'Trusting blindly can be the biggest risk of all': organised resistance to childhood vaccination in the UK

Sociological interest in vaccination has recently increased, largely in response to media coverage of concerns over the safety of the MMR (measles, mumps and rubella) vaccine. The resulting body of research highlights the importance of risk and trust in understanding parental and professional engagement with vaccination. To date, only limited attention has been paid to organised parental groups that campaign against aspects of vaccination policy. This paper reports findings from a qualitative study of contemporary groups in the UK, and develops three main lines of argument. First, these actors are best analysed as 'Vaccine Critical groups' and include Radical and Reformist types. Second, Vaccine Critical groups discursively resist vaccination through a reframing that constructs risk as unknown and non-random. Third, trust as faith is negatively contrasted with the empowerment that is promised to result from taking personal responsibility for health and decision-making. Whilst representing a challenge to aspects of vaccination policy, this study confirms that the groups are involved in the articulation and promotion of other dominant discourses. These findings have implications for wider sociological debates about risk and trust in relation to health.     

GPs and the social amplification of BSE-related risk: An empirical study

Social studies of risk have consistently shown that physicians and health professionals are viewed by the general public as a trustworthy source of information and communication regarding risks. However, few if any empirical investigations have focused on the role physicians, particularly general practitioners (GPs), may play as a ‘social station’ in the processes of amplification or attenuation of risks to health that Kasperson et al described in their framework. The purpose of the present study is to investigate whether French GPs acted as amplifiers or attenuators in the BSE (‘mad cow disease’) crisis. A sample of 602 general practitioners completed a questionnaire aimed at assessing in a variety of ways their cognitive, affective and behavioural responses to BSE. Results show that, (1) GPs expressed moderate concern about BSE-related risks: Mad cow disease only ranked tenth in averaged ratings of 14 current risks to health. (2) However, about 90% of respondents reported having recommended one or several modifications in their patients' food habits. Remarkably, only 44% did the same at home. (3) By far the most common recommendation was to avoid organ meats from cattle, even though specified risk materials (which included some of those cuts) had been withdrawn from the market as early as April 1996. Such results point to potentially complex—perhaps even contradictory—responses to BSE from the GPs, with a clear dichotomy between reported private and professional behaviour. Our data suggest that social agents may act simultaneously as risk amplifiers and risk attenuators depending on the public towards which their communication was directed.     

Information,education, and health behaviors: Evidence from the MMR vaccine autism controversy

In the wake of strong, although later refuted, claims of a link between autism and the measles‐mumps‐rubella (MMR) vaccine, I examine whether fewer parents immunized or delayed vaccinations for their children and if there was a differential response by mother's education level. Using various controls and a differencing strategy that compares in MMR take‐up with other vaccines, I find that the MMR–autism controversy led to a decline in the immediate years and that there were negative spillovers onto other vaccines. I also find evidence that more highly educated mothers responded more strongly to the controversy either by not immunizing their children altogether or, to a lesser degree, delaying vaccination. Moreover, the educational gap was greater in states where there was greater media attention devoted to the controversy. This is consistent with the health allocative efficiency hypothesis whereby part of the education gradient in health outcomes is due to more‐educated individuals absorbing and responding to health information more quickly. However, unlike in the United Kingdom, where previous studies find that the gap was eliminated after the link was refuted, the evidence for the United States suggests that the educational gap persisted.     

Does qualitative synthesis of anecdotal evidence with that from scientific research help in understanding public health issues: a review of low MMR uptake

Study objective: To explore the professional and parental factorsunderlying low MMR uptake by qualitative synthesis of evidencefrom technical and non-technical anecdotal literature. Methods:An intensive investigation of literature covering research,press, online, E groups and grey literature was carried outusing devised search strategies. Key themes were identifiedfrom both the research and anecdotal evidence, which were mergedto form common themes. Results: The review of technical literatureidentified media scare and inadequate information from healthprofessionals as the main reasons for non-uptake of MMR. Thenon-technical anecdotal evidence showed that professionals'belief in parental right to choose, target payments and fearof autism were the major factors. Conclusions: Anecdotal evidencemay contribute to evidence-based public health practice, especiallyin widely debated public health issues.     

Severity of mumps disease is related to MMR vaccination status and viral shedding

BackgroundDuring recent years, various mumps outbreaks have occurred among measles, mumps, and rubella (MMR) vaccinated persons in various countries worldwide, including the Netherlands. We studied mumps virus shedding in MMR vaccinated and unvaccinated mumps patients and related these findings to clinical data.MethodsIn this study, we included 1112 mumps patients of whom diagnostic samples were tested positive in our laboratory between 1 January 2007 and 31 December 2014. We compared mumps virus shedding and severity of disease between patients who had received 2 doses of MMR (n = 592) and unvaccinated mumps patients (n = 195). Mumps virus shedding in saliva and urine specimens was measured by qPCR. Severity of disease was studied in a subset of patients with clinical data available.ResultsMumps patients who had received 2 MMR doses shed less often mumps virus in their urine than unvaccinated patients. Salivary viral loads were higher at day of onset of disease in twice MMR vaccinated patients with viruria than in twice MMR vaccinated patients without viruria. However, salivary viral loads did not significantly differ between patients who had received 2 MMR doses and unvaccinated patients. Bilateral parotitis and orchitis were less often reported in patients who had received 2 MMR doses than in unvaccinated patients. Furthermore, the prevalence of bilateral parotitis and orchitis was higher among twice MMR vaccinated patients with viruria than among twice MMR vaccinated patients without viruria.ConclusionsMMR vaccination was associated with less severe disease among mumps patients. Systemic spread of virus was associated with more severe disease. The elevated salivary viral loads in patients with systemic mumps disease suggest that these patients pose a higher risk for mumps virus transmission. Our study contributes to the understanding of mumps virus pathogenesis and shows the protective effect of MMR vaccination on severity of disease.     

Children's health and the social theory of risk: insights from the British measles, mumps and rubella (MMR) controversy

Recent debates in the United Kingdom about the measles, mumps and rubella (MMR) vaccine and its alleged link with autism have centred on contested notions of risk. This paper presents findings from 87 parents' focus group and interview discussions of their decision-making about the vaccine in light of three streams of theoretical literature on risk (cultural theory, risk society, psychometric models of risk perception) and models of vaccination acceptance and resistance. In addition to the risks of infectious disease and autism, parents balanced other risk concerns-both biological and social-in making their decisions. Such decisions, made on behalf of children unable to choose for themselves, and in the midst of contradictory information and uncertainty, symbolised what it means to be a 'good parent'. To cope with uncertainty, parents sought explanations for why some children seem to be more vulnerable to adverse outcomes than others. Debates about children's risks may need special theoretical consideration beyond that offered by the current risk literature. Specific aspects of the MMR debate, namely, selecting between potentially competing risks, making risk judgements on behalf of dependent others, and tensions between private and public good, provide a platform for exploring how social theories of risk might be adapted for children's health controversies.     

Knowledge,attitudes and opinions towards measles and the MMR vaccine across two NSW cohorts

Objective : Although the number of national measles cases has greatly decreased since 1980s, there has been resurgence in disease incidence in recent years. While parental knowledge and attitudes toward both disease and vaccinations are known to influence vaccine uptake, the contribution of these factors toward vaccination rates in NSW populations has not been studied. The aim of this study was to investigate the knowledge and opinions on measles and MMR vaccine in NSW Central and North Coast regions. Methods : Parents (n=201) of children <12 years were surveyed with a purpose design survey at public beaches at the Central Coast and community markets at the North Coast. Results : Eight per cent of respondents reported not immunising their child with MMR vaccine. Most respondents recognised that measles is a highly contagious disease. Non‐immunisers were found to be older, had a lower perceived severity of measles, were less likely to agree with the efficacy and safety of the vaccine, and were more likely to have encountered someone who had suffered side‐effects of the vaccine. Conclusions : There is considerable concern over safety of MMR vaccine among non‐immunisers. Implications for public health : Improving confidence in MMR vaccine should be a target of future public health interventions.     

The contagious nature of a vaccine scare: How the introduction of HPV vaccination lifted and eroded MMR vaccination in Denmark

BackgroundHuman papillomavirus (HPV) vaccine coverage was high in Denmark until it plunged following negative media coverage. We examined whether the decline in HPV vaccination undermined uptake of another adolescent vaccine, measles, mumps and rubella (MMR).MethodsThe Danish national health register provided data on uptake of MMR vaccine dose 2 (at age 13) for children born from 1991 to 2003 (n = 827,716). The primary exposure variable comprised three time periods: before HPV vaccine introduction, during high HPV vaccine coverage, and after the drop in HPV vaccine coverage. To examine the effect of HPV vaccination on MMR2 uptake, we estimated MMR2 uptake by age 13 using logistic regression, controlling for gender, birth month, birth year, and maternal education.FindingsMMR2 vaccination coverage was high for both girls and boys (86% and 85%) in 2009. Following the introduction of HPV vaccine for girls in 2009, MMR2 coverage increased for girls even as it decreased for boys (gender gap 4·6 percentage points, 95% CI 4·3 to 4·8). Coverage with MMR2 for girls continued to be high over the following four years, and almost all girls (91%) who received MMR2 vaccination also received HPV1 vaccination within the same week. When negative media coverage led to a decline in HPV vaccination, MMR2 uptake for girls also declined. By 2015, MMR2 coverage for girls and boys had become similar again (80% and 79%). Families with the highest level of maternal education showed the strongest decline in MMR2 coverage for girls.InterpretationConcomitant vaccine provision can increase overall vaccine uptake. However, reduced demand for one vaccine may reduce concomitant vaccination and undermine resiliency of a country’s vaccination program.FundingDrs. Gørtz and Ejrnæs appreciate generous funding from the Novo Nordisk Foundation (grant no. NNF17OC0026542) and from the Danish National Research Foundation through its grant (DNRF-134) to the Center for Economic Behavior and Inequality (CEBI) at the University of Copenhagen.     

Food risk communication: lessons from the Alar controversy

The Alar controversy in 1989 was a watershed event in the currentcrisis of consumer confidence in American food safety. To helprestore public confidence in food safety, scientists and policymakersare exploring improved ways of communicating with the publicabout food risks. This article reviews issues, concepts andstrategies for food risk communication in the context of lessonsfrom the Alar controversy. The process of effective food riskcommunication is often hampered by institutional and politicalfactors such as scientific debates about nutritional findings,statutory inconsistencies related to food risk and fragmentedfederal responsibility for food safety. In addition, there areother barriers such as conflicting views of food safety risks,lack of credibility of some risk communicators and scientificilliteracy of the American public. Health and nutrition educatorshave valuable knowledge and skills that can facilitate the dialoguebetween risk managers and the public on food issues. Expertisein needs assessment, message development and dissemination,and program planning and research are especially valuable.     

Recent MMR vaccination in health care workers and Covid-19: A test negative case-control study

BackgroundIt has been hypothesised that the measles-mumps-rubella (MMR) vaccine may afford cross-protection against SARS-CoV-2 which may contribute to the wide variability in disease severity of Covid-19.MethodsWe employed a test negative case-control study, utilising a recent measles outbreak during which many healthcare workers received the MMR vaccine, to investigate the potential protective effect of MMR against SARS-CoV-2 in 5905 subjects (n = 805 males, n = 5100 females).ResultsThe odds ratio for testing positive for SARS-CoV-2, in recently MMR-vaccinated compared to not recently MMR-vaccinated individuals was 0.91 (95% CI 0.76, 1.09). An interaction analysis showed a significant interaction for sex. After sex-stratification, the odds ratio for testing positive for males was 0.43 (95% CI 0.24, 0.79, P = 0.006), and 1.01 (95% CI 0.83, 1.22, P = 0.92) for females.ConclusionOur results indicate that there may be a protective effect of the MMR vaccine against SARS-CoV-2 in males but not females.     

Perceptions of mumps and MMR vaccination among university students in England: an online survey

Mumps is easily preventable through vaccination. Investigation of a number of recent mumps outbreaks in universities in the North West of England, however, found that affected students were either not vaccinated or only partially vaccinated. An online survey of students (n=2456) attending five universities in the region was undertaken during 2010 to establish MMR vaccination status, knowledge of mumps and willingness to take up vaccination if offered. Regression analysis was undertaken to identify characteristics of unimmunized students to ascertain likely target groups for future vaccination campaigns. Students least likely to be fully vaccinated with MMR included males; those not registered with a GP; first year students; mature students; and those with poor knowledge of mumps. A high proportion of students were willing to accept MMR vaccination if offered at university. Those least likely to take up vaccination included students not registered with a GP; mature students; and those who did not consider mumps to be a serious disease. The survey also highlighted that misconceptions remain about both the MMR vaccine safety and perceptions of risk/benefit of the vaccine. Encouraging registration with a GP and awareness raising should be a key part of campaigns to improve vaccination uptake among university students.     

Using campaigns to improve perceptions of the value of adult vaccination in the United States: Health communication considerations and insights

Vaccines have much relevance and promise for improving adult health in the United States, but to date, overall use and uptake remain far below desired levels. Many adults have not received recommended vaccinations and many healthcare providers do not strongly and actively encourage their use with patients. This has led some public health and medical experts to conclude that adult vaccines are severely undervalued by the U.S. public and healthcare providers and to call for campaigns and communication-based efforts to foster increased appreciation, and in turn, higher adult immunization rates. A narrative integrative review that draws upon the vaccine valuation and health communication literatures is used to develop a framework to guide campaign and communication-based efforts to improve public, provider, and policymakers’ assessment of the value of adult vaccination. The review does this by: (1) distinguishing social psychological value from economic value; (2) identifying the implications of social psychological value considerations for adult vaccination-related communication campaigns; and (3) using five core health communication considerations to illustrate how social psychological notions of value can be integrated into campaigns or communication that are intended to improve adult vaccination value perceptions and assessments, and in turn, motivate greater support for and uptake of recommended adult vaccines.     

Health literacy: communication for the public good

This article builds upon a presentation at the Fifth Global Health Conference on Health Promotion (Mexico City, 9 June 2000), seeking to advance the development of health literacy through effective communication. First, it offers a timely reflection for health promotion epistemology in particular, and the potential approach to framing health promotion activities in general, with health literacy as a bridging concept. The concept of health literacy is briefly explained and defined, followed by identification of some promising communication interventions to diffuse health literacy. Four predominant areas within the communication field are described that shed light on approaches for developing health literacy: integrated marketing communication, education, negotiation and social capital. Each component can contribute to strategic science-based communication. Finally, the article elucidates that communication and developing health literacy are not simple solutions. Communication is not simply message repetition, but includes the development of an environment for community involvement to espouse common values of humankind. With effective communication, worldwide health literacy can become a reality in the 21st century, embodying health as a central tenet of human life.     

Risk communication: identifying the importance of social context1

This editorial uses articles published in recent issues of Health, Risk and Society to critically review current approaches to risk communication. The effective communication of risk forms a key component of public health measures designed to improve the health of populations in countries such as the UK. These approaches assume that the recipients of the risk information are rational actors who will use the information to minimize their exposure to health hazards, and this will reduce the collective level of harm. However, a recent article in Health, Risk and Society indicated that individuals are not passive recipients of information and do not respond to risk information ‘rationally’. Individuals actively engage in looking for and using information but may also make conscious decisions to avoid certain forms of information. Their response to information is shaped by social context, their own needs for personal security and the extent to which they trust the source of specific items of information. As a result, there is little evidence that risk communication based on the rational actor model shapes an understanding or behaviour in ways in which health-policy makers and public health experts want.     

Examining uncertainties in government risk communication: citizens' expectations

With the shift towards more participative approaches to risk communication and risk management, policymakers are expected to be more transparent with the public concerning existing uncertainties about health risks, such as lack of data or contradictory evidence. There is, however, a debate among researchers as to whether this transparency about uncertainties is indeed welcomed by the public and if it is effective in promoting trust in risk regulatory institutions. The qualitative study on which this article is based aimed to clarify citizens' perceptions of diverse sources of uncertainty in government risk communication and their expectations with respect to discussing uncertainties. Forty-seven adults from two major Canadian cities took part in focus groups or individual interviews in which they voiced their expectations about who should be involved in risk communication, why uncertainties should be communicated, what sources of uncertainties were preferred, as well as how and when these should be discussed. Their discussions showed that they expected the government to include citizens in evaluating and managing uncertainties pertaining to risks under individual control and directly informing consumer choices about health risks. In contrast, they questioned the relevance of systematically exposing uncertainties relating to risks perceived as outside individual control, and associated with very low probability scenarios of possible threats. Globally, they appraised the desirability of discussing uncertainties in risk communication in relation to the perceived utility of the information for decision-making. These findings indicate that risk communicators and managers need to consider ways in which discussions of uncertainties can empower citizens.     

公共卫生决策与风险沟通

公共卫生决策是公共卫生管理的核心,风险沟通是保证决策制定及实施的重要条件,在公共卫生管理工作中发挥着重要的作用。本文探讨公共卫生决策与风险沟通及其影响因素,主要包括信息准确充分、沟通全面及时及合作与协调等,为今后公共卫生决策与管理工作提供信息参考。     

Social agents and news media as risk amplifiers: a case study on the public debate about the E. coli outbreak in Germany 2011

The social amplification of risk framework highlights the role which the news media play in risk communication by interacting with other agents in amplifying risk. However, the precise ways in which the media and other social agents actually amplify risks in public debates are unclear. In this article we draw on insights from the sociology of news to examine whether and to what extent social agents and news media amplify an emerging health risk. We use the debate about the Escherichia coli outbreak in Germany in 2011 to examine three issues: the amount of risk reporting by news media and social agents in their function as news sources; their evaluation of risk; and how they contribute to the escalation of risk, also known as ripple effects. In this article we draw on data from a content analysis of press releases from public health authorities and affected stakeholders and of news items in leading German news media. We found that the affected stakeholders were amplifying the risk to the greatest extent. We also found that there was a shift over time in the use of dominant frames. At the start of the debate the risk was framed as a public health issue and linked to medical-scientific progress. As the debate developed, more attention was given to political and economic consequences of the outbreak and the original health risk event was layered by other risk-related events.     

Demographic diversity,communication and learning behaviour in healthcare groups

An integrative model of group learning was tested in a sample of 40 healthcare groups (434 respondents), and the results show that age diversity reduces the frequency of face‐to‐face communication whereas educational diversity reduces the frequency of virtual communication in healthcare groups. Frequency of communication (both face‐to‐face and virtual), in turn, positively impacts on the emergence of trust and psychological safety, which are essential drivers of learning behaviours in healthcare groups. Additional results show that average educational achievement within groups is conducive for communication frequency (both face‐to‐face and virtual), whereas mean age within groups has a negative association with the use of virtual communication in healthcare groups. Copyright © 2012 John Wiley & Sons, Ltd.