by Charlotte Kilpatrick | Oct 24, 2024 | Technology |
The University of Connecticut (UConn) announced in October 2024 that associate Professor Thanh Nguyen’s research has received “significant” backing from The Bill and Melinda Gates Foundation. The Gates Foundation has awarded a series of grants totalling $6.6 million, following support from the National Institutes of Health (NIH) and the US Department of Agriculture (USDA). The funding will contribute to research and innovation for a microneedle array patch that can deliver multiple human vaccines at once. The Foundation initially awarded $2 million, which has increased after early success.
Microneedle array patch technology
Dr Thanh Nguyen works in the College of Engineering’s School of Mechanical, Aerospace, and Manufacturing Engineering. His microneedle method is “far less painful” than traditional syringe delivery and offers access and uptake benefits.
“What if we were able to mail people vaccines that don’t need refrigeration, and they could apply to their own skin like a bandage?”
The technology delivers highly concentrated vaccines in powder from over months, through a “nearly painless” 1-centimetre-square biodegradable patch.
“The primary argument is that getting vaccines and boosters is a pain. You have to go back two or three times to get these shots. With the microneedle platform, you put it on once, and it’s done.”
Funding increases
After the initial award of $2 million, the project made good progress and received additional funding to support the development of a scale-up manufacturing technology to produce patches on an industrial scale. In late September, the Gates Foundation awarded $4 million to take the patch “a step farther” as a pentavalent and Polio vaccine targeting diphtheria, tetanus, pertussis, HIV, Hepatitis B, and Polio. With this funding, the team can “build up productivity”. They are partnering with LTS to scale up production and are expanding the size of laboratory.
The award also marks a fundraising milestone for Dr Nguyen, who has earned more than $25 million in research awards, which he reflects “doesn’t come naturally”.
“It comes from the recognition of the high impact of the research and the lab’s success in publishing articles. It is a testament to the importance of what we are doing.”
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by Charlotte Kilpatrick | Sep 30, 2024 | Global Health |
In response to recent data on influenza-associated deaths in the United Kingdom and United States, experts from the UKHSA and the CDC are urging everyone who is eligible for a flu vaccine to get vaccinated. A survey from the National Foundation for Infectious Diseases (NFID) suggests that few adults in the United States intend to get vaccinated against flu, COVID-19, respiratory syncytial virus (RSV) or pneumococcal disease, expressing concerns about side effects and a “general distrust” of vaccines. A decrease in uptake has also been observed in the UK, a source of “real concern” for UKHSA.
NFID’s study
The National Foundation for Infectious Diseases (NFID) commissioned an annual survey of US adults to “better understand current attitudes and behaviours” about infectious diseases like influenza (flu) and COVID-19. The study was conducted in August 2024 and included 1,160 complete responses from adults aged 18 and over. The study found that, although 67% agreed that an annual flu vaccination is the “most effective” way of preventing flu-related hospitalisations and deaths, 45% did not plan to or were unsure if they would get vaccinated this season. Only 38% indicated intention to get a flu vaccine this year.
When asked about attitudes towards each disease, “less than 1 in 5” were concerned about themselves or someone in their family getting infected this season:
- RSV – 16%
- Flu – 17%
- Pneumococcal disease – 17%
- COVID-19 – 20%
The survey explored the “top reasons” for people who will or might get a flu vaccine to get vaccinated against flu, including:
- To protect yourself – 76%
- To protect your family – 65%
- To avoid severe complications, including hospitalisation and death – 51%
- To avoid getting sick and missing work or school – 51%
Nearly half (49%) of participants who are at higher risk for flu-related complications cited their chronic health condition as a reason to get vaccinated against flu. Almost 3 out of 4 (72%) of adults who were diagnosed with flu in the last 2 years were likely to get a flu vaccine.
Mistrust and confusion
The top reasons cited for not getting vaccinated included concerns about side effects and a lack of trust in vaccines. While 75% of respondents trust doctors, nurses, and pharmacists for information about vaccines, only 55% trust the CDC and 51% trust state and local health departments.
“Healthcare professionals remain the most trusted source of information about vaccines and play a critical role in protecting public health by providing clear, consistent, and strong vaccine recommendations.”
Data are concerning
At a press conference in September 2024, CDC Director Dr Mandy Cohen stated that in the previous flu season, “an estimated 25,000 people in the US died from flu or related complications”.
“We can protect ourselves and those we care about by getting updated vaccines to reduce the risk of serious illness from flu and COVID-19 and do more of the things we enjoy.”
CDC data indicate that the 2023-2024 flu season in the US was “moderately severe”, causing around 41 million illnesses, 490,000 hospitalisations, and 25,000 flu-related deaths. 199 children died due to flu-related illness, which matches the previous high from 2019-2020. Also at the press conference, Dr Robert H. Hopkins, Jr., NFID Medical Director, described vaccines as a “shield against illness” and an “important tool in our public health efforts”.
“The low vaccination rates among persons with chronic health conditions are of particular concern because they are more likely to develop serious and even life-threatening complications from respiratory infections.”
Dr Hopkins encouraged “everyone at increased risk” to speak to a healthcare professional about vaccination.
“Vaccines save lives, and we all play an important role in helping protect ourselves, our loved ones, and our communities from preventable infectious diseases.”
Dr Reed V. Tuckson, co-founder of the Black Coalition against COVID and chair of the board of the Coalition for Trust in Health & Science, emphasised the importance of building trust by “enhancing our support for people in using science and evidence to make personally appropriate decisions”.
“The pandemic taught us that it is possible to close some of the gaps in immunisation rates among communities of colour, but we still have a long way to go. In addition to evidence-based messaging, we know that guidance from familiar, trusted healthcare professionals working with minority communities is essential to building vaccine confidence.”
Similar concerns across the pond
UKHSA modelling suggests that in the 2023-2024 season, influenza-attributable mortality was around 2,776 deaths due to influenza, a significant decrease from 15,465 in the previous season. Estimates of influenza vaccine effectiveness (VE) against laboratory confirmed influenza in primary care ranged between 46% and 54%. Effectiveness against hospitalisation ranged from 30% in individuals aged 65 and above to 74% in children between 2 and 17 years. However, uptake was low in people with long-term health conditions (41%), 2- and 3-year-olds (44%), and pregnant women (1 in 3).
“Across eligible groups, influenza vaccine uptake in the UK was generally lower in the 2023 to 2024 season compared to the 2022 to 2023 season.”
The decrease from 2022-2023 to 2023-2024 is broken down into various risk categories:
- Aged 65 years and over: 77.8% compared with 79.9%
- Aged 6 months to under 65 years with one or more long-term health conditions: 41.4% compared with 49.1%
- Pregnant women: 32.1% compared with 35%
There was an increase observed in the 2- and 3-year-olds group, from 43.7% to 44.4%.
Get Winter Strong
A scaled-up Get Winter Strong campaign, the result of a collaboration between UKHSA, the Department for Health and Social Care, and NHS England, is set to launch on 7th October to “help reduce the impact of winter viruses on those most at risk” and ease NHS “winter pressures”. The campaign will urge people who are eligible to get their flu and COVID-19 vaccines when invited, and (for the first time) will encourage pregnant women to get RSV and whooping cough vaccination. The maternal RSV vaccine provides “strong protection” for newborns in their first few months of life, when they are at the greatest risk of severe illness from RSV.
Dr Gayatri Amirthalingam, UKHSA Deputy Director of Immunisation, emphasised that “getting vaccinated ahead of winter is by far your best defence” against the “many dangerous viruses circulating in our communities”.
“If you’re pregnant or have certain long-term health conditions, you are at greater risk of getting seriously ill. Older people and young infants with flu are also much more likely to get hospitalised. So, if you or your child are offered the flu, COVID-19, or RSV vaccines, don’t delay in getting them. Please speak to your nurse or doctor if you have any concerns.”
Maryam Sheiakh from Manchester is quoted by UKHSA reflecting on her experience with her daughter’s flu infection. Saffy, aged 4 at the time of infection, spent a week in hospital and was transferred to a High Dependency Unit. Luckily, Saffy made a full recovery, and Maryam encouraged parents to ensure that their children get vaccinated.
“Just go and get it, don’t take the risk. No parent wants to watch their child suffer like we did with Saffy.”
The Get Winter Strong campaign will last 10 weeks, appearing on television, radio, poster sites, and social media channels. What efforts are your national health agencies making to encourage vaccination ahead of the flu season, or how are they communicating the risks of infection and benefits of vaccination?
To discuss flu vaccine development and strategies with your colleagues at the Congress in Barcelona next month, get your tickets here, and don’t forget to subscribe to our weekly newsletters for the latest vaccine news.
by Charlotte Kilpatrick | Sep 27, 2024 | Global Health |
A study in The Lancet Public Health in September 2024 evaluates the measles dynamics in England between 2010 and 2019 to understand the effects of waning of vaccine-induced immunity. The researchers find that, although the MMR vaccine remains “highly protective” against measles infections for decades, and most transmission is “connected to people who are unvaccinated”, breakthrough infections in vaccinated individuals aged 15 years or older are “increasingly frequent”. However, they emphasise the importance of adequate coverage alongside vaccine effectiveness.
In England, measles “follows typical near-elimination transmission dynamics”, with “sporadic localised outbreaks and high national vaccine coverage”. England reached measles elimination status after “large outbreaks” between 2011 and 2013. From 2017 onwards a resurgence has been observed.
Highly protective vaccines
The authors describe measles vaccines as “highly protective against infection” recognising that they enabled a “great decrease in the global burden of measles” after immunisation programmes began in the 1970s and 1980s. Indeed, some countries became eligible for an elimination status since 2000 after the successful implementation of routine immunisation programmes. However, this is slipping out of reach for many countries in Europe and the Americas, which have reported a resurgence between 2015 and 2020.
“This resurgence was mostly reported in under-immunised communities and linked to past variations in vaccine coverage.”
Further outbreaks have been reported in “highly vaccinated” groups in Portugal and Japan, inviting questions about the waning of measles immunity in adults who had received two doses in childhood. Research suggests a waning of antibodies in young adults who had received two doses of vaccine “more than 20 years earlier”, in contrast to no decrease in previously infected individuals. Analysis of outbreak data suggest a “drop” in vaccine effectiveness in young adults who had received two doses of vaccine. However, effectiveness estimates appear to be “sensitive to assumptions on infection-induced immunity”.
The study
The study addressed the need to understand whether the measles case dynamics of settings with high vaccine coverage result from a waning of vaccine-induced immunity or if changes in the distribution of immunity in the population are driving the distribution of vaccine status among cases. A mathematical transmission model, stratified by age, region, and vaccine status was used to evaluate whether the measles dynamics in England from 2010 to 2019 were “in line with a waning of vaccine-induced immunity”. Three scenarios were modelled:
- Vaccinated individuals might only become infected because of primary vaccine failure
- Vaccinated individuals might become infected because of primary or secondary vaccine failure, with the risk of secondary vaccine failure depending on age
- Vaccinated individuals might become infected because of primary or secondary vaccine failure, with the risk of secondary vaccine failure depending on age and time since measles stopped being endemic
Each scenario was fitted to measles case data reported in England between 2010 and 2019, and the authors compared the resulting performance. Data were collected by UKHSA (formerly Public Health England), and included date of symptom onset, region of residence, age, and vaccine status. The final case dataset included 7,504 cases. The annual proportion of individuals who had been infected with measles and received two doses of the vaccine out of the overall number of individuals with measles was three times higher in 2019 than in 2011. The median age of individuals with measles was 12.5 years.
Results
Scenarios integrating waning of vaccine-induced immunity “better captured measles case dynamics” than the scenario without waning. In the scenario where waning started in 2000, the estimated waning rate was 0.039% per year.
“Although slow, waning was associated with an increased burden over time; setting the waning variable in this scenario to 0 led to a substantial decrease in cases.”
While overall vaccine effectiveness was estimated to stay high over the decades, the estimation suggested that the increasing number of breakthrough infections contributed to the measles burden in England. The additional burden brought by waning is “directly related to the risk of transmission from vaccinated cases”, as individuals infected by people who had been vaccinated would not have otherwise been infected.
“Our results suggest that the waning of vaccine-induced immunity likely explains the observed dynamics and age distribution of vaccinated measles cases in England between 2010 and 2019.”
Low vaccination rates a bigger factor
Dr Alexis Robert, Research Fellow in Infectious Disease Modelling at London School of Hygiene and Tropical Medicine (LSHTM) drew attention to the “biggest factor for measles outbreaks”: low vaccination rates. Dr Robert emphasised that the MMR vaccine is “highly effective” and two doses “will protect you and those around you”.
“This 0.04% waning each year is relatively slow, but because measles is so infectious, over time, this would add up to a ‘gap’ in a population’s defences the virus can exploit, which may increase the duration and size of outbreaks.”
The data patterns in the study emerge “because outbreaks have occurred as a result of declines in vaccine coverage”, said Dr Robert.
“If there were no outbreaks, this small amount of waning would not show up in any data. The key issue here is coverage, not the effectiveness of the vaccine.”
Dr Anne Suffel, co-author from LSHTM, agreed that the study “looks at one small part of the picture” and recognised that the “larger issue” is that “uptake of the MMR vaccine has been decreasing in England since 2015”.
“Understanding the impact of vaccine immunity waning will help anticipate the potential impact of measles in countries where incidence has been low for decades, but vaccine uptake is reducing. The best way to limit the impact of measles and protect everyone from what can be a horrible disease, is to keep vaccine uptake as high as possible.”
Dr Adam Kucharski, Professor of Infectious Disease Epidemiology and co-author from LSHTM, acknowledged the role of “other factors” such as “changes in testing patterns over time”.
“However, the consistency and age distribution of the increase in England – combined with reports of cases in vaccinated individuals in other countries and previous laboratory studies showing a decline in measles antibodies – suggests a biological explanation is involved.”
Join us at the Congress in Barcelona next month to explore the reasons for a resurgence in measles from an uptake perspective, and don’t forget to subscribe to our weekly newsletters for more vaccine news.
by Charlotte Kilpatrick | Sep 25, 2024 | Global Health |
A study in Patient Education and Counselling explores the experiences of primary care physicians (PCPs) with vaccine-hesitant patients in the hope that specific challenges can be addressed to support efforts to increase vaccine acceptance. All the PCPs who participated understood the significance of discussing COVID-19 vaccination, but they found strategies targeting people’s thoughts and feelings were “generally ineffective”. They also expressed “frustration” at their interactions with vaccine hesitant patients, which sometimes led them to “truncate their communication with these patients”.
Fostering acceptance and increasing uptake
The authors describe vaccine hesitancy as a “major public health threat” as demonstrated in the COVID-19 pandemic; an estimated 234,000 deaths could have been prevented through vaccination between June 2021 and March 2022 when COVID-19 vaccines were “widely available” in the United States. Despite this availability and evidence of vaccine effectiveness, around 20% of the US population is undervaccinated against COVID-19.
“Strategies to foster vaccine acceptance and increase COVID-19 vaccination are needed.”
Many evidence-based strategies for healthcare organisations to promote vaccine uptake put health care providers (HCPs) at the centre, with doctors “consistently cited” as a trusted source of information. However, the perspectives of primary care providers (PCPs) are a research gap. Thus, the authors identified a need to generate a “more in-depth understanding” of PCPs’ experiences communicating with vaccine hesitant patients. This understanding is a “critical first step to maximising the potential for PCPs to promote COVID-19 vaccination”.
The study
The study was intended to describe PCPs’ experiences and perspectives on COVID-19 vaccine communication with patients, with a focus on COVID-19 vaccine hesitant patients. The researchers conducted focus groups with PCPs from 3 healthcare systems in central Massachusetts. Acknowledging prior research that documents higher rates of COVID-19 vaccine hesitancy among members of racial/ethnic minority groups and those with socioeconomic disadvantage, the authors chose clinics from 3 health systems that serve higher proportions of patients who are a member of a racial/ethnic minority group, primarily speak a language other than English, and/or are insured through MassHealth.
Nine focus groups, conducted for around an hour over Zoom between December 2021 and January 2022, involved 40 PCPs. These included 23 attending physicians, 10 resident physicians, 6 nurse practitioners, and 1 physician assistant. Experiences were characterised by the following themes:
- Importance of and perceived responsibility for discussing COVID-19 vaccination with their patients
- Strategies for promoting COVID-19 vaccination
- Challenges PCPs encountered
- PCPs’ reactions and emotions
- Tailored communication according to degree of hesitancy
- Resources that would be helpful to support these conversations
The findings were integrated with the Increasing Vaccination Model, but the authors added the challenges encountered among “staunchly vaccine hesitant patients” and resultant frustration, truncated communication, and shifting priorities.
Study findings
All participants perceived discussing COVID-19 vaccination with their unvaccinated patients as “extremely important” and described feeling responsible for providing patients with accurate information about vaccination and recommending vaccination to all their unvaccinated patients. However, most PCPs did not feel responsible for whether their patient chooses to get vaccinated.
The focus groups revealed a range of communication strategies for influencing COVID-19 disease risk appraisal and/or increasing confidence in the vaccine. For example, facts and statistics appeared “ineffective”, directing PCPs to other strategies such as emphasising a patient’s risk of disease, sharing stories of other patients who experienced serious illness, and highlighting the risk of Long COVID. Some PCPs acknowledged “explicitly trying to induce fear about COVID-19″.
The main strategy for increasing vaccine confidence across PCPs was sharing information, including referring to studies and/or CDC information, answering questions, acknowledging risks, and addressing myths and misconceptions. Many PCPs presented vaccination as a risk/benefit calculation, emphasising safety by comparing the small number of vaccine-related adverse events with the number of people who had received the vaccine. They also put the risk of vaccine-related adverse events into the context of the larger risk of dying of COVID-19 or risks inherent in everyday activities.
PCPs explored various relationship-based strategies to promote COVID-19 vaccine uptake, including making personalised recommendations for vaccination, leveraging pre-existing relationships, sharing personal decisions to be vaccinated, and building trust. Common approaches to build trust included avoiding making patients feel stigmatised, acknowledging concerns and uncertainty, encouraging repeated discussions, empathising with concerns, and being explicit that PCPs are motivated by the patient’s interests. Although many offered patients a chance to ask questions, only a few reported trying to find common ground and empathise with concerns. However, those who did found it helpful.
“COVID-19 vaccine availability in clinic was consistently cited by PCPs as one of the most influential factors in getting their COVID-19 vaccine hesitant patient vaccinated.”
PCPs observed that vaccine availability overcame practical barriers, and those who worked at clinics without vaccine availability described it as a “major barrier”. Other practical challenges included inadequate time and competing medical priorities, as well as difficulty following ever-changing information on COVID-19 and vaccinations.
Efforts to influence the most “staunchly vaccine hesitant” patients’ thoughts and feelings were “generally ineffective”. Many PCPs reported struggling to overcome strongly held beliefs based in misinformation or conspiracy theories. For some, patients refused them a chance to discuss it, including those who prevented PCPs from leveraging their relationships.
“All PCPs felt frustrated and defeated with not being able to convince some patients to get vaccinated.”
This experience was compounded by the “disheartening” transition between attending to critically ill patients with COVID-19 in the ICU and being unable to get through to patients who have access to a preventative intervention. PCPs also expressed “frustration and anger” with unvaccinated patients who sought treatment for COVID-19 and described “emotional exhaustion” with trying to discuss vaccination with hesitant patients.
“Recognising that most of their strategies were ineffective among the most staunchly hesitant patients, most PCPs tailored their communication according to the degree of COVID-19 vaccine hesitancy.”
Patients were broadly categorised as those who were:
- Very easy to convince or just want PCPs’ confirmation
- Undecided but open to and seeking information
- Staunchly opposed to vaccination
The “staunchly opposed” group demanded the most time and effort, often rejecting data and/or science and having fixed belief systems informed by misinformation, politics, and personal experience. Most PCPs therefore limited the time they committed to discussing COVID-19 vaccination with patients who seemed staunchly opposed. This was also influenced by a desire to maintain relationships and ensure patients continue to seek care for other conditions.
The participating PCPs felt “ill-equipped” to communicate with their most hesitant patients but commented on the value of focus groups for learning from peers and feeling less alone in facing challenges. They expressed interest in easy-to-understand patient-facing educational materials to address common myths, questions, and concerns in multiple languages. They also indicated a desire for accurate, up to date, and easy to find information sources for their own reference. It might also be valuable to develop system-level resources to identify unvaccinated patients, conduct outreach, and offer professional counselling.
Implications and conclusions
“As the spread of medical misinformation and disinformation is expected to persist and potentially increase, our study illustrates the need for innovative and effective strategies for refuting misinformation related to vaccination, and health misinformation more broadly.”
The authors comment that “very few PCPs” in the study described empathising and expressing understanding with their vaccine hesitant patients, but the few who did found it “quite effective”. Expressing empathy and understanding the viewpoint of a staunchly vaccine hesitant patient are “necessary first steps to establishing trust with this population” before refuting misinformation. However, this is “understandably difficult” for healthcare providers.
The paper identifies a need for training in effective approaches for countering misinformation and communication. As a presumptive-style recommendation is the “most well proven provider-based strategy” for encouraging vaccine uptake, PCPs should be trained in making presumptive-style recommendations. However, the effects of this training could be limited if COVID-19 vaccine availability in primary care clinics is “inconsistent”. Efforts should focus on increasing in-clinic availability as an “important first step”.
Associate professor of medicine at UMass Chan Medical School and principal investigator, Dr Kimberly Fisher reflected that the key message from PCPs was “universal frustration” at the number of patients they “couldn’t get through to, despite their pre-existing relationship and feeling like the patients really trusted them”. This challenge continues as advice changes.
“In the early communication, public health officials obviously didn’t know that it would be required every year, and so I think there is a degree of frustration among patients about actually needing to get one every year, like a flu shot.”
Dr Fisher recognised the importance of tempering vaccine advocacy with maintaining a trusting relationship.
“Maybe they won’t get vaccinated. But you could still convince them to get a mammogram or colonoscopy or something else.”
For more on effective vaccine communication and encouraging participation in necessary immunisation strategies, get your tickets to join us at the Congress in Barcelona next month, and don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Sep 17, 2024 | Global Health |
A statistical report from UKHSA and NHS England in September 2024 reveals a drop in childhood vaccination coverage in England in 2023-2024. The report uses data from the COVER (cover of vaccination evaluated rapidly) programme, which collates information for children aged 1, 2, and 5 by financial year. The UK routine childhood immunisation programme includes WHO Europe’s recommendations as well as others advised by the Joint Committee on Vaccination and Immunisation (JCVI) and defined by UKHSA.
Coverage details
6-in1
For the 6-in-1 vaccine (previously 5-in-1), which protects against diphtheria, pertussis, tetanus, polio, disease caused by Haemophilus influenzae type b, and hepatitis B, vaccination is scheduled at ages 8, 12, and 16 weeks.
Coverage at 12 months in England has remained below the WHO Europe target of at least 95% of children immunised; for 2023-2024, 91.2% of children were reported to have completed their primary course of 3 doses at 12 months. This is a decrease from the previous year, which was 91.8%, and a continued “downward trend” since a peak of 94.7% in 2012-2013. In the 2023-2024 period, 8 out of 9 regions exceeded 90%, with 1 region (North East) exceeding the national target of 95%, reaching 95.2%. London had the lowest coverage of 86.2%.
Coverage at 24 months was 92.4%, lower than the previous year, which reached 92.6%, and continuing the “downward trend” since the peak at 96.3% in 2012-2013. This has not exceeded the target since 2018-2019. For regional coverage at 24 months, 8 out of 9 regions reached 90% coverage and 1 region met the national target of 95%. Again, London had the lowest regional coverage (87.7%).
At the 5-year coverage assessment, coverage was 92.6%, lower than the 93.2% coverage reported for the 5-in-1 vaccine in 2022-2023. This is the lowest since 2009-2009. However, at regional level, coverage exceeded 90% in 8 of 9 regions with the South West exceeding the 95% target. Once more, London had the lowest coverage (86.9%).
MMR
The MMR vaccine protects against measles, mumps, and rubella; doses are scheduled at 12 months (MMR1) and 3 years and 4 months (MMR2). Coverage is measured at 24 months (MMR1) and 5 years (both doses).
MMR1 coverage at 24 months reached 88.9% in 2023-2024; this is a decrease from 89.3% in the previous year and is the third consecutive year that coverage has been below 90%. For the 10 years between 2011-2012 and 2020-2021, coverage exceeded 90%. Regionally, 6 out of 9 regions reached 90% coverage, but no region met the national target of 95%. London had the lowest coverage (81.8%). At 5 years, MMR1 coverage was 91.9%, a decrease from 92.5% the previous year. 95% was achieved for the first and only time in 2016-2017; coverage has “consistently decreased” since then. The North East was the only region to meet the target of 95%.
MMR2 coverage at 5 years reached 83.9%, a decrease from 84.5% the previous year. Coverage decreased in all regions; no regions exceeded 90% coverage. The lowest coverage was in London (73.3%).
Rotavirus
The rotavirus vaccine is administered at 12 weeks and coverage is measured at 12 months; unlike other vaccines in the primary schedule, the rotavirus vaccine cannot be given beyond 6 months. This means that coverage at 12 months is “likely to be lower” than other vaccines.
National coverage at 12 months was 88.5%, a decrease from 88.7% in the previous year. This means that rotavirus vaccine coverage is “now at its lowest level since data became available” in 2016-2017. In 4 regions, coverage exceeded 90%, but none achieved 95%. London was the region with the lowest coverage at 83.6%.
PCV
The pneumococcal conjugate vaccine (PCV) protects against pneumococcal disease. The primary course is scheduled at 12 weeks and the booster dose at 12 months; coverage is measured at 12 months and 24 months.
The primary course coverage at 12 months was 93.2%, a decrease of 0.5% from 2022-2023. The booster coverage reached 88.2%, a decrease from 88.5% the previous year and a continuation of the downward trend since it peaks in 92.5% in 2012-2013. 5 out of 9 regions reached 90% coverage for the booster, but no regions exceeded the national target of 95%. London had “consistently lower coverage” between 2021-2024 and achieved 80.4% in 2023-2024.
Hib/MenC
The Hib/MenC vaccine protects against Haemophilus influenzae type b (Hib) and meningococcal disease group C (MenC). The combined vaccine is administered at 12 months, with coverage measured at 24 months and 5 years. It includes a booster for Hib, which is offered within the DTaP/IPV/Hib/HepB primary course.
At 24 months, coverage in England remained below 90% for the third year; it has declined consistently since a peak of 92.7% in 2012-2013. 88.6% of children were reported as having received the Hib/MenC vaccine. 6 out of 9 regions reached 90% coverage and no region achieved 95%. The lowest coverage was 81.2% in London. At 5 years, coverage was 89.4%, a decrease from 90.4% the previous year. This takes coverage to its lowest point since 2011-2012. 7 out of 9 regions reached 90% but no regions met 95%. London had the lowest coverage at 82.5%.
MenB vaccine and booster
The MenB vaccine and booster protects against meningococcal disease (group b). It is a combined vaccine scheduled at 8 weeks with a booster at 12 months, and coverage is measured at 12 months and 24 months.
At 12 months, 90.6% received 2 doses; this is a decrease from 91.0% the previous year. London had the lowest coverage at 85.5%. At 24 months, coverage was 87.3%, a decrease from 87.6% the previous year. Again, London had the lowest coverage (79.3%).
Parents encouraged to seek vaccines
Responding the report, Minister for Public Health and Prevention Andrew Gwynne urged parents to “take up vaccinations to keep children safe”, particularly as they return to school or nursery this Autumn.
“Vaccines are our best form of protection against serious illness.”
Steve Russell, NHS National Director for Vaccinations and Screening is concerned that “too many children are still not fully vaccinated” against vaccine-preventable diseases that can cause “serious illness”.
“Vaccinations have been protecting children for decades and are offered free as part of the NHS routine immunisation programme, saving thousands of lives and preventing tens of thousands of hospital admissions every year.”
UKHSA Consultant Epidemiologist Dr Vanessa Saliba emphasised the importance of the drive to increase vaccine uptake so that “no child is left at risk of serious illness or life-long complications”.
“These vaccines offer the best protection as children start their journey into nursery and mixing more widely. Many who missed out on their vaccinations have already been caught up, but more needs to be done to ensure all those eligible are vaccinated.”
For more on ensuring uptake levels match the pace of vaccine innovation, join us at the Congress in Barcelona next month. Don’t forget to subscribe to our weekly newsletters for the latest vaccine updates.
by Charlotte Kilpatrick | Sep 17, 2024 | Global Health |
The first round of an emergency polio vaccination campaign in the Gaza Strip reached around 560,000 children under ten between 1st and 12th September 2024. WHO reported that the campaign delivered novel oral polio vaccine type 2 (nOPV2) to 558,963 children after the identification of circulating variant poliovirus type 2 (cVDPV2) in July and August 2024. The effort used an “extensive network” of teams, providing vaccinations at selected fixed sites. Mobile and transit teams engaged families living in shelter homes, tents, and camps for the displaced, and community workers raised awareness.
Efforts continue
The initial campaign target was 640,000 children, which WHO suggests may have been an over-estimate in the absence of an accurate survey and population displacement. The campaign used 473 teams, including 230 mobile teams, and 143 vaccination sites in central Gaza. This was followed by 91 fixed sites and 384 mobile teams in southern Gaza. The campaign concluded in northern Gaza, with 127 teams at fixed sites and 104 mobile teams. Each of the three phases was conducted under an “area-specific humanitarian pause” of nine hours daily, agreed to guarantee the safety of communities and health workers and ensure vaccination targets could be achieved.
749 social mobilisers engaged communities, encouraged families to vaccinate their children, and addressed concerns. Trained monitoring teams were deployed during the campaign to oversee the efforts, and a further 65 independent monitors will now cross-check the proportion of children vaccinated in the Gaza Strip to independently assess the level of coverage achieved in this first round. These monitors will need “safe, unimpeded access” to households, markets, transit points, and health facilities to check that children have purple dye on their little fingers, signifying vaccination.
The second round of the campaign is expected to follow in four weeks, providing a second dose of nOPV2. WHO, UNICEF, and UNRWA hope to reach enough children and stop further transmission, calling for another round of humanitarian pauses with “unimpeded access” to children in areas that require special coordination. The organisations highlight the need for a “long-lasting ceasefire” so that families can “begin to heal and rebuild their lives”.
Public engagement
WHO recognises the “traditionally positive health seeking behaviour among the Palestinian people” as critical to the success of the first round. Families reportedly “flocked” to health facilities to ensure that their children received vaccinations. This positive reaction was complemented by an “impactful campaign to raise awareness and mobilise the public”.
Dr Richard Peeperkorn, WHO Representative for the occupied Palestinian territory (oPt), commented on the “incredible resilience” of helath and community workers who carried out the campaign at “unprecedented scale and speed under the toughest conditions in Gaza”. Additionally, “swift action” from the Global Polio Eradication Initiative, from initial detection to campaign launch, “speaks to the effectiveness of the polio programme”.
“In areas where humanitarian pauses took place, the campaign brought not just vaccines, but moments of calm. As we prepare for the next round in four weeks, we’re hopeful these pauses will hold, because this campaign has clearly shown the world what’s possible when peace is given a chance.”
Jean Gough, UNICEF Special Representative in the State of Palestine emphasised the importance of carrying out the “ambitious campaign…quickly, safely, and effectively”. This will protect children in the Gaza Strip and neighbouring countries from “life-altering poliovirus”.
“The progress made in this first round is encouraging, but the job is far from done. We are poised to finish the task and call on all involved to ensure we can do so in the next round in four weeks’ time, for the sake of children everywhere.”
For insights into effective emergency vaccination campaign delivery and strategies to encourage uptake, get your tickets to the Congress in Barcelona next month, and don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Sep 16, 2024 | Global Health |
A paper in npj vaccines in September 2024 explores the significance of “biased processing” of information relating to vaccines in addressing vaccine hesitancy during the COVID-19 pandemic. Although vaccine hesitancy is influenced by various factors, the research suggests that “deliberate ignorance” was more closely associated with vaccine refusal than “typically investigated demographic variables”. This emphasises the importance of tailored information to meet individual information-processing needs.
Hesitancy and interventions
Vaccine hesitancy, “the reluctance or refusal to get vaccinated despite the availability of vaccines”, was recognised as a top ten global health threat by WHO in 2019. The authors acknowledge that it is a “complex phenomenon”, determined by “historical, political, and socio-cultural factors” as well as “individual knowledge and risk perception”.
Recent research has highlighted the significance of concerns about side effects and effectiveness for vaccine hesitancy. Therefore, many responses to vaccine hesitancy use information on vaccine evidence, including possible harms or potential benefits. However, there is evidence that “transparent communication of the evidence” does not influence vaccination intentions and neglects factors such as experiences of racism or mistreatment by medical professionals or distrust of the pharmaceutical industry.
The study
The authors consider “how (if at all) people use information about vaccine evidence”. They combine theoretical and analytical ideas with methodological tools from cognitive and behavioural science to investigate how individuals with different attitudes towards COVID-19 vaccines process vaccine evidence information. They characterise and measure how people process “commonly provided information about vaccine evidence” and compare the influence of “extraneous factors” on vaccination decisions.
With a process-tracing methodology and computational modelling, the authors examine the extent to which people may engage in “deliberate ignorance”. In this context, deliberate ignorance signifies “choosing not to inspect a piece of information on a vaccine’s side effects, benefits, and their probabilities in the pre-decision phase”. Deliberate ignorance is distinguished through three levels:
- Full deliberate ignorance – people abstain from inspecting any information on vaccine evidence; their decisions may be based on other factors instead.
- Partial deliberate ignorance – people ignore some, but not all, vaccine evidence information. The research focusses on ‘probability neglect’, in which a vaccination outcome is inspected, but its probability is not.
- No deliberate ignorance – people inspect all information on vaccine evidence and consider it in their decision. However, even in this category this information may be processed in a distorted fashion, deviating from a “rational way” of processing information.
As vaccination decisions are conceptualised as “instances of risky choice”, the authors use a framework that considers two types of cognitive distortions: (nonlinear) probability weighting and loss aversion:
- Probability weighting – people make risky decisions as if they processed probabilities nonlinearly, with low and high probabilities being over- and underweighted.
- Loss aversion – people make risky decisions as if the psychological impact of losses is greater than that of gains.
The online study involved 1200 United States citizens who self-reported as having anti- (365), neutral (373), or pro- (462) COVID-19 vaccine attitudes. Participants made a series of decisions concerning their willingness to get vaccinated with each of eight internationally licensed COVID-19 vaccines. For each of these vaccines, participants could choose to inspect information on vaccine evidence, including side effects and benefits. Information inspection behaviour was recorded through Mouselab, a process-tracing tool.
Findings
61.9% of participants in the anti-vaccination group, 11.7% of participants in the neutral group, and 0.4% of participants in the pro-vaccination group refused all eight vaccines. On average, participants accepted one (anti-vaccination), three (neutral), and five (pro-vaccination) of the eight vaccines. Notably, the non-zero acceptance rate in the anti-vaccine group was influenced by almost 30% of participants indicating willingness to accept the Bharat Biotech vaccine.
The strongest predictors of vaccine acceptance were vaccination attitude, the number of COVID-19 vaccinations a participant had received by the time of the study, and vaccine brand. Political orientation and education level were related to vaccination decisions in raw data, but these relationships “vanished” in the full statistical model.
Statistical models were used to investigate the relationship between deliberate ignorance of vaccine evidence and vaccination decisions. Mouselab data facilitated an analysis of participants’ information inspection behaviour. This found that anti-vaccination, neutral, and pro-vaccination groups exhibited full deliberate ignorance in 18%, 9%, and 7% of decisions respectively. The level of deliberate ignorance was “strongly related” to vaccination decisions; probability of vaccine refusal was highest when participants exhibited full deliberate ignorance and lowest when they exhibited no deliberate ignorance.
“In the anti-vaccine group, full deliberate ignorance was almost always followed by vaccine refusal; in the pro-vaccination group, by contrast, full deliberate ignorance was associated with a higher probability of vaccine acceptance than partial deliberate ignorance.”
Probability neglect was defined as cases in which there was at least one instance where a participant inspected an outcome but not its probability. Participants in the anti-vaccination, neutral, and pro-vaccination groups exhibited probability neglect for side effects in 15%, 13%, and 9% of vaccination decisions respectively. For benefits, they exhibited this in 8%, 6%, and 4% of decisions respectively.
To account for the possibility that the effect of probability neglect on vaccination decisions depended on side effect severity, the authors distinguished whether the probability neglect occurred for an “extreme, severe, or mild” side effect or for a benefit. This revealed that vaccine refusal was “much more likely” in trials where the probability of an extreme side effect was neglected, and vaccine refusal was “much less likely” in trials where the probability of a mild side effect was neglected.
“How participants inspected and ignored information about vaccine evidence seemed to be a key predictor of their decision to get vaccinated with given vaccine or not.”
The authors then used computational modelling to explore cognitive distortions in the processing of the inspected vaccine evidence and its effect on vaccination decisions. For quantitative measures of each participant’s subjective valuation of a vaccine’s possible outcomes, participants were asked to rate the emotion they would feel due to each effect. The anti-vaccination group gave the most negative affect ratings for side effects and the least positive affect ratings for benefits; the pro-vaccination group gave the least negative affect ratings for side effects and the most positive affect ratings for benefits.
To investigate how vaccination decisions were driven by individual decision biases, vaccine-specific effects, and subject distortion of vaccine evidence, the authors developed a computational model to capture paths to a decision. This identified a decision bias in most of the anti-vaccination group to refuse the vaccine; this was strong that the effects of the vaccine’s properties and valuations “rarely pushed the probability of acceptance” higher than 50%.
Neutral group participants showed a “weak a priori propensity to refuse a vaccine” but vaccination decisions were driven by vaccine-specific effects and consideration of vaccine evidence information. Most participants in the pro-vaccination group showed a bias towards vaccine acceptance, but this was not as pronounced as the refusal bias in the anti-vaccination group.
“The subjective valuations of the vaccine’s effectiveness, side effects, and probabilities drove the vaccination decisions, particularly among the neutral and pro-vaccination participants.”
Implications for vaccine interventions
An insight that the authors highlight is the importance of “tailoring interventions” to specific target groups. If a person is asked to self-assess their general vaccination attitude, the content and format of vaccine information could be adjusted. Although the deliberate ignorance of vaccine evidence among the anti-vaccination group is a “practical barrier to the approach of risk communication that is meant to inform but not persuade”, health communicators and health authorities should not abandon their goal of informing.
“Risk evidence communicators need to be realistic about their expectations. It also means that they must consider other aspects of their efforts, such as the relationship between the communicator and the audience.”
Communicators must also explicitly address the “major concerns” of vaccine sceptical people, such as “what science does not know”; this must be communicated in “understandable, nontechnical, and transparent language”. However, once trust is re-established among people with anti-vaccination attitudes, the “tendency to close one’s eyes to probabilities” presents a challenge. Targeted interventions that address this “disregard of probabilities” would be useful. For example, interactive simulations could be used to convey vaccine evidence, imitating the “sequential and experiential mechanisms by which people naturally encounter risk information”.
The observed side-effect aversion in all groups might lead communicators to avoid disclosing side effects. This could initially decrease vaccine hesitancy but “at a huge cost”. Full transparency is critical for maintaining trust. Again, interactive simulations might be a solution, or targeting the strong negative emotions associated with side effects.
Concluding that behavioural scientists have the “task” of understanding the reasons for vaccine refusal, the authors emphasise the need for effective evidence communication to take “new and innovative paths”.
“Societies can be fully prepared for future pandemics only when technological ingenuity is coupled with cognitive and behavioural insights.”
If the ideas explored in the study are of interest to you, you could participate in the pre-Congress Vaccine Equity Workshop in Barcelona next month; you will hear from experts on the importance of effective vaccine outreach and how social and cultural factors contribute to vaccine inequities. Don’t forget to subscribe to our weekly newsletters here for the latest vaccine news.
by Charlotte Kilpatrick | Sep 3, 2024 | Global Health |
A study in Vaccine X presents a “comprehensive view of people’s opinions, fears, and behaviours” about mpox. The authors searched various sites for descriptive cross-sectional study designs from 2022 and 2023 addressing “knowledge, attitude, perception, preparedness, willingness to get vaccinated, and practices” against mpox infection. They conclude that there is a need to increase knowledge about mpox and spread awareness on the importance of preventive measures like vaccination.
Awareness, attitudes, and actions
“The public’s response to an epidemic is influenced by each person’s perceptions of the illness and their ability to change their behaviour as conditions change.”
The paper describes prevention and treatment of mpox as “challenging” in areas where it is endemic. Prevention measures include isolation and immunisation, with WHO recommending the use of MVA-BN or LC16 vaccines, or the ACAM2000 vaccine “when the others are not available”. Further preventive actions require “good understanding of the nature of the virus”. For example, environmental surveillance can identify the spread of pathogens within societies, shedding light on possible pathways of transmission.
A key challenge in controlling the spread of Mpox is a lack of knowledge in healthcare workers (HCWs).
“Therefore, there must be good awareness and appropriate attitudes and actions toward mpox among the HCWs and the general population.”
The study
The study was intended to provide an overview of “knowledge, attitudes, willingness to get vaccinated, level of awareness, worry, and perception of risk” among different populations. The researchers searched several databases in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Eligibility criteria included studies in any language, descriptive cross-sectional study designs conducted in 2022 and 2023, and studies addressing knowledge, attitude, perception, preparedness, willingness to get vaccinated, and practices against mpox infection. Studies measuring these outcomes were included through validated questionnaires. An overall score was calculated to determine the knowledge, attitude, perception, preparedness, worries, and practices as well as willingness to get vaccinated.
The search resulted in a total of 493 articles, reduced to 289 after the exclusion of duplicates. 37 articles were included in full-text screening, resulting in 30 eligible articles for the systematic review and meta-analysis. These were cross-sectional studies featuring healthcare workers (14), general population (10), medical students (4), and university students in different specialities (2).
Findings
The authors describe knowledge of the disease, attitudes to prevention, and intentions to follow advised practices as “major determinants” of the adoption of preventive measures. For many diseases for which vaccines currently exist, higher vaccination rates are “very important” to generate higher immunity rates. To create necessary demand, the authors highlight the need to develop safe and effective vaccines but also to “ensure that the necessary logistical issues, equitable distribution, and the population acceptance are addressed”.
The results show that “less than half had good knowledge, while the majority had good attitudes toward mpox”. Most respondents were willing to take the mpox vaccine, and the majority were reported to be aware of mpox. Less than half had worries and perception of risk toward mpox, and knowledge was highest in the general population, followed by HCWs. However, HCWs were the “most willing population” to be vaccinated against mpox.
Different characteristics had influences on knowledge about mpox but not always to the same effect; for example, “gender may have an impact on knowledge levels, but the direction of that influence may be determined by other factors, such as cultural or societal standards”. Although some studies suggested that “higher education levels and certain professional backgrounds were related with more knowledge”, professional experience was not always associated with high knowledge levels.
65% of participants expressed willingness to get vaccinated, which “can’t be considered a high percentage” as herd immunity demands more than 80% of population vaccination. A study that reported only 8.8% willingness for vaccination attributed this to “inadequate levels of factual knowledge”. Factors associated with not getting vaccinated were “various” including gender, age, income level, and education level.
Less than half of the participants were reported to be worried about mpox (42.7%), but one study found 33.2% of participants were more about mpox than COVID-19. Another study reported that male HCWs were “less worried” about mpox than females, medical students were “significantly more worried” compared to other participants, and HCWs who had experienced COVID-19 infection were “significantly less worried” about the mpox outbreak.
Conclusion
The paper concludes that mpox knowledge should be increased through awareness campaigns and social media. The importance of advice to take mpox vaccines is also highlighted, with a focus on vaccine efforts in “vulnerable groups”.
“If adequate management and prevention strategies are implemented in the early steps, the virus will be controlled adequately.”
After the declaration of mpox as a PHEIC in August 2024, how might these attitudes change? Do you think the study can be used to inform public awareness campaigns and vaccination drives? For more on encouraging vaccine confidence at the Congress in Barcelona this October get your tickets here, and don’t forget to subscribe to our weekly newsletters for the latest vaccine updates.
by Charlotte Kilpatrick | Aug 30, 2024 | Global Health |
The Annenberg Public Policy Centre (APPC) shared a report in August 2024, revealing that the number of Americans believing COVID-19 vaccination misinformation has risen and their “willingness” to take or recommend vaccination against COVID-19 is “lower than in the past”. The Annenberg Science and Public Health (ASAPH) Knowledge Monitor tracks national levels of health knowledge and misinformation to generate “indices of knowledge” about health topics. The latest report is based on 20 waves of a nationally representative panel survey of US adults, the most recent of which was conducted in July 2024.
Confidence levels
The survey asks respondents to report their level of confidence in people who provide public health information. Respondents had the most confidence in primary care providers regarding “matters of public health” in 2023 and 2024. However, they had less confidence in public health institutions like the FDA and CDC. Respondents expressed least confidence in Dr Fauci, who stepped down as NIAID Director at the end of 2022.
In February 2024, Americans reported trusting scientists and police officers to act in their best interests “more than other groups”, including business leaders and journalists. Medical scientists were trusted “significantly more than any other group”. Confidence in the trustworthiness of the FDA exceeded specific measures of confidence concerning the FDA’s vaccine approval process. The four items assessing the FDA protecting the vaccine process from outside influence were the most highly correlated with each other and general confidence in the FDA.
COVID-19 misinformation and vaccines
The report emphasises that vaccines are “one of the great success stories of public health”. However, recent years have seen “declines in Americans’ perceptions that a variety of vaccines are safe and effective”. Although “most respondents” report vaccines as safe (65%-81%) and effective (61%-83%), respondents showed “significant declines” in perceptions of safety for MMR and COVID-19 vaccines, and in perceptions of efficacy for MMR, seasonal flu, and pneumonia vaccines.
Respondents considered MMR and seasonal flu vaccines safer and more effective (75%-83%) than the COVID-19 (65%-66%), even though CDC evidence indicates that the COVID-19 vaccines are “actually more effective” than flu vaccines. The authors also identify an increase in perceptions that the COVID-19 vaccines are “very or somewhat unsafe” (18%-24%).
The surveys tracked the amount of endorsement of five COVID-19 vaccine misinformation beliefs for nearly three years. Although most respondents still endorse the “science-consistent response” (55%-65%), endorsing the “science-inconsistent response” has increased over time. The “misinformed belief” that COVID-19 vaccinations have been responsible for thousands of deaths in the US increased from 22% in June 2021 to 28% in July 2024. Another trend was an increase in the “false belief” that it is safer to get a COVID-19 infection than a COVID-19 vaccine.
Vaccination in pregnancy
From June 2023 to April 2024, respondents increased their understanding of the vaccinations recommended during pregnancy by the CDC. In the most recent assessment, many respondents knew that seasonal flu (50%), COVID-19 (43%), and the Tdap (35%) vaccines are recommended in pregnancy. However, the recent survey also found that “large numbers of people” are “uncertain or do not know” the benefits of COVID-19 vaccination during pregnancy. Opinions were divided on whether to recommend the RSV vaccine to a pregnant friend or family member.
Measles
Despite the availability of an MMR vaccine that provides “long-lasting protection” against measles for people who have received both recommended doses, only 93% of kindergarten students in the US in 2022-2023 had received both doses. Exemption requests in the 2022-2023 school year, while still low, increased to 3.0% from 2.6% in the previous year.
“These increases in exemptions could be attributable to actual increases in vaccine hesitancy or persistent barriers to vaccination for families whose access to routine childhood vaccination series was reduced by the COVID-19 pandemic.”
The American public “remains relatively confident” in the vaccine for measles, mumps, and rubella. In October 2023, respondents perceived the MMR vaccine as “safer and more effective than any other surveyed vaccine”; 81% reported that the MMR is either “somewhat or very safe” and 83% reported it as “somewhat or very effective”. However, these perceptions represent a “significant decline” from August 2022, when 88% of respondents reported that the MMR vaccine was “somewhat or very safe” and 87% perceived it as “somewhat or very effective”.
In April 2024, a “large proportion of the public” knew that medical professionals recommend taking the MMR vaccine. However, less than half of respondents (49%) know that it is not more harmful than helpful to give children more than a single vaccine on the same day, and many were “not sure” (23%). Indeed, combining vaccines reduces the overall number of visits to the doctor, reducing barriers to “full, on-time vaccination”. Only 63% of respondents believe that healthy children should meet school vaccination requirements for attendance in public schools.
Most respondents (56%) were unsure about the effect of measles on potential pregnancy complications. About 4 in 10 people correctly identified two complications associated with contracting measles while pregnant: delivering a low-birth-weight baby and early delivery. Some people incorrectly indicated that diabetes (7%), blurred vision (11%), and death (12%) are more likely to occur if measles is contracted during pregnancy; this is not the case. Of particular concern is that a quarter of US adults still do not know that there is “no causal evidence” linking the measles vaccine to autism.
Mpox
As the “salience” of mpox receded in the US after the 2022 global outbreak, so has the public’s knowledge concerning the issue. The public is “significantly less worried about contracting mpox”; only 5% of respondents reported being “somewhat or very worried” about contracting mpox in the next 3 months. In July 2024, only 9% were worried about personally contracting mpox or someone in their family contracting mpox. 76% of respondents reported in October 2022 that they were “very likely or somewhat likely” to receive an mpox vaccine if they were exposed.
“In the immediate aftermath of the 2022 global mpox outbreak, many in the public learned important public health knowledge to help prevent and treat the disease. With new outbreaks recently declared in Kenya and the Central Africa Republic, now is the time for public health officials to remind the public of the risks, symptoms, and means of treatment.”
STIs
Sexually transmitted infections (STIs) are “on the rise” in the US. Thus, it is “not surprising” that 47% of respondents reported either having personally been diagnosed or knowing someone who had been diagnosed with an STI. However, just over half of respondents (54%) know that a case of syphilis can be permanently cured and most either believe (mistakenly) that there is a vaccine to prevent it (16%) or are unsure (45%). The public is “not sure” whether some STIs can be permanently cured or whether a vaccine exists to prevent them.
When asked about vaccines to prevent these infections, 67% of the public are aware that these a vaccine for HPV. 44% know that there is a vaccine for mpox. For infections without a vaccine, most of the public is either unsure or incorrect about whether that is the case:
- 61% of people do not know there is no vaccine for syphilis
- 52% of people do not know there is no vaccine for HIV
- 57% of people do not know there is no vaccine for gonorrhoea
- 55% of people do not know there is no vaccine for genital herpes
- 59% of people do not know there is no vaccine for chlamydia
To read the full report click here. Get your tickets to join us at the Congress in Barcelona for discussions about vaccine confidence, public health communication, and vaccine uptake, and don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Aug 29, 2024 | Global Health |
A study in The Lancet Public Health by researchers at Karolinska Institutet finds “disparities’ in cervical cancer prevention among girls with mental health conditions in Sweden. The authors call for research to ensure equitable protection after their population-based cohort study found that uptake of the first human papillomavirus (HPV) vaccine dose was “lower among girls with versus without any mental health condition”. HPV vaccination is critical to WHO’s global goal of eliminating cervical cancer as a public health problem, with an aim 90% of girls vaccinated against HPV by the age of 15.
Uptake concerns
Cervical cancer is the “fourth most common” cancer among women worldwide, and women with mental illness or neurodevelopmental conditions have a “higher risk of invasive cervical cancer and lower cervical screening participation rate”. They also face “worse cervical cancer-specific survival”. Opportunistic HPV vaccination for girls began in Sweden in 2006; a nationwide school-based programme was initiated in 2012, bringing free vaccination to all girls in school grades 5-6 (ages 10-13 years). Coverage reached 91% in 2023.
Mental illness or neurodevelopmental conditions have been linked to reduced uptake of “various” vaccines. Although there are “multifactorial” and varied reasons for this, potential barriers include:
- Lower engagement in preventive behaviours
- Psychological factors resulting in challenges with assess the benefits versus harms of vaccination
- Absence of specialist knowledge among vaccination providers
The study
The authors aimed to explore a potential link between mental illness and neurodevelopmental conditions in girls and their parents and uptake of HPV vaccination in the Swedish school-based HPV vaccination programme. They conducted a population-based cohort study, identifying all girls born between 1st January 2002 and 1st March 2004.
Psychiatric disorders (mental illness) and neurodevelopmental conditions were included in the definition of mental health conditions, which were defined using specialist diagnoses from inpatient and outpatient hospital visits reported in the Swedish National Patient Register (NPR). Mental health conditions were also categorised by severity and treatment status:
- No specialist diagnosis of mental health condition or prescribed use of psychotropic medication
- Medication use but no diagnosis
- Diagnosis but no medication use
- Diagnosis and medication use
Parental mental health conditions were also defined according to this framework. HPV vaccination was defined through the Swedish HPV Vaccination Register (SVEVAC), the National Vaccination Register (NVR), and the Prescribed Drug Register (PDR).
131,869 girls were identified with the Swedish Total Population Register. Those who emigrated from Sweden (4,610), died before the 15th birthday (498), immigrated to Sweden after the 10th birthday (11,626), or received an HPV vaccine before the 10th birthday (31) were excluded. Therefore, the study population was 115,104 girls. Information was available for 110,055 mothers and 107,862 fathers. 2,211 girls had a specialist diagnosis of any mental health condition and 21,185 were exposed to any parental mental health condition diagnosis.
Uptake of the first dose of the HPV vaccine was 80.7%. First dose vaccine uptake was lower among girls with a specialist diagnosis of any mental condition, compared to girls without. Similar findings were identified across mental health conditions, except for stress-related disorders.
“The diagnoses of autism or intellectual disability were most strongly associated with lower first dose HPV vaccine uptake.”
First dose uptake was also lower among girls with prescribed use of any psychotropic medication; this was most strongly observed for antipsychotics. First dose vaccine uptake was “similar” for girls with and without exposure to parental mental health condition diagnosis, but “small differences” were observed according to whether the diagnoses were present in only the mother, only the father, or in both parents.
Although the association of any mental health condition or prescribed psychotropic medication use with first dose uptake was “similar” across sociodemographic variables and parental mental health condition variables, the association varied across paediatric comorbidity index (PCI) scores.
“Post-hoc analyses showed that girls with a psychiatric and neurodevelopmental condition had lower vaccine uptake than those with none of these conditions, and those with intellectual disability and autism had the lowest uptake.”
92,912 girls who received the first vaccine dose were eligible for analysis of second dose uptake. Of these, 1,576 had a specialist diagnosis of any mental health condition. Uptake of the second HPV vaccine dose was 95.0%; 1,468 girls had a specialist diagnosis of any mental health condition and 86,840 did not. Second dose uptake was similar between girls with exposure to parental mental health condition diagnosis and those without.
Conclusions and comments
The study develops previous research to reveal that the “presence of neurodevelopmental conditions and psychiatric disorders or multiple neurodevelopmental conditions” is associated with “particularly low vaccine uptake”. However, it doesn’t show a strong association between mental health conditions and the uptake of a second HPV vaccine dose. The authors infer that the “main barriers” to HPV vaccination faced by those with mental health conditions are experienced at “vaccine initiation” and could “diminish” after receipt of the first dose.
“Research into the potential barriers for vaccination among individuals with mental health conditions, especially young people, is scarce. However, lower access to, or engagement with, preventive health care, including vaccination opportunities, due to more frequent absence from school among girls with mental health conditions is likely to play a part.”
The researchers conclude that future research should strive to facilitate “equitable protection”. Dr Kejia Hu from the Institute of Environmental Medicine emphasises the need for “targeted interventions” to achieve “equitable healthcare for all children”.
“All girls should have equal access to life-saving vaccines regardless of their mental health status.”
Dr Karin Sundström of the Centre for Cervical Cancer Elimination at the Department of Clinical Science, Intervention, and Technology, looks forward to future studies to address the inequalities.
“More research is needed to find out the underlying reasons why fewer girls with mental illness or neuropsychiatric conditions are vaccinated against HPV so that we can tackle this challenge.”
We will consider barriers to uptake of various vaccine programmes at the Congress in Barcelona this October so do get your tickets to join these discussions and don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Aug 14, 2024 | Global Health |
An article in npj vaccines in August 2024 describes vaccine uptake for COVID-19 and influenza vaccines in pregnancy as “suboptimal”. The authors explored COVID-19 and influenza vaccine uptake and disparities through data from the Oxford Royal College of General Practitioners Research and Surveillance Centre Database in England and the Secure Anonymised Information Linkage Databank in Wales. They found that “socioeconomically deprived and ethnic minority groups” showed lower vaccination rates, highlighting the “necessity for interventions” to reduce vaccine hesitancy and encourage acceptance in pregnancy.
The study
Although infections with COVID-19 and influenza during pregnancy can “increase the risk of adverse pregnancy outcomes” and effective vaccines against these outcomes are included in routine immunisation schedules for pregnant women in the UK, the authors describe their uptake during pregnancy as “suboptimal”. This could be attributed to “concerns about side effects and vaccine safety”, which are related to “demographics and baseline health conditions”.
“Understanding vaccine uptake disparities in pregnant women would inform clinicians and policymakers in developing strategies to promote vaccination and reduce adverse pregnancy outcomes in the UK.”
During the pandemic, uptake of COVID-19 and influenza vaccines in pregnant women “could differ from normal times because of changes in vaccines hesitancy” and the introduction and deployment of new COVID-19 vaccines. Furthermore, vaccine hesitancy “may be more prevalent” for COVID-19 vaccines as evidence on maternal and neonatal safety was “limited” at the time.
The study was an opportunity to explore COVID-19 and influenza vaccine uptake and disparities in pregnant women in England and Wales during the pandemic between September 2020 and March 2022. 133,300 pregnant women were eligible for COVID-19 vaccination during pregnancy in England and Wales, and 178,690 pregnant women were eligible for 2020/2021 or 2021/2022 seasonal influenza vaccination in England and Wales. 133,140 pregnant women were eligible for both vaccinations during pregnancy.
Of the influenza cohort, 74,740 (41.8%) pregnant women received at least one dose of influenza vaccine. Of the 133,300 pregnant women in the COVID-19 cohort, 53,550 (40.2%) received at least one dose of COVID-19 vaccine. Among the 133,140 pregnant women eligible for both vaccinations, 57,970 (43.6%) did not receive either vaccine; 27,350 (20.5%) received both vaccines. 26,190 (19.7%) received only the COVID-19 vaccine, and 21,630 (16.2%) received only influenza vaccine.
Low uptake and disparities
The analysis presented “low” vaccine uptake during the pandemic and uptake disparities across “various baseline characteristics”, particularly among “different ethnic groups and socioeconomic statuses”.
“Women of lower socioeconomic status had a significantly lower chance of receiving COVID-19 or influenza vaccination. Women in black, mixed, and other ethnic groups had a lower chance of being vaccinated in comparison to women in white or Asian ethnic groups.”
The results of the study align with existing data and highlight disparities in vaccine uptake. Determinants of vaccine acceptance in the study included “being socioeconomically affluent, of white or Asian ethnicity, living in rural areas, and residing in two-person households”. These are aligned with research from other countries. The “suboptimal” uptake during the pandemic can include the following mechanisms:
- Access to transport
- Confidence in vaccination
- Vaccination knowledge
- Trust in healthcare or vaccination providers
Other possible contributing factors to low vaccine uptake could be a language barrier, or over-registration in the UK primary care system.
Implications
The authors state that the importance of a “direct recommendation” from healthcare providers can “significantly increase influenza vaccine uptake in pregnant women”. They also recommend “frequent updates” on evolving vaccine safety evidence. Another implication is that public agencies can “routinely assess the efficacy and inequalities in vaccination delivery” and respond with tailored policies. The research can also inform vaccination strategies for the future, such as the possible rollout of RSV vaccination for pregnant women.
“Disparities in COVID-19 and influenza vaccine uptake among pregnant women underscore the necessity for interventions from the perspectives of healthcare providers, public agencies, and scientists to reduce vaccine hesitancy and improve acceptance in pregnant women.”
For a session on vaccination in pregnancy with Dr Jenny Hendriks of Janssen Vaccine and Prevention BV, join us at the Congress in Barcelona this October. Don’t forget to subscribe to our weekly newsletters here for vaccine updates.
by Charlotte Kilpatrick | Aug 9, 2024 | Infection |
Data from the UK Health Security Agency (UKHSA) released in August 2024 reveal that 10,493 laboratory confirmed cases of pertussis in England were reported between January and June 2024. This compares with 856 laboratory confirmed cases reported in 2023. Since the outbreak began in November 2023, there have been 10 reported infant deaths; 9 of these deaths were reported between January and June 2024. UKHSA continues to urge pregnant women to get vaccinated to “protect their babies from birth onwards”.
Cases “notably high”
The last major outbreak of pertussis was recorded in 2012, followed by a cyclical increase in 2016; it is a cyclical disease that peaks every 3 to 5 years. Pertussis activity was “exceptionally low” in England between April 2020 to Summer 2023. Although numbers in 2023 “remained lower than pre-pandemic years”, an increase has since been observed in all age groups and in “every region” in England.
10,493 cases were confirmed between January and June 2024. Around half of these cases (5,769) were in people aged 15 years or older; 2,226 cases were reported in children aged 10 to 14 years and 1,253 cases in children aged 5 to 9 years. 328 cases were reported in infants younger than 3 months. These infants are at highest risk of severe disease and are too young to be fully vaccinated.
Vaccination in pregnancy
Although vaccination in pregnancy is “key to passively protecting babies” before they are “directly protected” through the infant vaccine programme, maternal vaccine uptake is declining. Uptake fell from 74.7% in December 2017 to 58.9% in March 2024. Pertussis vaccination is recommended in every pregnancy and is often administered around the time of the mid-pregnancy scan. To give maximum protection, the vaccine should be given before 32 weeks.
Dr Mary Ramsay, UKHSA’s Director of Immunisation, emphasises that vaccination is the “best defence against whooping cough”.
“It is vital that pregnant women and young infants receive their vaccines at the right time.”
As cases continue to rise and infant deaths are recorded, Dr Ramsay states that “ensuring women are vaccinated in pregnancy has never been more important”.
“Our thoughts and condolences are with those families who have so tragically lost their baby.”
The team at UKHSA return to the Congress in Barcelona to share their insights with the community in October, so do get your tickets to join these discussions and don’t forget to subscribe for weekly vaccine updates.
by Charlotte Kilpatrick | Aug 2, 2024 | Global Health |
A paper in Nature Human Behaviour (not open access) in August 2024 presents a meta-analysis examining different types of vaccination intervention strategies and their applications in different countries. The authors analysed the results from 88 eligible randomised controlled trials involving 1,628,768 participants in 17 countries. They estimated the efficacy of seven intervention strategies to find that incentives and increased access were “most promising” in improving vaccination uptake; the access strategy was particularly effective in countries with “lower incomes and less access to healthcare”.
The study
The systematic review and meta-analysis study develops previous research, which has previously focused on specific vaccines, specific intervention strategies, or specific populations. The team considered 7 types of vaccine intervention strategies:
- Increasing access to vaccination
- Sending vaccination reminders
- Providing incentives
- Supplying information
- Correcting misinformation
- Promoting active and passive motivation
- Teaching behavioural skills
Interventions were associated with around a 50% higher chance of vaccination than ‘control’ situations without an intervention. Two interventions were “most promising”; interventions that increased access to vaccines had a “moderate effect”, especially in countries with low access to vaccines and quality of healthcare. There was also a “small effect” from incentives, and “non-significant effects” from the other interventions.
The interventions to increase access to vaccines included offering transportation assistance or bringing vaccines to recipients at nursing homes, family homes, or workplaces. These methods tripled the odds of vaccination, with greater effects in lower-income countries. Financial incentive interventions included a US study that reached an 85% influenza vaccination rate when physicians were reimbursed $1.60 a dose. This is an increase on the 70% vaccination rate when they were reimbursed $0.80 per dose.
Evidence of successful interventions
Dr Dolores Albarracín, Amy Gutmann Penn Integrates Knowledge University Professor at the University of Pennsylvania and director of the Communication Science division at the Annenberg Public Policy Centre (APPC) states the importance of “figuring out which approaches help increase immunisation, and under what circumstances”. This could enable global public health leaders to “allocate resources more efficiently and ultimately improve health outcomes”.
“Public health officials often say that ensuring vaccine access is the first step to promoting immunisation. Our meta-analysis provides hard evidence in support of this recommendation and indicates that this should be a special priority in under-resourced areas with limited access to health care.”
On the other hand, Dr Albarracín reflects the research suggests that correcting misinformation does not ensure health behaviours like vaccination. This is despite its challenge to democracy and “highly salient” threat.
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by Charlotte Kilpatrick | Jul 16, 2024 | Global Health |
In July 2024, Grattan Institute shared a report on the importance of GPs in providing vaccination services. The authors, Peter Breadon and Anika Stobart, call for better government support for these “trusted experts” in delivering this service, such as increased investment or better data. Although there are other barriers to vaccination, Breadon and Stobart describe the role of GPs in closing the vaccination gap as “clearly crucial”. Their report presents specific recommendations to improve vaccination rates for GP patients, suggesting that the government should “level the playing field”.
Differing vaccination rates
“GPs are the foundation of Australia’s healthcare system. As well as diagnosing and treating many conditions, GPs give advice and treatment to prevent problems or stop them getting worse. This includes ensuring patients are up to date with their recommended vaccinations.”
The report begins by identifying a range in GP patient vaccination rates, with some GPs having “very low” adult vaccination rates and others exceeding expectations. These rates range from a two-fold difference for flu to a 13-fold difference for pneumococcal. The lowest coverage is linked to “disadvantaged areas”, “culturally and linguistically diverse backgrounds”, and “residential aged care”. This is concerning as these groups are “often” at “greater risk of severe illness”.
“Structural barriers to vaccination are often to blame for low vaccination, not individual, or cultural, attitudes towards vaccines.”
To determine variation in adult vaccination rates and which GPs might need “more targeted support”, the authors used data at patient and GP level. For COVID vaccination, the bottom 5% of GPs (around 1,600) had only 16% of their patients aged 65 and older up to date, less than one third of the average. Flu vaccination saw a two-fold difference, with GPs with lowest flu coverage having only 43% of their patients vaccinated compared to 90% for highest flu coverage.
Shingles had a four-fold difference, ranging from 5% to 22% on average; the top 5% had 85% of their patients up to date. However, pneumococcal had the “biggest disparity”. The bottom 5% of GPs had only 6% of their patients vaccinated, compared to the top 5% who had 82% of their patients vaccinated. This was a 13-fold difference.
“While some variation is inevitable, these differences are unacceptably large, especially for COVID and pneumococcal. They suggest the system is failing to give everyone good access to potentially life-saving preventative healthcare.”
Key barriers
The report identifies an “imbalance” in the health system, finding that “Australians who are more vulnerable to disease are less likely to get the high-quality, preventive care they need”. Factors such as proficiency in English, where someone lives, or highest level of education attained, have a “big effect”. For example, people who speak a language other than English at home or “do not speak English proficiently”, are “much less likely” to be up to date with vaccinations. People born in North Africa and the Middle East were between 15 and 25% less likely to be vaccinated than people born in Australia, and being born overseas was “nearly always associated with lower vaccination”.
“These low vaccination rates could be due to a range of factors including discrimination, language barriers, lower health literacy, or higher rates of vaccine hesitancy. But because vaccination is lower for virtually all non-English language groups, and for migrants from almost all international regions, it is clear that the problem is not just about the beliefs or preferences of any specific cultural group.”
Other groups are also less likely to be vaccinated, including “older people with higher rates of economic disadvantage” and people with “lower levels of education”. Although people from “disadvantaged areas” suffer greater rates of chronic disease and are “more than twice as likely to die from potentially preventable causes”, people in “outer regional and remote areas” are less likely to be vaccinated.
“Groups who need healthcare more having a greater risk of missing out is a systemic problem that goes well beyond vaccination”.
People in aged care are also at “significant risk” of severe illness and death from disease, but their vaccination rates are “far too low”. For example, only 38% of aged care residents were up to date with COVID vaccinations in June 2024. Almost 100 aged care facilitates had less than 10% of residents vaccinated against COVID in a year, and a quarter of facilities have “less than half” of their residents vaccinated. These rates are “far below” those of “similar countries” – the authors refer to Ireland and England as examples.
Another trend is that people who visit a GP “frequently, regularly, or who visit more expensive GPs, are more likely to be vaccinated”. People who visit a GP “frequently” are up to 27% more likely to be vaccinated than those who don’t, and seeing a GP who charges more “increases your chances of being vaccinated” by up to 17%. While the report highlights a “range of barriers” to vaccination and recognises that they demand “structural changes to healthcare”, it suggests that “some” differences in GP vaccination rates could be attributed to differences in GP practices.
GP practices
Despite accounting for a “wide range” of barriers to vaccination, the report found that some GPs still have lower rates than might be expected. The authors infer that “other factors” may be contributing. These might include the effects of the primary care funding model, which has caused GPs to compress “increasingly complex care” into appointments that average around 15 minutes. They are “under pressure” to complete appointments quickly and “skip” preventive healthcare. Therefore, they may find it hard to make time for patients who are hesitant about vaccination, call in interpreters, or handover to a nurse (if there is one), to enable patients to get vaccinated.
Funding and regulatory barriers also mean that GPs might have “less support from a broader team”, such as nurses or allied health professionals. Thus, explaining vaccine risks and benefits or countering misinformation “often falls on the GP alone”. They also might have “different levels of focus” on vaccination; an Australian study found that GPs only initiate discussions about vaccinations in around 10% of consultations. There is also the possibility that GPs are “unaware of the latest vaccination information” as the guidance is “unclear and changing”. Finally, they may not “immediately” have information on a patient’s vaccination history on their software programmes.
What should be done?
“Australia’s health system can only get better and fairer if governments measure care and outcomes and strive to improve them at every level, using funding, data, and focused improvement support.”
A key concern for the authors is that GP clinics should be able to “choose a funding model” that “supports team care” and enables GPs to spend time with complex patients by combining appointment fees with a budget that is based on each patient’s level of need. This “blended” funding model is “common in other countries” and has been introduced by the federal government for some patients through “MyMedicare”. It should be expanded to other patients to increase funding for “older, poorer, and sicker patients”.
“This funding based on need not speed would give GPs the opportunity to provide preventive care to the patients who need it most.”
GPs should also be supported with “better information” on how their patient vaccination rates compare to their peers. The federal government could give Primary Health Networks data to share with GPs, even extending to pharmacies. As Primary Health Networks are “responsible for improving primary care”, they should also get new funding to “expand their work supporting GP clinics to boost vaccination”.
The authors emphasise that efforts to improve vaccination rates “cannot be one-size-fits-all” but should respond to different barriers with specific support. Breadon comments that “Australia urgently needs to lift its vaccination game”.
“Our report shows that the system is failing to give every Australian good access to potentially life-saving preventive healthcare.”
For more on the importance of adult vaccination strategies and approaches to encouraging uptake, get your tickets to join us at the Congress in Barcelona this October, and don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Jul 9, 2024 | Global Health |
A study in Jama Network Open in July 2024 explores the possibility of association between nonadjuvanted bivalent respiratory syncytial virus prefusion F (RSVpreF) protein subunit vaccination during pregnancy and preterm birth. The researchers find no increased risk of preterm birth, adding to existing evidence in support of the safety of prenatal RSVpreF vaccination with Pfizer’s Abrysvo. The team at Weill Cornell Medicine hope that their results will bring confidence to pregnant people considering vaccination and healthcare providers.
RSV concerns
The authors state that respiratory syncytial virus (RSV) contributes to between 58,000 and 80,000 hospitalisations each year in the US and between 100 and 300 annual deaths in children younger than 5 years. Recent strategies for RSV infection prevention in infants have been approved by the US FDA:
- Seasonal administration of a nonadjuvanted bivalent recombination RSV prefusion F (RSVpreF) protein subunit vaccine (Pfizer) to pregnant individuals
- Postnatal nirsevimab (monoclonal antibody) for infants aged up to 8 months
However, during the 2023 to 2024 RSV season, limited supply of nirsevimab shifted importance to prenatal vaccination. In September 2023, the US CDC’s Advisory Committee on Immunisation Practices recommended the RSVpreF vaccine to be administered to most pregnant individuals from September to January in the continental US. This contrasts GSK’s RSV adjuvanted vaccine, which is not approved for use in pregnancy after a trial was terminated early due to an elevated risk of premature birth and associated neonatal deaths.
Although the RSVpreF vaccine was approved, the gestational age window was limited to 32 0/7 to 36 6/7 weeks in response to concerns about the numerical difference in preterm birth (PTB) among participants who received the RSVpreF vaccine from 24 to 36 weeks’ gestation. While the FDA recommendation has been largely endorsed by obstetric care professionals, clinical data from the US 2023 to 2024 RSV season are “lacking”. Thus, the authors wanted to examine the uptake of RSVpreF vaccination among a medically and demographically diverse pregnant population in that season and compare those who were prenatally vaccinated with those who were not.
Study findings
Between 22nd September 2023 and 31st January 2024, 2,973 eligible pregnant individuals were included. Among them, 1,026 had electronic health record (EHR) evidence of RSVpreF vaccination before delivery and 1,947 did not. The mean gestational age at time of vaccination was 34.5 weeks. Overall preterm birth (PTB) occurred in 191 of 2,973 patients (6.5%) in the cohort, and evidence of RSVpreF vaccination during pregnancy was “not significantly associated with an increased risk for PTB”. In the time-dependent model an increased risk of overall hypertensive disorders of pregnancy (HDP) was observed in the vaccinated group, as well as more cases of gestational hypertension and preeclampsia. However, these were “not statistically significant”.
Providing confidence
Dr Moeun Son, associate professor of obstetrics and gynaecology at Weill Cornell Medicine, hopes that the “real-world evidence provides an additional layer of confidence” about the safety of the vaccine during pregnancy”.
“Randomised clinical trials don’t always emulate the populations we see in the clinical setting, but now we have data from multiple populations showing no increase in preterm birth risk. Patients and clinicians can feel confident that vaccination during pregnancy is a safe way to protect infants from harmful RSV infections.”
Further research is required to understand whether the three analyses conducted reveal genuine concerns or differences between the two groups; for example, vaccinated women were more likely to have insurance or to have undergone in vitro fertilisation.
“These are things we will continue to explore in future studies.”
Additionally, Dr Son’s team will be speaking to “different communities” to understand the causes of vaccine hesitancy and “barriers to access”.
“We want to ensure that all who would benefit will receive the vaccine.”
For more on RSV vaccination in pregnancy do get your tickets to join us at the Congress in Barcelona this October, and don’t forget to subscribe to our weekly newsletters here.
by Charlotte Kilpatrick | Jun 17, 2024 | Technology |
In June 2024 Vaxart announced that it has received a project award valued at up to $453 million to conduct a Phase IIb comparative study to evaluate Vaxart’s oral pill COVID-19 vaccine candidate against an FDA-approved mRNA vaccine comparator. The funding will be provided in two parts, with approximately $65.7 million available immediately; this will be followed by $387.2 million when Vaxart and BARDA have established that the study can proceed.
The vaccine and the trial
Vaxart’s oral pill vaccine “holds the promise of longer protection from infection, broader protection against virus variants, and a greater reduction in virus transmission than the first-generation injectable vaccines”. The vaccine triggers “strong” IgA and T-cell responses. It is designed to be room temperature-stable to facilitate global distribution with “wide public acceptance, minimal cost, and maximum speed”.
The Phase IIb trial is a double-blind, multi-centre, randomised, comparator-controlled study to determine the relative efficacy, safety, and immunogenicity of the oral pill candidate against an approved mRNA injectable vaccine in adults who have previously been immunised against COVID-19 infection. The study will enrol around 10,000 healthy adults.
A next-generation approach
Dr James F. Cummings, Vaxart’s Chief Medical Officer, is “grateful to BARDA for this funding”, which will enable Vaxart’s pursuit of a Phase IIb trial for the COVID-19 oral pill vaccine candidate.
“This trial will evaluate whether our oral pill vaccine candidate compares favourably against an approved mRNA injectable vaccine. We are excited to explore the results of this head-to-head comparison. Previous research showed that our earlier COVID-19 vaccine constructs triggered long-lasting immune responses and induced a cross-reactive immunogenic response against all tested SARS-CoV-2 variants.”
Vaxart’s Chief Executive Officer, Steven Lo, commented that “vaccine delivery has relied primarily on injection for more than 150 years”.
“This funding from BARDA will assist us in determining whether we can bring a transformational, next-generation approach to global vaccination. We believe our oral pill vaccine platform can better meet societal needs not just for COVID-19, which now in the endemic phase, but for other infectious diseases that present significant endemic and pandemic threats.”
We look forward to hearing more about this oral vaccination strategy from Vaxart at the Congress in Barcelona this October; get your tickets to join us here and don’t forget to subscribe for more updates.
by Charlotte Kilpatrick | Jun 5, 2024 | Global Health |
A study from the Annenberg Public Policy Centre (APPC) in June 2024 reveals that a quarter of US adults are unaware that “claims that the MMR vaccine causes autism are false”. Despite CDC assurance that there is no evidence linking the vaccine to autism, 24% of US adults reject this, with another 3% not sure. The association was falsely asserted in a 1998 paper that has since been retracted. The survey, conducted between 18th and 24th April 2024, questioned over 1,500 US adults about their knowledge of how a person can contract measles, its symptoms, and whether medical professionals recommend the measles vaccine for pregnant people.
Survey findings
APPC suggests that “a majority” of survey respondents know how measles can and cannot be spread; nearly 6 in 10 correctly said that measles can be spread through coughing and sneezing and by touching a contaminated surface before touching one’s nose, mouth, or eyes. Although measles cannot be spread through unprotected sexual contact with an infected person, over a fifth of people surveyed (22%) thought this was a way of catching the virus.
“Very few” survey respondents knew how long a person who is infected with measles can spread the virus before developing the “signature” rash. Just over 1 in 10 (12%) correctly estimated that a person can spread the infection for four days before developing a rash, while 12% estimated that the period is one week. 55% were not sure.
The survey also asked respondents to select whether a series of possible complications were associated with having measles while pregnant. Fewer than 4 in 10 people correctly identified two complications associated with contracting measles while pregnant: delivering a low-birth-weight baby (38%) and early delivery (37%). Smaller numbers of people incorrectly indicated that diabetes (7%), blurred vision (11%), and death (12%) are more likely to occur if you have measles while pregnant. APPC emphasises that “they are not”.
Most people (57%) were unsure whether pregnant people should get vaccinated against measles if they have not already been vaccinated against it. Only 12% knew that medical professionals do not recommend the vaccine for pregnant individuals, because the vaccine uses a live attenuated form of the virus.
Dr Kathleen Hall Jamieson, director of the Annenberg Public Policy Centre, commented that the “persistent false belief that the MMR vaccine causes autism” is still “problematic”, particularly “in light of the recent increase in measles cases”.
“Our studies on vaccination consistently show that the belief that the MMR vaccine causes autism is associated not simply with reluctance to take the measles vaccine but with vaccine hesitancy in general.”
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by Charlotte Kilpatrick | Jun 4, 2024 | Global Health |
A study in Science in May 2024 explores the link between social media misinformation and vaccination intentions in the US. The researchers consider misinformation flagged and unflagged by fact-checkers on Facebook in relation to US COVID-19 vaccine hesitancy. The authors define the “impact” of misinformation as a combination of “exposure and persuasive influence” as they seek to quantify the impact of misinformation on Facebook. They find that, while exposure to fact-checked misinformation can cause vaccine hesitancy, the degree to which a story “implies health risks from vaccines” best predicts negative persuasive influence. Furthermore, content that suggested that the vaccine was harmful to health reduced vaccination intentions.
The infodemic
The authors recognise the spread of misinformation online as a “key concern” for policymakers and the public, as well as a “major focus of study” for researchers.
“This attention is largely motivated by the assumption that misinformation causes substantial real-world harm.”
However, this attention has been “largely relegated to assertions”. This has created a “gap” that is relevant to COVID-19 vaccine misinformation, and although the term “infodemic” is “frequently cited as an obstacle to the adoption of public health measures”, there has been little done to show a causal connection.
A framework for Facebook
The paper presents a framework for estimating causal impact at scale and applies the approach to quantify the “harm” caused by COVID-19 vaccine misinformation on Facebook. First, the authors consider what would be necessary for online misinformation to “have the sweeping societal impact so broadly ascribed to it”. They suggest that for any information to have a “widespread impact on people’s behaviour” it must be seen, and by a “large” number of people.
“Thus, impact arises from the interaction between exposure and persuasive influence.”
The approach that is proposed combines:
- Results from experiments measuring the effect of different vaccine-related headlines on vaccination intentions
- Data about the exposure to vaccine-related URLs on Facebook
All popular vaccine-related URL content on Facebook was included, not just content that was flagged by fact-checkers, but they contrast misinformation with “vaccine-sceptical” content.
Content informing behaviour
The research considered “which types of vaccine content changed willingness to take a COVID-19 vaccine, conditional on exposure”, through two large-scale online survey experiments. The approach measured behavioural intentions and assessed differences in persuasive effects across messages.
In the first study, 8,603 American participants on Lucid, an online survey platform, were shown a neutral control post or single piece of vaccine misinformation from a bank of 40 pieces of content that had been debunked by fact-checkers. Participants were asked to answer a set of questions about the willingness to take a COVID-19 vaccine before and after exposure.
“Consistent with conventional wisdom, we found that exposure to a single piece of vaccine misinformation decreased vaccination intentions by 1.5 percentage points on average.”
While the effect did not vary significantly on the basis of participants pretreatment vaccination intentions, gender, age, political party, or vaccine status, it varied “substantially” across different pieces of misinformation.
“An item did not lower vaccination intentions simply by virtue of being false, which suggests that other dimensions of the content were relevant beyond veracity.”
The second study involved a collection of 90 “highly shared” vaccine-related articles from Facebook. 10,122 American participants were involved in this attempt to measure the causal effect of each piece of content on vaccination intentions through the same procedure as the previous study. A new set of raters was presented to quantify content dimensions, labelling headlines on whether they were:
- Surprising
- Plausible
- Favourable to Democrats or Republicans
- Familiar
- Whether the item suggested that the vaccine was harmful versus helpful to a person’s health
The researchers ran a random-effects meta-regression predicting the treatment effect of each headline on vaccination intentions and found that the “only content dimension that consistently predicted a headline’s effect on vaccination intentions” was the extent to which a headline suggested the vaccine was harmful to a person’s health.
Interestingly, there was “no significant effect” on vaccination intentions from the source of the headline, contrasting a “low-quality domain” with a “mainstream domain”. Falsity was associated with a “more negative effect on vaccination intentions”, but when predicting treatment effect size using veracity and the extent to which a headline suggested the vaccine was harmful found the latter “remained significant”, whereas did not.
“These results indicate that suggesting the vaccine was harmful to health reduced vaccination intentions, irrespective of any potential effect of whether the headline was factually inaccurate.”
Information on Facebook
The paper then considers levels of exposure to vaccine-related content on Facebook, using the large-scale Social Science One dataset that was released by Facebook. The authors identified 13,206 URLs about the COVID-19 vaccine that were shared publicly >100 times on Facebook and published during the initial rollout period for the vaccine in the US: the first 3 months of 2021.
They found that URLs flagged by professional fact-checkers as false, out-of-context, or a mixture (flagged misinformation) received 8.7 million views. These accounted for “only 0.3% of the 2.7 billion vaccine-related URL views during this time. Content from “low credibility” domains received only 5.1% of views.
“Thus, exposure to flagged URL misinformation about vaccines on Facebook was relatively infrequent, owing to some combination of low baseline user viewership and explicit downranking by Facebook.”
However, the authors note that “even content not flagged by fact-checkers may have negative effects on vaccination intentions”. This is described as “vaccine-sceptical” content. Stories that did not contain “intentional falsehoods” but had implications that the vaccine might be harmful to health, did not face the same “scrutiny” as “outright falsehoods or content from low-credibility sources”.
“We find that exposure to vaccine-sceptical content far outstripped exposure to flagged misinformation.”
Lowered vaccine intentions
The authors estimate that the combination of flagged misinformation and unflagged vaccine-sceptical content lowered US vaccination intentions by “2.3 percentage points per Facebook user”. However, this effect was “almost entirely” by vaccine-sceptical content from mainstream sites that was not flagged by fact-checkers, rather than “outright false content published by fringe outlets”. This means that veracity-oriented interventions are “unlikely” to have reduced the spread of the content that had the “most overall negative impact”: unflagged vaccine-sceptical stories, often from mainstream outlets.
“Had exposure to this content been prevented, we estimate that vaccination intentions could have been 2.3 percentage points higher on average among Facebook’s 233 million US users – translating into ~3 million more vaccinated Americans.”
It is important to note that the data included only URL link content, which excluded information about native video, photo, or text-only content. Therefore, the finding is a “lower bound” of the total.
Policy implications
The results have “important policy implications” and highlight the need to consider “reach and impact” as well as veracity. In particular, the “grey area” content that is “misleading without being factually inaccurate” has potential to “inflict substantial societal harm”. Therefore, the authors call for a move beyond a “narrow focus on veracity” to “understanding, tracking, and potentially intervening on harmful content that is misleading without being literally false”.
Check out the full article here and don’t forget to get your tickets to join important discussions about vaccine misinformation at the Congress in Barcelona. For the latest vaccine insights and updates, why not subscribe to our weekly newsletters here?
by Charlotte Kilpatrick | May 28, 2024 | Global Health |
A paper in Nature Communications in May 2024 presents the results of a self-controlled case-series study of over 5 million children in England that compared risks of hospitalisation from vaccine safety outcomes after COVID-19 vaccination and infection. The authors find that SARS-CoV-2 infection was associated with “increased risks” of hospitalisation from seven outcomes. However, these risks were “largely absent” in those who had been vaccinated prior to infection.
Vaccines for children
The authors state that the UK approved COVID-19 vaccination for all children aged 12 and over in September 2021, a decision that was extended to 5-11-year-olds in April 2022 in a one-off programme. Although uptake was “very high” in adults, uptake was lower in children. Most vaccinated children received the Pfizer/BioNTech vaccine. In November 2022 the Joint Committee on Vaccination and Immunisation (JCVI) recommended that 16-49-year-olds who were not in a clinical risk group should no longer be offered a third vaccine dose from February 2023, and that primary course vaccination in 5-49-year-olds should be targeted to groups at high risk of severe COVID-19.
Recognising that the benefits of COVID-19 vaccines in older adults “clearly outweigh the risks of rare complications”, the authors identify an “uncertain” balance of risks and benefits in young people. Although clinical trials have demonstrated the effectiveness of COVID-19 vaccines in reducing the risk of severe COVID-19 in children between the ages of 5 and 15, the absolute risk of severe outcomes after infection is “low”. However, a “serious consequence of SARS-CoV-2 infection in children is multisystem inflammatory syndrome (MIS-C). Another “serious outcome” of infection is post-COVID syndrome, or long COVID.
An identified barrier to COVID-19 vaccine acceptance is concern around vaccine safety, and the study authors acknowledge that an increased risk of myocarditis has been “consistently reported” after the delivery of mRNA vaccines; this has been observed “predominantly” in males aged 18 to 36 and “most notably” after the second dose”. The need to “quantify the overall risks and benefits of COVID-19 vaccination” in the younger age group is “important”, so the authors sought to investigate and compare the risks of pre-specific vaccine safety outcomes following vaccination with BNT162b2, mRNA-1273, and ChAdOX1 in children.
The study
The researchers used the English National Immunisation Management Service (NIMS) database of COVID-19 level to national data for mortality, hospital admissions, and SARS-CoV-2 infection. The self-controlled case series design was used to investigate the association between the three vaccines and hospitalisation with the following pre-specified outcomes:
- Myocarditis
- MIS-C
- Immune thrombocytopenia (ITP)
- Epilepsy
- Acute pancreatitis
- Acute disseminated encephalomyelitis (ADEM)
- Guillain-Barré syndrome
- Appendicitis
- Demyelinating disease
- Myositis
- Angioedema
- Anaphylaxis
The researchers also investigated the association of SARS-CoV-2 infection with these outcomes in children who were vaccinated before infection compared to those who were unvaccinated at time of infection. The total children included in the study was 5,197,925; this comprised 1,842,159 children 5-11 years and 3,355,766 adolescents aged 12-17. A further 4,347,781 young adults, aged 18-24 years, were included as a comparison.
What does the study find?
The authors identify “several key findings” that have relevance to public health policy makers. The first is that there was “no strong evidence for increased risks of any of the 12 safety outcomes investigated” after COVID-19 vaccination in children aged 5-11 years. The second is that, in adolescents between the ages of 12 and 17, there was an increased risk of hospital admission for myocarditis after a first or second dose of BNT162b2 and an increased risk of hospitalisation with epilepsy and demyelinating disease (in females only) following a second dose of BNT162b2.
“Children and adolescents aged 5-17 years who had not received a COVID-19 vaccine dose prior to SARS-CoV-2 infection had an increased risk of hospitalisation from seven of the pre-specified safety outcomes including MIS-C and myocarditis.”
Furthermore, the risks of safety outcomes from SARS-CoV-2 infection were “largely absent” in 5-17-year-olds who had received at least one COVID-19 vaccine dose prior to infection. In children aged 5-11 who had not been vaccinated against COVID-19 prior to infection, the authors observed increased risks of hospital admission from MIS-C, myocarditis, acute pancreatitis, myositis, and ADEM. These risks were “absent” in both children and adolescents who had received at least one dose of a COVID-19 vaccine prior to infection; the exception to this was hospitalisation with epilepsy.
“This study has shown that vaccination is associated with a significantly reduced risk of most SARS-CoV-2 complications in young people, particularly MIS-C, which can be fatal.”
The researchers conclude that there was “no strong evidence for increased risks” of the 12 pre-specified vaccine safety outcomes following vaccination against COVID-19 in children aged 5-11 years. By contrast, in unvaccinated children, they found “increased risks of hospitalisation from seven adverse outcomes” that were either not observed or reduced after vaccination.
“Overall, our findings support a favourable safety profile of COVID-19 vaccination using mRNA vaccines in children and young people aged 5-17 years.”
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by Charlotte Kilpatrick | May 16, 2024 | Global Health |
A study in BMJ in May 2024 reveals that HPV vaccination reduced rates of cervical cancer and pre-cancerous conditions in women in England. The observational study, led by researchers from Queen Mary University of London (QMUL), analysed data from NHS England for women between the ages of 20 and 64 between January 2006 and June 2020. Alongside finding that the vaccine reduced cervical disease, the study suggests that the vaccine was most effective when taken by people in Year 8 (aged 12 or 13), rather than later.
HPV and the vaccine
The authors state that human papillomavirus (HPV) comprises a family of viruses, within which is a subset responsible for “virtually all cervical and some anogenital and oropharyngeal cancers”. While “more than 100” countries have introduced prophylactic HPV vaccination within routine immunisation schedules, the authors were interested in whether vaccination has “reduced or increased the inequalities seen for cervical disease” in the UK and other regions.
The national HPV vaccination programme in England began in 2008 with the bivalent Cervarix vaccine for prevention of infections from HPV types 16 and 18. These two types are estimated to cause around 80% of all cervical cancers in the UK. Originally offered to 12-13-year-old girls and those under 19 years old, the programme switched to the quadrivalent Gardasil in 2012. In 2019 the programme was extended to include 12-13-year-old boys.
The authors comment that the way the programme has been introduced and implemented enables a “rigorous evaluation” of its effectiveness because “noticeable discontinuities exist”; women born in August 1990 may not have been vaccinated, but those born from 1st September of the same year are likely to have received at least one dose.
Positive effects
There is a “wealth of real-world evidence” of the early effect of the national HPV vaccination programme on HPV prevalence and a growing body of evidence on effectiveness in reducing high grade cervical intraepithelial neoplasia (CIN) and cervical cancer in vaccinated women. However, a key concern for the researchers was the reduction of health inequalities; they investigated whether the effect of immunisation against HPV has resulted in a reduction or “widening” in inequalities in cervical disease. If the uptake of HPV vaccination were to be lower in those at greatest risk of cervical cancer health inequalities could be exacerbated.
Indeed, previous studies suggest that the initial effect of the HPV immunisation programme was increased inequity HPV related cancer incidence among ethnic minority groups in England because of the “differential effect of herd protection with dissimilar vaccination coverage”. Further research indicates that “white people have a higher awareness of HPV and acceptance of the immunisation”. However, data on HPV vaccination coverage by local area did not show variation by deprivation score.
“A full understanding of the effect of HPV vaccination across different socioeconomic groups is complicated by the poor uptake of cervical screening observed among younger women in the most deprived areas, leading to lower rates of screen detected cervical cancer and CIN3 at age 25 years compared with women in less deprived areas.”
The current study evaluated if the high effectiveness of the programme continued during a further year of follow-up and investigated the effect of the programme by socioeconomic deprivation.
What does the study find?
“In England, the social-class gradient for cervical cancer is one of the steepest of any cancers: women in the most deprived fifth have had double the risk of those in the least deprived fifth.”
This is attributed to differences in exposure to HPV and risk of infection becoming persistent, but also “differential uptake of cervical screening”. The need for “new engagement strategies” has been highlighted. However, a positive note is that coverage of HPV vaccination was, at least until before the COVID-19 pandemic, “uniformly high”.
The authors found that previously identified high vaccination effectiveness was “confirmed” in the more recent data. Between 1st January 2006 and 30th June 2020, 29,968 women between 20 and 64 received a diagnosis of cervical cancer and 335,228 received a diagnosis of CIN 3. In the cohort of women offered routine vaccination, adjusted age standardised incidence rates of cervical cancer were 83.9% lower than the reference cohort. For CIN3 the cohort that were offered the routine vaccination had 94.3% lower incidence rates.
By mid-2020, HPV vaccination had prevented an estimated 687 cervical cancers and 23,192 CIN3s. Although the HPV vaccination programme had a “large effect” in all five levels of deprivation, the highest rates did remain among women living in the most deprived areas.
Three key factors
The authors suggest that observed incidences of cervical cancer and CIN3 depend on “three key factors”:
- Intensity of exposure to HPV infections (including age at first exposure)
- Uptake of cervical screening
- HPV vaccination coverage
They recognise that it is “difficult to disentangle” the effects of these three on the index of multiple deprivation specific rates with available data.
The power of vaccination
Professor Peter Sasieni, lead author from QMUL, commented that the research “highlights the power of HPV vaccination” for “people across all social groups”. Professor Sasieni recognised that cervical cancer has had “greater health inequalities than almost any other cancer”, noting concern that the vaccination programme “may not reach those at greatest risk”.
“Instead, this study captures the huge success of the school-based vaccination programme in helping to close these gaps and reach people from even the most deprived communities.”
Professor Sasieni emphasised that elimination of cervical cancer in the UK is “possible with continued action to improve access to vaccination and screening for all”. Cancer Research UK senior health information manager, Sophia Lowes, urged continued “momentum” to bring about a “future virtually free from this disease”.
“We’re calling for targeted action to ensure that as many young people as possible get the lifesaving HPV vaccine. Better reporting on uptake by deprivation and ethnicity, along with more research, will help us understand how to reach those most at risk.”
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