Critical Findings on COVID-19: Select Publications from the National Academies of Sciences, Engineering, and Medicine (2021)

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THE NATIONAL ACADEMIES PRESS This PDF is available at http://nap.edu/26134 SHARE     The Critical Public Health Value of Vaccines: Tackling Issues of Access and Hesitancy: Proceedings of a Workshop (2021) DETAILS 230 pages | 6 x 9 | PAPERBACK ISBN 978-0-309-46156-6 | DOI 10.17226/26134 CONTRIBUTORS GET THIS BOOK Julie Liao, Charles Minicucci, and Anna Nicholson, Rapporteurs; Forum on Microbial Threats; Board on Global Health; Health and Medicine Division; National Academies of Sciences, Engineering, and Medicine FIND RELATED TITLES SUGGESTED CITATION National Academies of Sciences, Engineering, and Medicine 2021. The Critical Public Health Value of Vaccines: Tackling Issues of Access and Hesitancy: Proceedings of a Workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/26134.  Visit the National Academies Press at NAP.edu and login or register to get: – Access to free PDF downloads of thousands of scientific reports – 10% off the price of print titles – Email or social media notifications of new titles related to your interests – Special offers and discounts  Distribution, posting, or copying of this PDF is strictly prohibited without written permission of the National Academies Press. (Request Permission) Unless otherwise indicated, all materials in this PDF are copyrighted by the National Academy of Sciences. Copyright © National Academy of Sciences. All rights reserved. 

The Critical Public Health Value of Vaccines: Tackling Issues of Access and Hesitancy: Proceedings of a ... 1 Introduction I mmunization against disease is among the most successful global health efforts of the modern era, and substantial gains in vaccination coverage rates have been achieved worldwide. However, that progress has stag- nated in recent years, leaving an estimated 20 million children worldwide either undervaccinated or completely unvaccinated (UNICEF, 2020). The determinants of vaccination uptake are complex, mutable, and context specific. A primary driver is vaccine hesitancy—defined as a “delay in acceptance or refusal of vaccines despite availability of vaccination ser- vices”—which was identified by the World Health Organization (WHO) as one of the top 10 threats to global health in 2019 (WHO, 2019). While there exists a vocal minority of people who are entirely opposed to vaccina- tion, the majority of vaccine-hesitant people fall somewhere on a spectrum from vaccine acceptance to vaccine denial. Vaccine uptake is also hampered by socioeconomic or structural barriers to access. Targeted approaches are needed to mitigate barriers to accessing routine and pandemic-related vac- cination services, build trust between patients and providers to encourage effective communication about vaccines, and dispel the myths and misin- formation that erode public confidence in vaccines (CDC NCIRD, 2019). The Forum on Microbial Threats convenes workshops spanning a range of issues related to infectious diseases, from their economic drivers (NASEM, 2018) to their convergence with noncommunicable diseases (NASEM, 2019a) to the frontiers of innovation to counter microbial threats (NASEM, 2020), including antimicrobial resistance (NASEM, 2017). In 2018, the forum examined the state of national and interna- tional readiness for pandemic threats in a workshop that explored lessons 1 PREPUBLICATION COPY—Uncorrected Proofs Copyright National Academy of Sciences. All rights reserved. 

The Critical Public Health Value of Vaccines: Tackling Issues of Access and Hesitancy: Proceedings of a ... 2 THE CRITICAL PUBLIC HEALTH VALUE OF VACCINES learned a century after the 1918 influenza pandemic, which seems prescient in hindsight (NASEM, 2019b). To tackle the entwined issues of vaccine access and hesitancy, in August 2020 in the midst of the global pandemic of coronavirus disease 2019 (COVID-19), the disease caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the forum convened this second workshop in a series focused on the critical public health value of vaccines and strategies. The issues of vaccine confidence, access, and uptake have never been more critical or pressing, given that ending the pandemic will likely hinge on the deployment of a safe and effective vaccine on an unprecedented scale in the United States and worldwide. However, public concerns about the vaccine—which are exacerbated by misinformation and distrust—continue to be a feature of its distribution. This has brought new urgency to the need for effective approaches to build vaccine confidence, address access barriers, and encourage uptake. The pandemic has disrupted the supply chain for vac- cines and, in many settings, has interrupted or halted routine immunization programs for people of all ages. Examples of these interrupted vaccination services include childhood vaccinations (Santoli et al., 2020), the human papillomavirus vaccination (Gilkey et al., 2020), and those for vaccine- preventable diseases. The COVID-19 pandemic is also likely to affect vaccine uptake during seasonal influenza vaccination season, which already varies widely by state (Wexler et al., 2020). WORKSHOP OBJECTIVES On August 17–20, 2020, a planning committee convened by the Forum on Microbial Threats at the National Academies of Sciences, Engineering, and Medicine held a 4-day virtual workshop titled The Critical Public Health Value of Vaccines: Tackling Issues of Access and Hesitancy.1 This workshop was the second of a series of two workshops on the critical value of vaccines. The workshop gave particular consideration to health systems, research opportunities, communication strategies, and policies that could be consid- ered to address access, perception, attitudes, and behaviors toward vaccina- tion. The workshop featured presentations on two main topic areas: vaccine access and vaccine confidence. Specific topics included the following:2 1  The planning committee’s role was limited to planning the workshop, and the Proceed- ings of a Workshop was prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus. 2  The full Statement of Task is available in Appendix A. PREPUBLICATION COPY—Uncorrected Proofs Copyright National Academy of Sciences. All rights reserved. 

The Critical Public Health Value of Vaccines: Tackling Issues of Access and Hesitancy: Proceedings of a ... INTRODUCTION 3 • The global impact of declining immunization rates on vaccine- preventable diseases from lack of access; • Trends and indicators used to monitor attitudes surrounding vac- cine safety and efficacy, including a focus on regional and cultural differences; • The complex determinants of vaccination that hinder or promote vaccine uptake; • The role of health systems and professionals in improving access, influencing vaccine behavior, protecting at-risk communities from vaccine-preventable disease outbreaks, and preserving and building confidence in immunization strategies and practices; • The role of media, anti-vaccine networks, and online misinforma- tion in reinforcing anxieties about vaccine safety and drivers of vaccine hesitancy; • Communication approaches that could help assuage anxieties about vaccine safety and strengthen public trust in science and health professionals; • The ethics and effectiveness of legislation that aims to address vac- cine hesitancy; and • Potential priority actions—as well as partnerships and collabora- tions among policy makers, health professionals, national and inter- national health organizations, parents, and community groups—to increase immunization access and vaccine confidence. ORGANIZATION OF THE PROCEEDINGS OF THE WORKSHOP In accordance with the policies of the National Academies, this Pro- ceedings of a Workshop will not attempt to establish any conclusions or recommendations about needs and future directions, focusing instead on information presented, questions raised, and improvements suggested by individual workshop participants. Chapter 2 presents the workshop’s two keynote addresses, which addressed the effect of the COVID-19 pandemic on vaccination uptake and access, the state of global vaccine confidence, and strategies to counter vaccine hesitancy. Chapter 3 assesses the current state of vaccine-preventable diseases worldwide and examines approaches to improve access to vaccines and close the global immunization gap. Chapter 4 focuses on the global and local drivers along the continuum of vaccine hesitancy that affect vaccine behavior. Chapters 5 and 6 explore opportuni- ties to employ a systems approach to building confidence and increasing uptake and includes a legal perspective of vaccination policies, with Chapter 5 examining opportunities in research, communication, legislation, and tech- nology and Chapter 6 focusing on community-based approaches. Chapter 7 summarizes the plenary presentation on new vaccines in the midst of an PREPUBLICATION COPY—Uncorrected Proofs Copyright National Academy of Sciences. All rights reserved. 

The Critical Public Health Value of Vaccines: Tackling Issues of Access and Hesitancy: Proceedings of a ... 4 THE CRITICAL PUBLIC HEALTH VALUE OF VACCINES outbreak, a panel on inoculating against misinformation and rebuilding the public’s trust, and visionary statements on priorities in building vaccine acceptance and uptake for the next generation. PREPUBLICATION COPY—Uncorrected Proofs Copyright National Academy of Sciences. All rights reserved.