical companies or government agencies (18/130, 13.8%), distrust of the health care system or providers (15/130, 11.5%), past negative experiences with vaccination or beliefs (10/130, 7.7%), and attitudes about health and prevention (10/130, 7.7%). Almost 40% (29/74, 39%) of the positive comments communicated the risks of not vaccinating, followed by judgments on the knowledge level of nonvaccinators (13/74, 18%). A total of 10 positive comments (10/74, 14%) specifically refuted the link between autism and vaccination.ConclusionsThe presence of more than 100 unsolicited user-driven comments on a platform not intended for discussion, nor providing any information on immunization, illustrates the strong sentiments associated with immunization and the arbitrariness of the online platforms used for immunization debates. Health authorities should be more proactive in finding mechanisms to refute misinformation and misperceptions that are propagating uncontested online. Online debates and communications on immunization need to be identified by continuous monitoring in order for health authorities to understand the current themes and trends, and to engage in the discussion.

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Section: Introductionmentioning

confidence: 99%

User-Driven Comments on a Facebook Advertisement Recruiting Canadian Parents in a Study on Immunization: Content Analysis

Tustin¹,

Crowcroft²,

Gesink³

et al. 2018

JMIR Public Health Surveill

View full text Add to dashboard Cite

show abstract

“…Such interventions span from face‐to‐face interactions for educating or informing parents about early childhood vaccination (Ryman et al ; Saeterdal ; Kaufman et al ) to mass media campaigns to promote vaccination uptake (Shea et al ). Similar to the themes of the broader noncompliance literature, additional studies of noncompliance with childhood immunizations draw on factors that have been found to influence parents’ vaccination hesitance and recommend what government should or could do to enhance compliance (e.g., Dubé et al ). Such recommendations emphasize the need to map and identify parents’ concerns (Oladejo et al ), the need to apply cognitive and social psychological insights while shaping interventions (Rossen et al ) as well as the need to develop web‐based interventions for the purpose of helping parents make evidence‐based decisions (Glanz et al ).…”

Section: Public Noncompliance With Childhood Immunizationmentioning

confidence: 99%

Negotiated compliance at the street level: Personalizing immunization in England, Israel and Sweden

Gofen

Blomqvist

Needham

et al. 2018

Public Administration

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Often portrayed as behaviour that is inconsistent with policy goals, public noncompliance poses a significant challenge for government. To explore what compliance efforts entail on the ground, this study focuses on childhood immunization as a paradigmatic case where a failure to ensure compliance poses a public health risk. The analysis draws on 48 semi‐structured interviews with frontline nurses and regional/national public health officials in England (N = 15), Sweden (N = 17) and Israel (N = 16), all of which have experienced periodic noncompliance spikes, but differ in direct delivery of vaccination provision. Compliance efforts emerged as a joint decision‐making process in which improvisatory practices of personalized appeals are deployed to accommodate parents’ concerns, termed here ‘street‐level negotiation’. Whereas compliance is suggestive of compelling citizens’ adherence to standardized rules, compliance negotiation draws attention to the limited resources street‐level workers have when encountering noncompliance and to policy‐clients’ influence on delivery arrangements when holding discretionary power over whether or not to comply.

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“…Overselling by emphasizing the facts about vaccine benefits and disease risks alone may exacerbate hesitancy and diminish on-time vaccine acceptance (8). The article in this issue by Eve Dubé and colleagues emphasizes the complexity of the vaccine hesitancy problem and offers potential intervention and prevention strategies that may be useful in the Canadian context (9). Sadly, there is no "magic bullet" intervention that will address all concerns about vaccine complacency, convenience and confidence hesitancy such that vaccine acceptance would become the norm for all but the very small minority (likely under one to two percent) who are firm vaccine deniers (8).…”

Section: Addressing Vaccine Hesitancymentioning

confidence: 99%

“…As noted by Dubé and others, listening to and determining the factors underlying delay or refusal are critical first steps at the individual and program level (9)(10)(11). Communication and intervention strategies must be tailored to address the problem.…”

Section: Addressing Vaccine Hesitancymentioning

confidence: 99%

The long and winding road to improving immunization rates: Sharing best practices in Canada

MacDonald

2016

Can Commun Dis Rep

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Vaccines are one of the most effective ways to decrease childhood mortality. Unfortunately, however, Canada placed 28th out of 29 high-income countries in a 2013 UNICEF report that compared national uptake rates of early childhood immunizations. Work is underway to address this issue as reflected in the 2016 federal budget which highlights the importance of improving access to immunization. There are many steps that can be taken to improve vaccine uptake, such as identifying and better understanding the individual and program level factors that underlie delay or refusal to receive vaccines. However, it is challenging to find evidence and ensure its relevancy within the Canadian context. Targeted resources are needed that address the complexity of immunization along the entire continuum from vaccine manufacture through to patient uptake. Although there is a lot of information relevant to Canada, it has not been gathered together in one "go to" site and it is not curated. Canada needs a solid, easily accessible, user-friendly platform for sharing what works in immunization with health care professionals as well as parents and patients. This platform would be a major step in facilitating vaccine acceptance in Canada.

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Vaccine acceptance, hesitancy and refusal in Canada: Challenges and potential approaches

Cited by 57 publications

References 55 publications

User-Driven Comments on a Facebook Advertisement Recruiting Canadian Parents in a Study on Immunization: Content Analysis

User-Driven Comments on a Facebook Advertisement Recruiting Canadian Parents in a Study on Immunization: Content Analysis

Negotiated compliance at the street level: Personalizing immunization in England, Israel and Sweden

The long and winding road to improving immunization rates: Sharing best practices in Canada

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