Vaccine Confidence in Europe: Time for Action - Seminar Report

"It's all about communication..."

This report summarises the presentations and discussions of a vaccine confidence seminar that was organised by the European Public Health Association (EUPHA) on November 7 2018 in Brussels, Belgium. EUPHA is an international, multidisciplinary, scientific organisation, bringing together around 14,000 public health experts for professional exchange and collaboration throughout Europe. Choosing to gather around the theme of "vaccine confidence" rather the less optimistic topic of "vaccine hesitancy" (VH), the 40 or so participants at the conference discussed opportunities to increase vaccine coverage rates going forward.

Citing research finding that a majority of the European public have confidence in vaccines - e.g., 83% agree that vaccines are safe, and 90% agree that vaccines are important - the report acknowledges that, in some areas in Europe, vaccine coverage rates are below the recommended levels. Low vaccine coverage rates can result in outbreaks (e.g., of measles), such as Poland and Albania experienced in 2018. As noted here, it is important to realise that some confidence challenges and solutions may apply to a specific vaccine. An example of tackling VH for a specific vaccine is the Development of Robust and Innovative Vaccine Effectiveness (DRIVE) project, which aims to increase the understanding of influenza vaccine effectiveness in Europe.

Drawing on country case studies (Italy, Poland, United Kingdom (UK), and Albania) and the discussions that emerged from a multidisciplinary panel at the conference, the report sets forth some opportunities for building vaccine confidence in the European region, including:

• Investment in education for physicians and nurses to communicate more efficiently and emphatically could be an opportunity to increase vaccine confidence, as (primary) healthcare professionals are key in motivating families to vaccinate their children. In Albania, a recommended control strategy is to have meetings with paediatricians and other healthcare professionals who have proposed delaying vaccination.
• Communication is central:
  • Positive messaging is recommended; for example, the European Centre for Disease Prevention and Control (ECDC) purposely titled its report about enhancing childhood vaccination uptake "Let's Talk about Protection" without including the terms "vaccination" or "immunisation", as they could trigger anti-vaccine responses.
  • As vaccine confidence is related to people's trust, which is related to the cultural context, information and awareness raising material should be provided in local languages.
  • In 2015, Italian doctor Roberto Burioni created Facebook and Twitter accounts and started addressing anti-vaxxers with facts about vaccination. His posts and tweets became trending on social media platforms, leading to more balanced information online.
  • The European Commission and ECDC are planning to set up a "European Vaccine Information Portal" online to provide objective, transparent, and updated evidence on the benefits and safety of vaccines.
  • The Commission also plans to set up a Coalition for Vaccination, which will bring together European associations of healthcare professionals as well as relevant students' associations in the field to commit to delivering accurate information to the public, combating myths, and exchanging best practice.
• National/systems-level action may be necessary. Participants noted, for example, that vaccination is becoming a political issue in Europe, as demonstrated by the country case studies. Specifically, in Italy, a so-called "populist" government aims to turn back compulsory vaccination, and, in Poland, anti-vaccine groups and individuals, including doctors, appear to be strongly involved with members in the Polish parliament. In such contexts, strong leadership is needed to continue efforts against vaccine-preventable diseases.
• Blockchain technology could ensure safety and empower people by providing information on the supply chain of vaccines.
• With both governments and pharmaceutical companies as key stakeholders in vaccination, public-private partnerships are needed.
• Hard-to-reach groups, such as the Roma population, are often distributed across several countries in Europe and, hence, require a regional approach to prevent outbreaks of vaccine-preventable diseases.
• Medical students should be included in vaccine confidence interventions (e.g., those building capacity in "soft skills"); they can act as multipliers of the vaccine confidence movement.

Among the conclusions to emerge from the seminar is that joint actions - at the European, national, and local levels - are needed to boost vaccine confidence in Europe. Coordination of these actions on various levels can ensure complementary activities that increase vaccine confidence. As the multidisciplinary panel demonstrated - including representatives from primary care, vaccine production and distribution, minority groups, future (public) health workforce, decision-makers, and politicians - a multi-stakeholder involvement allowed identification of additional opportunities to increase vaccine confidence.