Skip to main content

Currently Skimming:

5 A Systems Approach to Increasing Vaccine Confidence and Uptake: Opportunities in Research, Communication, Legislation, and Technology
Pages 85-114

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.


From page 85...
... Dan Carucci, global medical director at McCann Health, presented on the Immunity Charm project, which harnessed cultural insights to promote vaccination. Todd Wolynn, chief executive officer at Kids Plus Pediatrics, presented on the role of physicians in building vaccine confidence and countering anti-vaccine attacks.
From page 86...
... The federal government does not -- and likely could not -- mandate vaccination, but it currently plays several roles in increasing vaccination rates. Although the Commerce Clause is one of the tools used by the federal government to regulate public health, it probably would not allow for a federal childhood vaccine mandate.
From page 87...
... States have primarily regulated childhood vaccination through school immunization requirements and adult vaccination through workplace immunization requirements, but Reiss emphasized that states have many other tools available. Children's Rights and Childhood Vaccines In more than 100 years of contentious jurisprudence on the issue, Reiss pointed out that no state or federal court has ever struck down an immunization mandate.
From page 88...
... Every other state allows some degree of nonmedical exemptions on the basis of personal beliefs or religious beliefs, although the ease of obtaining such an exemption varies between states. Reiss noted that many of the other tools available to states are less coercive than school immunization mandates, which limit access to schooling based on children's immunization status.
From page 89...
... IMPACT OF ELIMINATING NONMEDICAL EXEMPTIONS IN CALIFORNIA Presented by Michelle M Mello, Stanford University Law School Mello explored the effect of California's elimination of nonmedical exemptions within its school immunization mandate.
From page 90...
... Senate Bill (SB) 277, passed in 2015 and effective as of January 1, 2016, eliminated California's personal belief exemption, making medical exemptions the only permissible basis for forgoing required vaccines.
From page 91...
... . First, states without nonmedical exemptions have lower rates of vaccination exemptions and vaccine-preventable diseases than states with such exemp
From page 92...
... Fourth, if vaccination exemption laws leave open avenues for avoiding vaccination, parents opposed to vaccination will always find ways to do so. Lessons Learned from California's Experience Mello described lessons learned from California's experience in eliminating nonmedical exemptions.
From page 93...
... . California's legislation is broad in scope, eliminating all nonmedical exemptions and creating evenhanded rules that apply to private schools and day care centers, not just public schools.
From page 94...
... . HARNESSING CULTURAL INSIGHTS TO INCREASE VACCINATION UPTAKE Presented by Daniel Carucci, McCann Health Carucci discussed the Immunity Charm project as an example of how cultural insights can be harnessed to increase vaccination uptake.
From page 95...
... In areas where access is not a primary driver of underimmunization, increasing demand is critical for improving vaccination uptake and compliance. Carucci discussed underimmunization as a demand-driven problem that can be addressed by considering how young mothers perceive the value of childhood vaccinations.
From page 96...
... Response to the Immunity Charm Project McCann conducted a small qualitative project in Kabul to assess the acceptability of the bracelet among health care staff and mothers attending a vaccine clinic, said Carucci. His team found that the bracelet was readily acceptable to mothers and health care workers at the immunization clinic.
From page 97...
... THE ROLE OF PHYSICIANS IN BUILDING VACCINE CONFIDENCE AND ACCEPTANCE Presented by Todd Wolynn, Kids Plus Pediatrics Wolynn discussed the role of physicians in building vaccine confidence and acceptance. He noted that perceptions of infectious diseases, physicians, and the field of medicine have all evolved over time.
From page 98...
... Because they are generally ill-equipped to address the challenges of these anti-vaccination forces, many health care providers have begun to lose confidence in their own ability to influence and help the populations they serve, he suggested. Forces of Vaccine Hesitancy Wolynn discussed the forces that act on vaccine hesitancy, explaining that approximately 75 percent of the U.S.
From page 99...
... , developed by John ParrishSprowl and Angus Thomson,7 that can be used by health care providers who encounter vaccine hesitancy. This method, which focuses on using powerful active listening and communication skills to build a trusting relationship, involves four components: announce, inquire, mirror, and secure.
From page 100...
... The original toolkit is being revamped and will be available in English, French, Portuguese, and Spanish. Shots Heard Round the World has partnered with Stronger, a national campaign aimed at stopping the spread of harmful misinformation about science, medicine, and vaccines by sharing correct information and arming people to fight back against misinformation.9 Strategies for Vaccine Advocacy Wolynn emphasized that the battle between vaccine hesitancy and vaccine confidence spans both face-to-face and virtual communication, that there are ways to address both, and that effective communication can be 8  More information about Shots Heard Round the World is available at https://www.
From page 101...
... COMMUNICATING WITH VACCINE-HESITANT PARENTS Presented by Sean O'Leary, University of Colorado School of Medicine O'Leary described various strategies that health care providers can use to communicate with vaccine-hesitant parents using face-to-face communication, presumptive conversations, and motivational interviewing. Although his presentation focused on effective communication in patient–provider encounters, he emphasized that patient–provider communication is only one strategy among many that need to be implemented simultaneously to achieve and maintain high vaccination coverage.
From page 102...
... Even though vaccine rejectors are often vocal, they make up an exceedingly small proportion of the population, he noted. O'Leary suggested using strategies for vaccine communication with parents who accept vaccines and those who are hesitant about vaccines but not with a parent who is determined to reject vaccines.
From page 103...
... what facts address vaccine misconceptions. However, only studying the what is not sufficient to address vaccine hesitancy.
From page 104...
... O'Leary endorsed the technique for its adaptability and because it can be used to improve conversations about most topics. Evidence that this interview technique helps increase vaccine uptake comes from a study that tested the effect of motivational interviewing 12  The status quo bias is also called the default bias.
From page 105...
... Furthermore, there was a 9.5 percent increase in HPV vaccine initiation in the intervention arm versus the control arm. Motivational Interviewing Skills for Use in Vaccine Conversations O'Leary described five motivational interviewing skills that can be used for vaccine conversations, but noted that the broader practice of motivational interviewing can involve a longer process than the one used for vaccine conversations.
From page 106...
... The motivational interviewing technique lets providers and patients feel that their concerns have been heard, and it leaves providers feeling confident that they can communicate the facts without drawing patients into an argument. BOX 5-2 Example of Motivational Interviewing for Vaccine Conversations The following scenario between a provider and a parent illustrates five skills for using motivational interviewing in vaccine discussions: open-ended questions, affirmation, reflection, autonomy support, and asking permission to share.
From page 107...
... Polio has an R0 of 5–7, so between 80 and 85 percent vaccination coverage is sufficient for achieving herd immunity against polio. The R0 of influenza is less than 2, so approximately 40 percent vaccination coverage against influenza is sufficient for herd immunity.13 Legal Options to Protect Children from Vaccine-Preventable Disease John asked whether community members may seek a legal mandate to vaccinate a child with a vaccine exemption if that child is a known source of a vaccine-preventable disease.
From page 108...
... Shared Clinical Decision Making and Vaccination Discussions in Clinical Settings John asked how physicians should approach shared clinical decision making in the context of vaccine discussions. O'Leary acknowledged that this issue has arisen in discussions around motivational interviewing techniques.
From page 109...
... Thus, any attempt to improvise or engage in shared decision making about vaccine schedules is, by definition, departing from the clear recommendations about vaccination schedules, said O'Leary. Wolynn added that children whose parents delay vaccinations may be at an increased risk of not receiving all recommended vaccines (Smith et al., 2010)
From page 110...
... Designing Public Health Messages to Promote Vaccination John asked about the approach of public service announcements that use shock value to promote public health awareness -- such as advertisements about the risks of smoking and the importance of HPV vaccines -- and whether this approach may be employed to promote forthcoming COVID19 vaccines. Wolynn commented that these campaigns are designed to evoke an emotional response, which is known to be an effective approach.
From page 111...
... Reiss said that long-standing vaccine advocates, such as Voices for Vaccines14 and Vaccinate Your Family,15 are preparing messaging to promote forthcoming COVID-19 vaccines. Wolynn said that leveraging trust and relationships is key to addressing vaccine hesitancy, and physicians and vaccine advocates must be armed with good information and use their trusting relationships appropriately.
From page 112...
... Online Communication About Vaccination John asked for specific advice about how vaccine advocates should communicate online about vaccines, noting that merely providing facts is not always effective. Wolynn said that Shots Heard Round the World has approximately 900 volunteer advocates.
From page 113...
... Status of Immunization Exemption Policies Across the United States John asked about the status of immunization exemption policies among states that are considering restricting their exemptions. Mello explained that the measles outbreaks in 2014, 2015, and 2018 have raised concerns about vaccination exemption policies among state legislators.
From page 114...
... 16  More information about Families Fighting Flu is available at https://www.families fightingflu.org (accessed October 15, 2020)


This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More information on Chapter Skim is available.