Legitimising a ‘Zombie idea’: childhood vaccines and autism

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Rizzi ◽  
K Attwell ◽  
V Casigliani ◽  
J Taylor ◽  
F Quattrone ◽  
...  
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Media Coverage ◽  
Economic Benefits ◽  
Lessons Learned ◽  
Strategic Decision ◽  
Childhood Vaccination ◽  
Vaccine Hesitancy ◽  
Scientific Authority ◽  
Immunization Rates

Abstract Background In June 2017 the Italian government made childhood vaccination mandatory following a drop in immunization rates. In the years preceding, two court judgments affirmed a causal link between vaccines and autism. Studies have linked these decisions to internet searches about vaccine-autism, the popularity of 'no-vax' theories, and drops in immunization rates. This paper provides an in-depth case study of both decisions and their impact. Methods We use a synthetic research design reliant on: (i) a systematic collection of primary sources (publicly available and obtained via official access to information requests); (ii) interviews with key actors prominently involved in the two cases or privy to the Italian vaccine-injury compensation regime (iii) a systematic analysis of media coverage. Results Circumstantial and systemic flaws enabled these decisions. Poor trial strategies, insufficient resources and laborious communication practices between arms of government were facilitators. Lack of awareness of the social sensitivity of vaccine issues, underestimation of the phenomenon of vaccine hesitancy, and a tendency to 'think in silos' informed the lack of attention dedicated to the cases. The decisions created false expectations of economic benefits and vindication for families with autistic children, resulting in increased litigation. Systemic flaws exist in the process of appointment of expert consultants acting for the court leading to judicial reliance on false data. Conclusions Lessons learned include greater levels of attention to vaccine cases by the administration and a matured attitude of adjudicating bodies. Two issues remain: (i) the inability of government lawyers to disseminate positive results to counteract unfounded narratives; (ii) flaws in the process of appointing expert consultants advising courts, which remains focused on the fiduciary nature of the relationship, rather than scientific authority. Key messages The Milan and Rimini decisions that directly affected vaccine governance stemmed from a combination of circumstantial decision-making and systemic flaws that still lurk in public health governance. Strategic decision-making that overlooks lower levels of the adjudicative system can lead to significant public health consequences as courts of law and courts of public opinion obey different logics.

Evidence-Based Decision-Making (Part 1): Origins and Evolution in the Health Sciences

2009 ◽  
Vol 24 (4) ◽  
pp. 298-305 ◽  
Author(s):  
David A. Bradt
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Evidence Based Medicine ◽  
Strategic Decision ◽  
Systematic Research ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Strength Of Evidence ◽  
Based Medicine ◽  
Evidence Based Decision Making

AbstractEvidence is defined as data on which a judgment or conclusion may be based. In the early 1990s, medical clinicians pioneered evidence-based decision-making. The discipline emerged as the use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine required the integration of individual clinical expertise with the best available, external clinical evidence from systematic research and the patient's unique values and circumstances. In this context, evidence acquired a hierarchy of strength based upon the method of data acquisition.Subsequently, evidence-based decision-making expanded throughout the allied health field. In public health, and particularly for populations in crisis, three major data-gathering tools now dominate: (1) rapid health assessments; (2) population based surveys; and (3) disease surveillance. Unfortunately, the strength of evidence obtained by these tools is not easily measured by the grading scales of evidence-based medicine. This is complicated by the many purposes for which evidence can be applied in public health—strategic decision-making, program implementation, monitoring, and evaluation. Different applications have different requirements for strength of evidence as well as different time frames for decision-making. Given the challenges of integrating data from multiple sources that are collected by different methods, public health experts have defined best available evidence as the use of all available sources used to provide relevant inputs for decision-making.

Grounding evaluation design in the socio-ecological model of health: a logic framework for the assessment of a national routine immunization communication initiative in Kyrgyzstan

2020 ◽  
Vol 27 (4) ◽  
pp. 59-68
Author(s):  
Renata Schiavo ◽  
Upal Basu Roy ◽  
Latisha Faroul ◽  
Galina Solodunova
Keyword(s):  
Public Health ◽  
International Development ◽  
Media Coverage ◽  
Ecological Model ◽  
Public Health Intervention ◽  
Immunization Coverage ◽  
Evaluation Framework ◽  
Routine Immunization ◽  
Attitudes And Practices ◽  
Immunization Rates

Childhood routine immunization (RI) is a highly effective public health intervention for the prevention of infectious diseases. Despite high immunization rates, a 2018 Knowledge, Attitudes, and Practices (KAP) study by the United Nations Children’s Fund (UNICEF) noted a growing practice of vaccine refusal among parents and primary caregivers as well as clusters of significantly lower immunization coverage in some provinces. Moreover, a 2018 Joint Appraisal report by GAVI (Global Vaccine Alliance) has highlighted a decrease in immunization rates among children under 1 year of age from 96.1% to 92% for some vaccines. As a result, UNICEF is spearheading a national communication initiative to increase the rates of RI in Kyrgyzstan. This initiative includes strengthening interpersonal communication skills of local healthcare workers, improving the quality and accuracy of media coverage via a tailored outreach to the Kyrgyz media, as well as fostering community engagement to give voice to local champions and engage hesitant parents and vaccine refuters. UNICEF has also partnered with a research team for the design phase of a suitable evaluation framework. Grounded in the socio-ecological model (SEM) of health, the framework recognizes the interconnection of behavioral, social, and policy change, and includes not only activity-specific indicators (process indicators) but also progress, outcome, and impact indicators to document results among key groups and stakeholders at different levels of the SEM, and, ultimately, on immunization rates in Kyrgyzstan. The framework reflects the importance of an integrated and multilevel approach to intervention and communication design, and integrates the SEM with a logic model that connects different components of the initiative. This paper introduces this evaluation framework, including implications for the evaluation of child health programs, and other public health, communication, and international development interventions.

scholarly journals A Perfect Storm: The Social and Institutional Contexts of Samoa’s 2019-2020 Measles Epidemic and the Lessons learned for the COVID-19 Pandemic

2020 ◽  
Vol 10 (10) ◽  
pp. 5-10
Author(s):  
Ramona Boodoosingh ◽  
◽  
Safua Akeli Amaama ◽  
Penelope Schoeffel ◽  
◽  
...  
Keyword(s):  
Public Health ◽  
Vaccination Coverage ◽  
Public Information ◽  
Small Population ◽  
Lessons Learned ◽  
Vaccine Hesitancy ◽  
Public Health Services ◽  
Contributing Factors ◽  
Effective Response ◽  
Institutional Contexts

In late 2019 and early 2020, an epidemic of measles ravaged Samoa, and nearly three people in every hundred (2.83%) in the small population were infected, with 1860 hospitalizations and 83 deaths, mainly children. In the circumstances of the 2020 Covid-19 pandemic, this case study shows that even when a proven vaccine exists for an infectious disease, circumstances may prevent its effective use. As academics and researchers who live and work in Samoa, this article seeks to shed some light into contributing factors to the measles outbreak. These include inadequate data collection, low vaccination coverage, weak institutional capacity, unpreparedness for an epidemic, lack of public information, vaccine hesitancy and anti-vaccine propaganda and public recourse to traditional and ‘alternative’ therapies. Through a combination of personal observation, analysis of media articles, government reports and historical documents, we present an overview of the circumstances of the measles epidemic. We trace the circumstances of low vaccination coverage, institutional weaknesses and an uninformed public resulting in a delayed an effective response. In conclusion we reflect on the lessons that history offers on public health services in Samoa. Keywords: Measles, Epidemic, Samoa, public health, Covid-19, vaccination.

scholarly journals Nursing Voices during COVID-19: An Analysis of Canadian Media Coverage

Aporia ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 109-113
Author(s):  
Marilou Gagnon ◽  
Amélie Perron
Keyword(s):  
Public Health ◽  
Health Care ◽  
Severe Acute Respiratory Syndrome ◽  
Media Coverage ◽  
Lessons Learned ◽  
Public Health Care ◽  
News Stories ◽  
Starting Point ◽  
The Media

While it is generally recognized that nurses and nursing issues are underrepresented in the media, the contrary is also true during major public health care crises like Ebola and SARS (Severe Acute Respiratory Syndrome). We see this phenomenon unfolding in the midst of the current COVID-19 pandemic with nurses and nursing issues receiving extensive media coverage in Canada and internationally. To gain more insights into this media coverage, we analyzed the content of Canadian news stories published in both English and French during the first five months of the COVID-19 pandemic. This paper presents the findings of our analysis and identifies important lessons learned. We believe that our findings serve as an important starting point for understanding nurses’ agency and the media savviness they displayed during the first months of the pandemic.

scholarly journals A Consent Support Resource with Benefits and Harms of Vaccination Does Not Increase Hesitancy in Parents—An Acceptability Study

Vaccines ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 500
Author(s):  
Ciara McDonald ◽  
Julie Leask ◽  
Nina Chad ◽  
Margie Danchin ◽  
Judith Fethney ◽  
...  
Keyword(s):  
Decision Making ◽  
Vaccine Safety ◽  
Decisional Conflict ◽  
Informed Decision ◽  
Childhood Vaccination ◽  
Vaccine Hesitancy ◽  
Informed Decision Making ◽  
Routine Childhood ◽  
Before And After ◽  
Support Resource

It is unclear whether information given about the benefits and risks of routine childhood vaccination during consent may cue parental vaccine hesitancy. Parents were surveyed before and after reading vaccine consent information at a public expo event in Sydney, Australia. We measured vaccine hesitancy with Parent Attitudes about Childhood Vaccine Short Scale (PACV-SS), informed decision-making with Informed Subscale of the Decisional Conflict Scale (DCS-IS), items from Stage of Decision Making, Positive Attitude Assessment, Vaccine Safety and Side Effect Concern, and Vaccine Communication Framework (VCF) tools. Overall, 416 parents showed no change in vaccine hesitancy (mean PACV-SS score pre = 1.97, post = 1.94; diff = −0.02 95% CI −0.10 to 0.15) but were more informed (mean DCS-IS score pre = 29.05, post = 7.41; diff = −21.63 95% CI −24.17 to −18.56), were more positive towards vaccination (pre = 43.8% post = 50.4%; diff = 6.5% 95% CI 3.0% to 10.0%), less concerned about vaccine safety (pre = 28.5%, post = 23.0%, diff = −5.6% 95% CI −2.3% to −8.8%) and side effects (pre = 37.0%, post = 29.0%, diff = −8.0% 95% CI −4.0% to −12.0%) with no change in stage of decision-making or intention to vaccinate. Providing information about the benefits and risks of routine childhood vaccination increases parents’ informed decision-making without increasing vaccine hesitancy.

scholarly journals Novel Predictors of COVID-19 Protective Behaviors Among US Adults: Cross-sectional Survey

10.2196/23488 ◽  
2021 ◽  
Vol 23 (4) ◽  
pp. e23488
Author(s):  
Ken Resnicow ◽  
Elizabeth Bacon ◽  
Penny Yang ◽  
Sarah Hawley ◽  
M Lee Van Horn ◽  
...  
Keyword(s):  
Public Health ◽  
Health Communication ◽  
Online Survey ◽  
Lessons Learned ◽  
Vaccine Hesitancy ◽  
Central Component ◽  
Protective Behaviors ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Conspiracy Beliefs

Background A central component of the public health strategy to control the COVID-19 pandemic involves encouraging mask wearing and social distancing to protect individuals from acquiring and transmitting the virus. Objective This study aims to understand the psychological factors that drive adoption or rejection of these protective behaviors, which can inform public health interventions to control the pandemic. Methods We conducted an online survey of a representative sample of 1074 US adults and assessed three novel potential predictors of COVID-19 behaviors: trait reactance, COVID-19 conspiracy beliefs, and COVID-19 apocalypse beliefs. Key outcomes (dependent variables) included an index of COVID-19 protective behaviors, the number of trips taken from the home, and COVID-19 knowledge. Results In bivariate analyses, all three predictors were significantly correlated in the hypothesized direction with the three COVID-19 outcomes. Specifically, each predictor was negatively (P<.01) correlated with the COVID-19 protective behaviors index and COVID-19 knowledge score, and positively correlated with trips taken from home per week (more of which was considered higher risk). COVID-19 protective behaviors and COVID-19 knowledge were significantly lower in the top median compared to the bottom median for all three predictors. In general, these findings remained significant after adjusting for all novel predictors plus age, gender, income, education, race, political party, and religiosity. Self-identified Republicans (vs other political affiliations) reported the highest values for each of the novel predictors. Conclusions This study can inform the development of health communication interventions to encourage the adoption of COVID-19 protective behaviors. Interestingly, we found that higher scores of all three novel predictors were associated with lower COVID-19 knowledge, suggesting that lack of an accurate understanding of the virus may be driving some of these attitudes; although, it is also possible that these attributes may interfere with one’s willingness or ability to seek and absorb accurate health information. These individuals may be particularly immune to accepting new information and yielding their beliefs. Health communication professionals may apply lessons learned from countering similar beliefs around climate change and vaccine hesitancy. Messages designed for individuals prone to reactance may be more effective if they minimize controlling language and emphasize the individual’s independence in adopting these behavioral recommendations. Messaging for those who possess conspiracy beliefs should similarly not assume that providing evidence contrary to these beliefs will alone alter behavior. Other communication techniques such as rolling with resistance, a strategy used in motivational interviewing, may be helpful. Messaging for those with apocalyptic beliefs may require using religious leaders as the message source and using scripture that would support the adoption of COVID-19 protection behaviors.

scholarly journals Methods to support evidence-informed decision-making in the midst of COVID-19: creation and evolution of a rapid review service from the National Collaborating Centre for Methods and Tools

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah E. Neil-Sztramko ◽  
Emily Belita ◽  
Robyn L. Traynor ◽  
Emily Clark ◽  
Leah Hagerman ◽  
...  
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Lessons Learned ◽  
Decision Makers ◽  
Rapid Review ◽  
Final Report ◽  
Health Crisis ◽  
Public Health Decision ◽  
Public Health Crisis ◽  
Health Decision

Abstract Background The COVID-19 public health crisis has produced an immense and quickly evolving body of evidence. This research speed and volume, along with variability in quality, could overwhelm public health decision-makers striving to make timely decisions based on the best available evidence. In response to this challenge, the National Collaborating Centre for Methods and Tools developed a Rapid Evidence Service, building on internationally accepted rapid review methodologies, to address priority COVID-19 public health questions. Results Each week, the Rapid Evidence Service team receives requests from public health decision-makers, prioritizes questions received, and frames the prioritized topics into searchable questions. We develop and conduct a comprehensive search strategy and critically appraise all relevant evidence using validated tools. We synthesize the findings into a final report that includes key messages, with a rating of the certainty of the evidence using GRADE, as well as an overview of evidence and remaining knowledge gaps. Rapid reviews are typically completed and disseminated within two weeks. From May 2020 to July 21, 2021, we have answered more than 31 distinct questions and completed 32 updates as new evidence emerged. Reviews receive an average of 213 downloads per week, with some reaching over 7700. To date reviews have been accessed and cited around the world, and a more fulsome evaluation of impact on decision-making is planned. Conclusions The development, evolution, and lessons learned from our process, presented here, provides a real-world example of how review-level evidence can be made available – rapidly and rigorously, and in response to decision-makers’ needs – during an unprecedented public health crisis.

scholarly journals Predictors of Vaccine Hesitancy: Implications for COVID-19 Public Health Messaging

2021 ◽  
Vol 18 (15) ◽  
pp. 8054
Author(s):  
Amanda Hudson ◽  
William J. Montelpare
Keyword(s):  
Public Health ◽  
Literature Review ◽  
Individual Difference ◽  
Search Strategy ◽  
Strategic Communication ◽  
Vaccine Hesitancy ◽  
Public Confidence ◽  
Health Campaigns ◽  
Immunization Rates ◽  
Public Health Campaigns

Objectives: Successful immunization programs require strategic communication to increase confidence among individuals who are vaccine-hesitant. This paper reviews research on determinants of vaccine hesitancy with the objective of informing public health responses to COVID-19. Method: A literature review was conducted using a broad search strategy. Articles were included if they were published in English and relevant to the topic of demographic and individual factors associated with vaccine hesitancy. Results and Discussion: Demographic determinants of vaccine hesitancy that emerged in the literature review were age, income, educational attainment, health literacy, rurality, and parental status. Individual difference factors included mistrust in authority, disgust sensitivity, and risk aversion. Conclusion: Meeting target immunization rates will require robust public health campaigns that speak to individuals who are vaccine-hesitant in their attitudes and behaviours. Based on the assortment of demographic and individual difference factors that contribute to vaccine hesitancy, public health communications must pursue a range of strategies to increase public confidence in available COVID-19 vaccines.

How to assess health policy impacts of new generation trade agreements

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Koivusalo
Keyword(s):  
Public Health ◽  
Decision Making ◽  
New Technologies ◽  
Data Access ◽  
Trade Agreements ◽  
Lessons Learned ◽  
Policy Space ◽  
Case Examples ◽  
Regulation Services ◽  
New Generation

Abstract Issue Negotiation of trade agreements has become a key part of current international policy environment with the consequence of increasing concerns over impacts on public health, health protection and policy space for health. Trade agreements represent 'meta-regulation' where key impacts will be on how governments can regulate with different implications depending on existing regulatory framework within a country. Engaging with trade requires understanding how health-related arguments can be made and where they reside. Results This presentation discusses where and how public health advocates can engage with trade related decision-making on new generation trade agreements with focus on regulation, services and protection of investment and intellectual property rights. The innovative approach on policy space for health will overcome focus on existing standards and allows discussion on what exceptions and exclusions in trade agreements actually imply. Policy space allows analysis on impacts which may not relate to direct health outcomes, such as issues with privacy, health data, access to new technologies, and pricing of medicines. The presentation will use case examples from European Union trade agreements and will discuss politics of mandate negotiations as well as how diversions, rhetorical/empty claims and circular traps are used in in political decision-making and the extent to which and how these can be counteracted on key public health and health systems -related issues. Lessons learned If negotiated agreements will affect how governments can regulate in future rather than existing standards, this requires a different approach for public health researchers and advocates. The lessons learned will provide suggestions on how to approach trade policies as part of Health in All Policies and where limits and opportunities of health and sustainability impact assessments reside. Key messages New generation trade agreements impact on regulatory policy space. Assessing impacts of trade agreements need to go beyond impact assessments.

scholarly journals Identification of a New Industrial Area Based on a Macro-Level Analysis – a Case of Bokaro District, Jharkhand, India

2019 ◽  
Vol 9 (2) ◽  
pp. 1626-1632
Keyword(s):  
Decision Making ◽  
Environmental Sustainability ◽  
Multicriteria Decision Making ◽  
Industrial Area ◽  
Economic Benefits ◽  
Strategic Decision ◽  
Industrial Site ◽  
Site Location ◽  
Political Issues ◽  
Location Determinants

Locating a new industrial area involves a strategic decision that covers several criteria with consideration for socio-economic benefits and environmental sustainability alongwith technical, and political issues. These different criteria are described using a number of indicators in terms of quantity and quality with some possible uncertainty. Decision making thus requires appropriate tools for data collection, analysis and knowledge management to address this multidisciplinary situation. This paper tries to find out the comprehensive method for industrial site location, a sustainable approach for finding the most suitable solution. Identifying the location determinants and site suitability models used for allocating an industrial site is observed to be an essential aspect of siting of industry, as such; level of decision making is dependent on predefined constraints. Multicriteria decision making method (M.C.D.M) seems to be a consistent and efficient solution which forms the basis for locating multiple sites for industrial activity in any delineated area.

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