Vaccine Confidence Index - PowerPoint Presentation

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Vaccine Confidence Index

Authors Team: Johnny Heald (Email: jheald@opinion.co.uk)Dr Sara Gilani (sigilani@hotmail.com)(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 onGLOBAL INDICES OF OPINIONS AND PERCEPTIONS

WAPOR Annual Congress (2015): Panel onGLOBAL INDICES OF OPINIONS AND PERCEPTIONS

Panel Paper # 3

Vaccine Confidence IndexSlide2

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WAPOR Annual Congress (2015): Panel onGLOBAL INDICES OF OPINIONS AND PERCEPTIONSVaccine 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.Slide3

BackgroundPage 2

WAPOR Annual Congress (2015): Panel onGLOBAL INDICES OF OPINIONS AND PERCEPTIONSVaccine Confidence Index

Section # 1Slide4

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’Page 3

WAPOR Annual Congress (2015): Panel onGLOBAL INDICES OF OPINIONS AND PERCEPTIONSVaccine Confidence IndexSlide5

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.Page 4

WAPOR Annual Congress (2015): Panel onGLOBAL INDICES OF OPINIONS AND PERCEPTIONSVaccine Confidence IndexSlide6

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).Page 5WAPOR Annual Congress (2015): Panel onGLOBAL INDICES OF OPINIONS AND PERCEPTIONS

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“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

.”Page 6WAPOR Annual Congress (2015): Panel onGLOBAL INDICES OF OPINIONS AND PERCEPTIONSVaccine Confidence IndexSlide8

The IndexPage 7

WAPOR Annual Congress (2015): Panel onGLOBAL INDICES OF OPINIONS AND PERCEPTIONSVaccine Confidence Index

Section # 2Slide9

THE INDEXThe 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)Page 8WAPOR Annual Congress (2015): Panel on

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Page 9PILOT SURVEY IN 5

COUNTRIESWAPOR Annual Congress (2015): Panel onGLOBAL INDICES OF OPINIONS AND PERCEPTIONSVaccine Confidence Index

Section # 3Slide11

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.

Page 10The 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.

Survey Size and Prevalence of Hesitancy and Refusal

WAPOR Annual Congress (2015): Panel on

GLOBAL INDICES OF OPINIONS AND PERCEPTIONS

Vaccine Confidence IndexSlide12

Page 11In 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.Overview of Confidence ComparisonsWAPOR Annual Congress (2015): Panel onGLOBAL INDICES OF OPINIONS AND PERCEPTIONSVaccine Confidence IndexSlide13

Page 12There 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.

Relationship Between Vaccine Confidence & Vaccination BehaviorWAPOR Annual Congress (2015): Panel onGLOBAL INDICES OF OPINIONS AND PERCEPTIONSVaccine Confidence IndexSlide14

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Reasons for HesitancyOverall, the highest percentage of reasons for hesitancy was due to confidence issues. Source:WAPOR Annual Congress (2015): Panel onGLOBAL INDICES OF OPINIONS AND PERCEPTIONS

Vaccine Confidence IndexSlide15

COMPLEMENTARY SOCIAL MEDIA STUDY ON VCIThe 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.Page 14WAPOR Annual Congress (2015): Panel onGLOBAL INDICES OF OPINIONS AND PERCEPTIONSVaccine Confidence IndexSlide16

DISCUSSION ON PILOT SURVEY FINDINGSAt 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 countriesPage 15WAPOR Annual Congress (2015): Panel on

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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 socio-political 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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Page 17Reflections on Developing aGlobal Index in Public Health

WAPOR Annual Congress (2015): Panel onGLOBAL INDICES OF OPINIONS AND PERCEPTIONSVaccine Confidence Index

Section # 4Slide19

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Reflections on Developing a

Global Index in Public Health

WAPOR Annual Congress (2015): Panel on

GLOBAL INDICES OF OPINIONS AND PERCEPTIONS

Vaccine Confidence Index

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.

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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.Slide20

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Reflections on Developing a

Global Index in Public Health

WAPOR Annual Congress (2015): Panel on

GLOBAL INDICES OF OPINIONS AND PERCEPTIONS

Vaccine Confidence Index

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 re-emphasized.

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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.Slide21

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Reflections on Developing a

Global Index in Public Health

WAPOR Annual Congress (2015): Panel on

GLOBAL INDICES OF OPINIONS AND PERCEPTIONS

Vaccine Confidence Index

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PRE-TESTING:

Pre-testing among a cross-section of nations and languages is helpful and high recommended.

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PILOT POLLS:

We find it extremely useful to pilot in a few nations representing a cross-section of circumstances and opening its data to an academic group for public discourse.

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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.Slide22

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Methodology for the Pilot Survey in 5 Nations

WAPOR Annual Congress (2015): Panel on

GLOBAL

INDICES OF OPINIONS AND PERCEPTIONS

Vaccine Confidence IndexSlide23

ReferencesLarson, 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. Page 22

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THANK YOU