THE CRITICAL PUBLIC HEALTH
VALUE OF VACCINES
Tackling Issues of Access and Hesitancy
PROCEEDINGS OF A WORKSHOP
Julie Liao, Charles Minicucci, and Anna Nicholson, Rapporteurs
Forum on Microbial Threats
Board on Global Health
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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This activity was supported by contracts between the National Academy of Sciences and the Burroughs Wellcome Fund (10005347), Johnson & Johnson (10004834), National Institutes of Health (10004179), New Venture Fund (10005366), Uniformed Services University of the Health Sciences (10003626, 10004736, 10005329), U.S. Agency for International Development (10004113), U.S. Department of Health and Human Services (10004491, 10004738, 10005070), U.S. Department of Homeland Security (10004697), and U.S. Department of Veterans Affairs (10004767, 10005209). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-46156-6
International Standard Book Number-10: 0-309-46156-1
Digital Object Identifier: https://doi.org/10.17226/26134
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2021. Thecriticalpublichealthvalueofvaccines:Tacklingissuesofaccessandhesitancy:Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/26134.
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PLANNING COMMITTEE ON THE CRITICAL PUBLIC HEALTH VALUE OF VACCINES: TACKLING ISSUES OF ACCESS AND HESITANCY1
HEIDI LARSON (Co-Chair), Professor of Anthropology, Risk and Decision Science, London School of Tropical Hygiene & Medicine; Director, Vaccine Confidence Project
MATTHEW ZAHN (Co-Chair), Medical Director, Division of Epidemiology and Assessment, Orange County Health Care Agency
KEVIN ANDERSON, Senior Program Manager, Science and Technology Directorate, U.S. Department of Homeland Security
ALISON BUTTENHEIM, Associate Professor of Family and Community Health, University of Pennsylvania School of Nursing; Associate Professor of Health Policy, University of Pennsylvania Perelman School of Medicine
ANDREW CLEMENTS, Deputy Director, Pandemic Influenza and Other Emerging Threats Unit, U.S. Agency for International Development
AMANDA COHN, Executive Secretariat, Advisory Committee on Immunization Practices and Acting Chief Medical Officer, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention
PETER DASZAK, President, EcoHealth Alliance
EVA HARRIS, Professor, Division of Infectious Diseases and Vaccinology; Director, Center for Global Public Health, University of California, Berkeley
ELIZABETH D. HERMSEN, Head, Global Antimicrobial Stewardship, Merck & Co., Inc.
NONI MacDONALD, Professor, Department of Pediatrics, Dalhousie University
WALTER ORENSTEIN, Professor, Emory University; Associate Director, Emory Vaccine Center; Director, Emory Vaccine Policy and Development
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1 The planning committee’s role was limited to planning the workshop, and the Proceedings 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.
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FORUM ON MICROBIAL THREATS1,2
PETER DASZAK (Chair), President, EcoHealth Alliance
KENT E. KESTER (Vice Chair), Vice President and Head, Translational Science and Biomarkers, Sanofi Pasteur
RIMA F. KHABBAZ (Vice Chair), Director, National Center for Emerging Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention
KEVIN ANDERSON, Senior Program Manager, Science and Technology Directorate, U.S. Department of Homeland Security
RICK BRIGHT, Director, Biomedical Advanced Research and Development Authority
TIMOTHY BURGESS, Director, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences
CRISTINA CASSETTI, Deputy Division Director, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health
ANDREW CLEMENTS, Deputy Director, Pandemic Influenza and Other Emerging Threats Unit, U.S. Agency for International Development
MARCOS A. ESPINAL, Director, Communicable Diseases and Health Analysis, Pan American Health Organization
EVA HARRIS, Professor, Division of Infectious Diseases and Vaccinology; Director, Center for Global Public Health, University of California, Berkeley
ELIZABETH D. HERMSEN, Head, Global Antimicrobial Stewardship, Merck & Co., Inc.
CHANDY C. JOHN, Director, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine
MICHAEL MAIR, Acting Director, Office of Counterterrorism and Emerging Threats, U.S. Food and Drug Administration
JONNA A. K. MAZET, Distinguished Professor of Epidemiology and Disease Ecology; Founding Executive Director, One Health Institute, University of California, Davis
SALLY A. MILLER, Distinguished Professor of Food, Agricultural and Environmental Sciences, Department of Plant Pathology, The Ohio State University
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
2 This roster was updated to identify membership as of the time of the workshop.
SUERIE MOON, Director of Research, Global Health Centre; Visiting Lecturer, Graduate Institute of International and Development Studies, Geneva; Adjunct Lecturer, Harvard T.H. Chan School of Public Health
DAVID NABARRO, Advisor, Health and Sustainability, 4SD - Skills, Systems & Synergies for Sustainable Development
RAFAEL OBREGON, Chief of Communication for Development, United Nations Children’s Fund
KUMANAN RASANATHAN, Board Member, Health Systems Global
GARY A. ROSELLE, Chief of Medical Service, U.S. Department of Veterans Affairs; Director, National Infectious Diseases Service, Veterans Health Administration
PETER A. SANDS, Executive Director, The Global Fund to Fight AIDS, Tuberculosis and Malaria
THOMAS W. SCOTT, Distinguished Professor, Department of Entomology and Nematology, University of California, Davis
ALAN TENNENBERG, Chief Medical Officer, Johnson & Johnson Global Public Health
MATTHEW ZAHN, Medical Director, Division of Epidemiology and Assessment, Orange County Health Care Agency
National Academies of Sciences, Engineering, and Medicine Staff
GILLIAN BUCKLEY, Senior Program Officer (until June 2020)
EDITH AMPONSAH, Associate Program Officer (until July 2020)
HANNAH GOODTREE, Senior Program Assistant (until August 2020)
JULIE LIAO, Associate Program Officer (from August 2020)
CHARLES MINICUCCI, Research Assistant (from July 2020)
CLAIRE BIFFL, Senior Program Assistant (from March 2021)
JULIE PAVLIN, Director, Forum on Microbial Threats; Senior Director, Board on Global Health
Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by GERALD T. KEUSCH, Boston University. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
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Acknowledgments
The workshop summarized in this proceedings is the product of many valuable contributions. Special thanks go to the presenters and discussants who gave generously of their time and expertise to make the event possible. A full list of the speakers and moderators and their biographical information may be found in Appendix C.
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Contents
Organization of the Proceedings of the Workshop
2 GLOBAL VACCINE UPTAKE DURING THE COVID-19 PANDEMIC AND THE STATE OF VACCINE CONFIDENCE
Impact of the COVID-19 Pandemic on Immunization Services and Access
Global Vaccine Confidence and Strategies to Enhance Uptake
3 IMPROVING ACCESS AND CLOSING THE GLOBAL IMMUNIZATION GAP
Applying an Equity Lens to Immunization to Close the Global Immunization Gap
Reducing Barriers and Increasing Vaccine Uptake Among Adults
Using Mobile Health Interventions to Improve Vaccination Coverage
The Role of Community-Based Pharmacy Interventions in Increasing Vaccine Access
4 ASSESSING GLOBAL AND LOCAL DRIVERS OF VACCINE HESITANCY
Measuring Behavioral and Social Drivers of Vaccination
Understanding Drivers of Vaccine Hesitancy
The Increasing Vaccination Model
Legal Approaches to Promote Parental Compliance with Childhood Vaccines in the United States
Impact of Eliminating Nonmedical Exemptions in California
Harnessing Cultural Insights to Increase Vaccination Uptake
The Role of Physicians in Building Vaccine Confidence and Acceptance
Communicating with Vaccine-Hesitant Parents
Social Mobilization as a Strategy to Increase Vaccine Acceptance and Uptake
Immunity Community: A Community Engagement Strategy to Boost Vaccine Confidence
7 REFLECTIONS AND WAYS FORWARD
New Vaccines in the Midst of an Outbreak
Inoculating Against Misinformation and Rebuilding the Public’s Trust in Science
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Boxes, Figures, and Tables
BOXES
2-1 Immunization Service Interruptions Caused by the COVID-19 Pandemic
2-2 Lessons from Current Evidence on Strategies to Increase Vaccine Acceptance
5-1 Exemption Provisions Under California’s Bill SB276
5-2 Example of Motivational Interviewing for Vaccine Conversations
FIGURES
2-1 Relative differences in diphtheria, tetanus, and pertussis vaccine dose 3 (2019 versus 2020)
3-1 Zero-dose, underimmunized, and immunized children in Gavi-supported countries (2000–2019)
Acronyms and Abbreviations
ACIP | Advisory Committee on Immunization Practices |
AFRO | WHO Regional Office for Africa |
AMRO | WHO Regional Office for the Americas |
APhA | American Pharmacists Association |
BeSD | behavioral and social drivers |
CDC | U.S. Centers for Disease Control and Prevention |
CEPI | Coalition for Epidemic Preparedness Innovations |
COVID-19 | coronavirus disease 2019 |
DTP | diphtheria, tetanus, and pertussis vaccine (pediatric) |
EPI | Expanded Programme on Immunization (WHO) |
FDA | U.S. Food and Drug Administration |
GACVS | Global Advisory Committee on Vaccine Safety |
HPV | human papillomavirus |
IEP | individualized education program |
IFRC | International Federation of Red Cross and Red Crescent Societies |
IPC | infection prevention and control |
LMIC | low- or middle-income country |
LSHTM | London School of Hygiene & Tropical Medicine |
MCV | measles-containing vaccine |
MERS | Middle East respiratory syndrome |
MMR | measles, mumps, and rubella |
MOH | Ministry of Health |
NGO | nongovernmental organization |
NIH | National Institutes of Health |
NITAG | National Immunization Technical Advisory Group (WHO) |
OR | odds ratio |
PHE | Public Health England |
PIRI | periodic intensification of routine immunization (WHO) |
PPE | personal protective equipment |
RCT | randomized controlled trial |
SAGE | Strategic Advisory Group of Experts on Immunization (WHO) |
SARS | severe acute respiratory syndrome |
SARS-CoV-2 | severe acute respiratory syndrome coronavirus 2 |
SMS | short message service |
TIP | Tailoring Immunization Programmes |
UCI | universal child immunization |
UNICEF | United Nations Children’s Fund |
VAERS | Vaccine Adverse Event Reporting System |
VSD | Vaccine Safety Datalink |
WHO | World Health Organization |