The role of healthcare provider attitudes in increasing willingness to accept seasonal influenza vaccine policy changes

BackgroundThis research explored the role of attitudes in acceptance of organizational change initiatives.MethodsA survey assessed factors associated with health care provider (HCP) likelihood to accept seasonal influenza vaccine policy changes. We evaluated the impact of knowledge and individual attitudes on this outcome measure.ResultsKnowledge of seasonal influenza vaccine and influenza recommendations was a significant predictor of HCP’s attitudes toward vaccine at the individual (p < 0.001), organizational (p < 0.05), and legislative level (p < 0.05). Mixed results were obtained when investigating the impact of knowledge on actual willingness to accept vaccine, suggesting that knowledge was only a significant predictor at the organizational (p < 0.05) and legislative levels (p < 0.05). Attitudes fully mediated the impact of knowledge at both the organizational and legislative levels.InterpretationKnowledge of seasonal influenza and vaccine recommendations is an important, but insufficient predictor of willingness to accept policy change.     

Rising rates of vaccine exemptions: Problems with current policy and more promising remedies

Parents of school-age children are increasingly claiming nonmedical exemptions to refuse vaccinations required for school entry. The resultant unvaccinated pockets in many areas of the country have been linked with outbreaks of vaccine-preventable diseases. Many states are now focused on reducing rates of nonmedical exemptions by making exemption processes more restrictive or burdensome for the exemptor. These strategies, however, pose ethical problems and may ultimately be inadequate. A shift to strategies that raise the financial liabilities of exemptors may lead to better success and prove ethically more sound. Potential areas of reform include tax law, health insurance, and private school funding programs. We advocate an approach that combines this type of incentive with more effective vaccination education.     

Enablers and barriers to COVID-19 vaccine uptake: An international study of perceptions and intentions

The development of COVID-19 vaccines is occurring at unprecedented speeds, but require high coverage rates to be successful. This research examines individuals’ psychological beliefs that may act as enablers and barriers to vaccination intentions. Using the health beliefs model as a guide to our conceptual framework, we explore factors influencing vaccine hesitancy and health beliefs regarding risks and severity of the disease, along with individual variables such as income, age, religion, altruism, and collectivism. A questionnaire using newly created measures for various antecedents provided 4303 usable responses from Australia, Canada, England, New Zealand, and the United States. A factor analytic and structural equation model indicates that trust in vaccine approval, the perceived effectiveness of the vaccine for protecting others, and conspiracy beliefs are the most significant drivers of intentions to vaccinate. Older people, those seeking employment, and those who have received a recent influenza vaccine are more likely to be vaccinated against COVID-19. The findings have implications for improving communication strategies targeting individuals about the merits of vaccination, particularly focusing on younger individuals and expanded message framing to include altruistic considerations, and to improve government transparency regarding the effectiveness and side effects of vaccines.     

Governing off-label vaccine use: An environmental scan of the Global National Immunization Technical Advisory Group Network

BackgroundNational Regulatory Authorities approve the indications for vaccine use in the product information. Occasionally, National Immunization Technical Advisory Groups (NITAGs) make off-label recommendations for use in different age groups, populations, and dosing schedules from the product information. We sought to determine the rationale, policies and procedures for NITAG off-label recommendations.MethodsWe conducted an environmental scan of Global NITAG Network members, immunization program managers and regulators in 38 high-, middle- and low-income countries. Participants completed an online survey regarding policies, procedures, and legislation governing development of off-label recommendations. A sub-sample of respondents met for a focus group and interviews which were analyzed qualitatively.ResultsThirty-four people responded from 26/38 (68%) countries surveyed; 76% of respondents were NITAG members or immunization program managers. Recommendations for off-label vaccine use were made in 14/26 (54%) countries; the NITAG made those recommendations in 8/14 (57%) countries. Reasons for off-label vaccine recommendations included response to disease outbreaks or vaccine shortages. Only one country had standard operating procedures for developing off-label recommendations while 6/14 (43%) countries had policies for implementing off-label recommendations. Nine respondents from 8 countries agreed to participate in a focus group (n = 6) or individual interviews (n = 3). Barriers to off-label recommendations included legal concerns, lack of standard definition for off-label use, and manufacturer reluctance to update product information. Facilitators included confidence in the decision-making process, and transparency of open communication among stakeholders.ConclusionsBest practice guidelines are needed that define off-label use and outline a transparent, evidence-based approach to develop off-label recommendations.     

Belief, knowledge and expertise: the emergence of the lay expert in medical sociology

Abstract The paper has three main aims. First, to trace – through the pages of Sociology of Health and Illness– the changing ways in which lay understandings of health and illness have been represented during the 1979–2002 period. Second, to say something about the limits of lay knowledge (and particularly lay expertise) in matters of health and medicine. Third, to call for a re‐assessment of what lay people can offer to a democratised and customer‐sensitive system of health care and to attempt to draw a boundary around the domain of expertise. In following through on those aims, the author calls upon data derived from three current projects. These latter concern the diagnosis of Alzheimer's disease in people with Down's syndrome; the development of an outcome measure for people who have suffered a traumatic brain injury; and a study of why older people might reject annual influenza vaccinations.     

Flu vaccination policy in old adults: Need for harmonization of national public health recommendations throughout Europe

The reading of the paper by Jansen et al. in a recent issue of Vaccine (2008, October 16) showing the “decline in influenza-associated mortality among Dutch elderly following the introduction of a nationwide vaccination programme” was for us the opportunity to present the results of a recently conducted survey of national Flu vaccination policies at a meeting of Presidents and representatives from 24 National Geriatric Societies. Combined results of these two studies advocate for promoting efficient, cost-effective and sustainable vaccine programme endorsed by all the National governments in Europe.     

The partnership for influenza vaccine introduction (PIVI): Supporting influenza vaccine program development in low and middle-income countries through public-private partnerships

Influenza vaccination remains the most effective tool for reducing seasonal influenza disease burden. Few Low and Middle-Income Countries (LMICs) have robust, sustainable annual influenza national vaccination programs. The Partnership for Influenza Vaccine Introduction (PIVI) was developed as a public-private partnership to support LMICs to develop and sustain national vaccination programs through time-limited vaccine donations and technical support. We review the first 5 years of experience with PIVI, including the concept, country progress toward sustainability, and lesson learned. Between 2013 and 2018, PIVI worked with Ministries of Health in 17 countries. Eight countries have received donated vaccines and technical support; of these, two have transitioned to sustained national support of influenza vaccination and six are increasing national support of the vaccine programs towards full transition to local vaccine program support by 2023. Nine additional countries have received technical support for building the evidence base for national policy development and/or program evaluation. PIVI has resulted in increased use of vaccines in partner countries, and early countries have demonstrated progress towards sustainability, suggesting that a model of vaccine and technical support can work in LMICs. PIVI expects to add new country partners as current countries transition to self-reliance.     

我国医联体建设省级政策的量化研究 ——基于政策工具、利益相关者、政策效力的三维分析框架

[目的]分析我国省级医联体建设政策,探究省级健康政策的制定实践同居民个体健康需求满足的动态耦合程度,为推进医联体建设及政策优化提出合理性的意见.[方法]检索省级政府建设医联体的政策文件,基于Rothwell和Zegveld政策工具编码分类,构建基本政策工具维度、利益相关者维度和政策效力维度的三维分析框架.[结果]最终纳...     

High burden of tick-borne encephalitis in Slovenia--challenge for vaccination policy

Slovenia is one of the countries with the highest reported incidence rates of tick-borne encephalitis (TBE). Vaccination uptake is low, estimated to be 12.4%. TBE surveillance data for the last 20 years were analysed. Though nearly all of Slovenia is endemic for TBE with national yearly incidence rates up to 26.7/100,000, we showed that two regions (Gorenjska and Koroška) were much more affected than other seven regions, with annual incidence rates up to 57.2/100,000 and 76.9/100,000 population, respectively. In the last decade, there was a shift in the age distribution of reported TBE cases to the older age groups, which resulted in the highest age-specific incidence rates nationally in 55-64 age group (up to 33.4/100,000 in 2006). To reduce this high burden of TBE, ideally the whole population of Slovenia should be offered free of charge vaccination against TBE. Alternatively, in view of limited resources available, sensible approach would be increasing vaccination coverage of the general population using social marketing and increasing TBE awareness, and in addition, offering free of charge vaccination to the most affected groups. The following priority target groups should be considered to be prospectively covered with free of charge vaccination: (1) 45-69 years old individuals in the two most affected regions (Gorenjska, Koroška), (2) the remaining age groups in the two most affected regions, (3) 45-69 years old individuals in the region with the next highest TBE incidence rates (Ljubljana), and (4) individuals 45-69 years old in all remaining Slovenian regions.     

From public health research to health promotion policy: on the 10 major contradictions

Summary The rise of evidence-based medicine has given impetus to calls for more research evidence to be incorporated into health policy. The difficulty in effecting this research transfer has often been attributed to the different worlds of researchers and policy-makers. There are other contradictions, however, that must be addressed in attempting to bridge public health research and health promotion policy. These include such issues as: what forms of evidence are required, what types of research are usually funded, the limited scope and duration of health promotion programs, how health policies are formulated, contemporary public sector management reforms, and so on. These contradictions need to be recognized and managed if closer links are to be formed between public health research and health promotion policy.     

新型农村合作医疗慢病补偿政策效果研究：基于双重差分模型的实证分析

目的：对新型农村合作医疗慢病门诊费用补偿政策的效果进行分析;方法：将研究对象按照是否实施慢病门诊费用补偿政策分为处理组和对照组,通过建立双重差分模型,分析政策前/后农村慢病患者家庭发生灾难性卫生支出的变化情况。结果：新型农村合作医疗慢病补偿政策对慢病患者家庭的疾病经济负担减轻不明显,但是新型农村合作医疗制度为农村慢病患者家庭提供了经济保障。结论：新型农村合作医疗对慢病患者门诊费用的补偿政策需要在补偿范围和强度上进一步加强。     

The introduction of policies for human papillomavirus vaccination in Europe

Background  Human papillomavirus (HPV) vaccines represent a major advance in the prevention of cervical cancer and other HPV-related diseases. The availability of HPV vaccination and cervical cancer screening creates the unique opportunity to combine primary and secondary prevention of a cancer. HPV vaccination is currently being adopted in Europe at a faster rate than has been seen with most previous vaccines. Aims and methods  This article analyses the reasons for the rapid and broad access to this cancer prevention measure to illustrate the new sociopolitical environment that drives vaccination policies in the 21st century. Results  The promise of this intervention to prevent infection by the virus that can cause these diseases in young women created an environment receptive to vaccination. However, it was robust data generated by research specifically targeted to public health needs that have convinced various stakeholders to advocate, license, recommend, and fund vaccination. It was not just the usual host of actors who rallied to this process: early support for decision-making came from experts and scientific societies, patient and women’s groups, and policy makers at the EU and national levels. Implementation now looms as the greatest challenge to vaccine uptake, in particular in the adolescent target group. Determinants of successful implementation include well-informed healthcare professionals who in turn can educate parents and adolescents on the infectious disease, its consequences, and the efficacy and safety of vaccination, and successful provision of equitable access to vaccination. The integration of vaccination and screening must also be carefully managed and adapted to the situation in each country. Conclusion  Inevitably, the impact of this promising public health intervention will depend upon the continuing engagement of all stakeholders to maintain interest and confidence in vaccination.     

The 5As: A practical taxonomy for the determinants of vaccine uptake

Suboptimal vaccine uptake in both childhood and adult immunisation programs limits their full potential impact on global health. A recent progress review of the Global Vaccine Action Plan stated that “countries should urgently identify barriers and bottlenecks and implement targeted approaches to increase and sustain coverage”. However, vaccination coverage may be determined by a complex mix of demographic, structural, social and behavioral factors. To develop a practical taxonomy to organise the myriad possible root causes of a gap in vaccination coverage rates, we performed a narrative review of the literature and tested whether all non-socio-demographic determinants of coverage could be organised into 4 dimensions: Access, Affordability, Awareness and Acceptance. Forty-three studies were reviewed, from which we identified 23 primary determinants of vaccination uptake. We identified a fifth domain, Activation, which captured interventions such as SMS reminders which effectively nudge people towards getting vaccinated. The 5As taxonomy captured all identified determinants of vaccine uptake. This intuitive taxonomy has already facilitated mutual understanding of the primary determinants of suboptimal coverage within inter-sectorial working groups, a first step towards them developing targeted and effective solutions.     

The primary care physician workforce: ethical and policy implications

PURPOSE We undertook a study to examine the characteristics of countries exporting physicians to the United States according to their relative contribution to the primary care supply in the United States.METHODS We used data from the World Health Organization and from the American Medical Association Physician Masterfile to gather sociodemographic, health system, and health characteristics of countries and the number of international medical graduates (IMGs) for the countries, according to the specialty of their practice in the United States.RESULTS Countries whose medical school graduates added a relatively greater percentage of the primary care physicians than the overall percentage of primary care physicians in the United States (31%) were poor countries with relatively extreme physician shortages, high infant mortality rates, lower life expectancies, and lower immunization rates than countries contributing relatively more specialists to the US physician workforce.CONCLUSION The United States disproportionately uses graduates of foreign medical schools from the poorest and most deprived countries to maintain its primary care physician supply. The ethical aspects of depending on foreign medical graduates is an important issue, especially when it deprives disadvantaged countries of their graduates to buttress a declining US primary care physician supply.     

炭疽疫苗和钩端螺旋体疫苗联合接种安全性实验研究

目的 对炭疽疫苗和钩端螺旋体(简称钩体)疫苗进行联合接种动物实验研究,评价联合接种疫苗的安全性,确定最佳实验免疫剂量,为炭疽疫苗和钩体疫苗的人群联合接种提供理论依据.方法 96只实验鼠分层随机分为6组,每组16只,雌雄各半.采用背部皮下接种,取炭疽疫苗1/10、钩体疫苗1/5的人用剂量进行联合接种,同时组合两种疫苗的临近剂量组,即炭疽疫苗1/20、1/40,钩体疫苗1/3的人用剂量进行联合接种,运用体重、血液学指标以及病理组织学等指标对疫苗的安全性进行评价.结果 实验动物接种2种疫苗48～72 h后,部分动物接种部位出现局部水肿,2组(Ⅰ、Ⅲ组)出现动物死亡.免疫后某些时间点白细胞计数有变化,其他指标与对照组差异无统计学意义(均有P＞0.05).结论 采用炭疽疫苗和钩体疫苗最佳剂量进行联合接种是可行的.     

General Practitioners,specialists and surveillance guidelines: Interpreting the socio-clinical context of decision-making

In contemporary times, evidence-based medicine is used as the basis for clinical decision-making. For a great number of diseases, surveillance guidelines, which are informed by evidence-based medicine, have been drawn up with much input from specialists in their relevant fields. However, these guidelines are implemented in general practice where different rationalities are brought to bear on clinical decision-making. This qualitative study interviewed both specialists and General Practitioners in New Zealand about their use of surveillance guidelines for colorectal cancer. Tension between both groups of medical professionals was apparent with regard to referral practices, with specialists advocating a rational approach to risk. However, the socio-cultural context within which General Practitioners' clinical decision-making takes place demands a more reflexive process. This paper argues the need to explore power within medical practice as the devolution of power to one group, specialists, who are constructed as the knowledge ‘elite’, sidelines other groups, in this case General Practitioners, who have to deal with the more qualitative aspects of health service delivery.