Top

BMC Public Health

Published in:

Open Access 01-12-2021 | Public Health | Research article

Public health practitioner perspectives on dealing with measles outbreaks if high anti-vaccination sentiment is present

Authors: Penelope Robinson, Kerrie Wiley, Chris Degeling

Published in: BMC Public Health | Issue 1/2021

Abstract

Background

Communities with low vaccination rates are at greater risk during outbreaks of vaccine preventable diseases. Most Australian parents support vaccines, but some refuse and are often judged harshly by their community, especially during an outbreak. We sought the perspectives of Australian public health experts on the key issues faced when managing a measles outbreak in an area with high anti-vaccination sentiment.

Methods

A measles outbreak scenario formed the basis of a 3-round modified Delphi process to identify key practitioner concerns in relation to parents/carers who don’t follow the recommended vaccination schedule. We surveyed a range of professionals in the field: policymakers, infectious disease experts, immunisation program staff, and others involved in delivering childhood vaccinations, to identify key priorities when responding to an outbreak in a community with low vaccination coverage.

Results

Findings indicate that responses to measles outbreaks in communities with high anti-vaccination sentiment are motivated by concerns about the potential for a much larger outbreak event. The highest operational priority is to isolate infected children. The two most highly ranked practical issues are mistrust from non-vaccinating members of the local region and combatting misinformation about vaccines. Trying to change minds of such individuals is not a priority during an outbreak, nor is vaccinating their children. Using media and social media to provide information about the outbreak and measures the public can take to limit the spread of the disease was a focus.

Conclusions

Our findings provide a deeper understanding of the challenges faced during an outbreak and priorities for communicating with communities where there is a high level of anti-vaccination sentiment. In the context of a global pandemic, the results of this study also have implications for managing public health responses to community transmission of SARS-CoV-2, as COVID-19 vaccines becomes widely available.

Available only for authorised users

Williamson KM, Merritt T, Durrheim DN. Australia: an island in a sea of measles. Med J Aust 2020;213(3):101–103. doi:https://doi.org/https://doi.org/10.5694/mja2.50650.

Macintyre CR, Kpozehouen E, Kunasekaran M, Harriman K, Conaty S, Rosewell A et al. Measles control in Australia – threats, opportunities and future needs. Vaccine 2018;36(30):4393–4398. doi:https://doi.org/https://doi.org/10.1016/j.vaccine.2018.06.022.

Wood JG, Heywood AE, Menzies RI, McIntyre PB, Macintyre CR. Predicting localised measles outbreak potential in Australia. Vaccine. 2015;33(9):1176–1181. doi:https://doi.org/https://doi.org/10.1016/j.vaccine.2014.12.071.

Gibney KB, Brahmi A, O’hara M, Morey R, Franklin L. Challenges in managing a school-based measles outbreak in Melbourne, Australia, 2014. Aust N Z J Public Health 2017;41(1):80–84. doi:https://doi.org/https://doi.org/10.1111/1753-6405.12620.

Communicable Diseases Network Authority. CDNA National Guidelines for Public Health Units. 7 May 2019 ed 2019.

NSW Health. Control Guideline for Public Health Units. NSW Health. 2019. https://www.health.nsw.gov.au/Infectious/controlguideline/Pages/measles.aspx. Accessed 27th July 2020.

South Australia Health. Measles - including symptoms, treatment and prevention. Adelaide: South Australia Health; 2020. https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/conditions/infectious+diseases/measles/measles+-+including+symptoms+treatment+and+prevention. Accessed 27th July 2020

Victorian Department of Health & Human Services. Disease information and advice: Measles. Melbourne: Victorian Department of Health and Human Services; 2019. https://www2.health.vic.gov.au/public-health/infectious-diseases/disease-information-advice/measles. Accessed 27/07/2020

Australian Government Department of Health. Immunisation coverage rates for all children: Department of Health. Canberra; 2020. https://www.health.gov.au/health-topics/immunisation/childhood-immunisation-coverage/immunisation-coverage-rates-for-all-children#local-area-coverage-rates. Accessed 12th October 2020

10.

National Centre for Immunisation Research and Surveillance. No Jab No Play, No Jab No Pay: National and state legislation in relation to immunisation requirements for child care: National Centre for Immunisation Research and Surveillance. Sydney; 2020. http://www.ncirs.org.au/public/no-jab-no-play-no-jab-no-pay. Accessed 7th September 2020

11.

Berman JM. Anti-vaxxers : how to challenge a misinformed movement. Cambridge, Massachusetts: The MIT Press; 2020. https://doi.org/10.7551/mitpress/12242.001.0001.CrossRef

12.

Hausman BL. Anti/Vax: Reframing the Vaccination Controversy. In: The culture and politics of health care work. Ithaca: Cornell University Press; 2019.

13.

Blume S. Anti-vaccination movements and their interpretations. Soc Sci Med. 2006;62(3):628–42. https://doi.org/10.1016/j.socscimed.2005.06.020.CrossRefPubMed

14.

Blume SS. Immunization : how vaccines became controversial. London: Reaktion Books Ltd; 2017.

15.

Chatterjee A. Vaccinophobia and vaccine controversies of the 21st century. New York, NY: Springer; 2013. https://doi.org/10.1007/978-1-4614-7438-8.CrossRef

16.

Kata A. Anti-vaccine activists, web 2.0, and the postmodern paradigm – an overview of tactics and tropes used online by the anti-vaccination movement. Vaccine. 2011;30(25):3778–89. https://doi.org/10.1016/j.vaccine.2011.11.112.CrossRefPubMed

17.

Smith N, Graham T. Mapping the anti-vaccination movement on Facebook. Inf Commun Soc. 2019;22(9):1310–27. https://doi.org/10.1080/1369118X.2017.1418406.CrossRef

18.

Hotez PJ, Nuzhath T, Colwell B. Combating vaccine hesitancy and other 21st century social determinants in the global fight against measles. Curr Opin Virol 2020;41:1–7. doi:https://doi.org/https://doi.org/10.1016/j.coviro.2020.01.001.

19.

Díaz Crescitelli ME, Ghirotto L, Sisson H, Sarli L, Artioli G, Bassi MC, Appicciutoli G, Hayter M A meta-synthesis study of the key elements involved in childhood vaccine hesitancy. Public Health 2020;180:38–45. doi:https://doi.org/https://doi.org/10.1016/j.puhe.2019.10.027.

20.

Bianco A, Mascaro V, Zucco R, Pavia M. Parent perspectives on childhood vaccination: how to deal with vaccine hesitancy and refusal? Vaccine 2019;37(7):984–990. doi:https://doi.org/https://doi.org/10.1016/j.vaccine.2018.12.062.

21.

Jarrett C, Wilson R, O’Leary M, Eckersberger E, Larson HJ, Hesitancy SWGV et al. Strategies for addressing vaccine hesitancy – a systematic review. Vaccine. 2015;33(34):4180–4190. doi:https://doi.org/https://doi.org/10.1016/j.vaccine.2015.04.040.

22.

Larson HJ, Jarrett C, Schulz WS, Chaudhuri M, Zhou Y, Dube E, Schuster M, MacDonald N, Wilson R, SAGE Working Group on Vaccine Hesitancy. Measuring vaccine hesitancy: the development of a survey tool. Vaccine 2015;33(34):4165–4175. doi:https://doi.org/https://doi.org/10.1016/j.vaccine.2015.04.037.

23.

Dubé E, Vivion M, MacDonald NE. Vaccine hesitancy, vaccine refusal and the anti-vaccine movement: influence, impact and implications. Expert Rev Vaccines 2015;14(1):99–117. doi:https://doi.org/https://doi.org/10.1586/14760584.2015.964212.

24.

Ward P, Attwell K, Meyer S, Rokkas P, Leask J. Understanding the perceived logic of care by vaccine-hesitant and vaccine-refusing parents: a qualitative study in Australia. PLoS One 2017;12(10):e0185955. doi:https://doi.org/https://doi.org/10.1371/journal.pone.0185955.

25.

Corben P, Leask J. Vaccination hesitancy in the antenatal period: a cross-sectional survey.(Report)(Survey). BMC Public Health. 2018;18(1). doi:https://doi.org/https://doi.org/10.1186/s12889-018-5389-6.

26.

Dyda A, King C, Dey A, Leask J, Dunn AG. A systematic review of studies that measure parental vaccine attitudes and beliefs in childhood vaccination.(Report). BMC Public Health. 2020;20(1). doi:https://doi.org/https://doi.org/10.1186/s12889-020-09327-8.

27.

Leask J, Kinnersley P, Jackson C, Cheater F, Bedford H, Rowles G. Communicating with parents about vaccination: a framework for health professionals. BMC Pediatr 2012;12(1):154. doi:https://doi.org/https://doi.org/10.1186/1471-2431-12-154.

28.

Beard FH, Hull BP, Leask J, Dey A, McIntyre PB. Trends and patterns in vaccination objection, Australia, 2002–2013. Med J Aust. 2016;204(7):275-. doi:https://doi.org/https://doi.org/10.5694/mja15.01226.

29.

Jones J, Hunter D. Consensus methods for medical and Health services research. BMJ Br Med J 1995;311(7001):376–380. doi:https://doi.org/https://doi.org/10.1136/bmj.311.7001.376.

30.

Ziglio E. The Delphi method and its contribution to decision-making. In: Adler M, Ziglio E, editors. Gazing into the oracle : the Delphi method and its application to social policy and public health. London: Jessica Kingsley Publishers; 1996.

31.

Degeling C, Johnson J, Gilbert G, L. Perspectives of Australian policy-makers on the potential benefits and risks of technologically enhanced communicable disease surveillance – a modified Delphi survey. Health Res Policy Syst 2019;17(1):1–11. doi:https://doi.org/https://doi.org/10.1186/s12961-019-0440-3.

32.

Degeling C, Johnson J, Ward M, Wilson A, Gilbert G. A Delphi survey and analysis of expert perspectives on one Health in Australia. EcoHealth 2017;14(4):783–792. doi:https://doi.org/https://doi.org/10.1007/s10393-017-1264-7.

33.

Kaufman J, Ryan R, Lewin S, Bosch-Capblanch X, Glenton C, Cliff J, Oyo-Ita A, Muloliwa AM, Oku A, Ames H, Rada G, Cartier Y, Hill S Identification of preliminary core outcome domains for communication about childhood vaccination: an online Delphi survey. Vaccine 2018;36(44):6520–6528. doi:https://doi.org/https://doi.org/10.1016/j.vaccine.2017.08.027.

34.

Sawford K, Dhand NK, Toribio JA, Taylor MR. The use of a modified Delphi approach to engage stakeholders in zoonotic disease research priority setting. BMC Public Health. 2014;14(1). https://doi.org/10.1186/1471-2458-14-182.

35.

Boylan S, Sainsbury E, Thow A-M, Degeling C, Craven L, Stellmach D et al. A healthy, sustainable and safe food system: examining the perceptions and role of the Australian policy actor using a Delphi survey. Public Health Nutrition. 2019;22(16):2921–2930. doi:https://doi.org/https://doi.org/10.1017/S136898001900185X.

36.

Wilkes L. Using the Delphi technique in nursing research. Nurs Stand. 2015;29(39):43–9. https://doi.org/10.7748/ns.29.39.43.e8804.CrossRefPubMed

37.

Bye C. Anti-vaxxers anger parents amid whooping cough outbreak on NSW north coast. Daily Telegraph. 2017. https://www.dailytelegraph.com.au/news/nsw/antivaxxers-anger-parentsamid-whooping-cough-outbreak-on-nsw-north-coast/news-story/b0f07635b3fca13ada570eba1862af99

38.

Daniel Z, Olson E. Measles outbreak prompts finger-pointing in US, with New York Orthodox Jews rejecting blame: ABC News. Sydney; 2019. https://www.abc.net.au/news/2019-05-23/measles-outbreak-blamed-on-jewish-community-and-anti-vaxxers/11126150. Accessed 09/03/2020 2020

39.

Hansen, J. "Byron Bay measles outbreak result of ‘irresponsible parents'", Daily Telegraph, September 9, 2019: https://www.dailytelegraph.com.au/news/nsw/byron-bay-measles-outbreak-result-of-irresponsible-parents/newsstory/b3d8cb1622647770dec31ee3f971bd9e

40.

Hansen, J. "Our hot spots for deadly measles", Daily Telegraph, April 7, 2019, page 22, Sydney, Australia.

41.

Worthington B. COVID vaccine likely to be mandatory in Australia, Scott Morrison says after signing deal with Oxford University: ABC News; 2020. https://www.abc.net.au/news/2020-08-19/morrison-coronavirus-covid-19-vaccine-mandatory/12572992. Accessed 30/9/2020 2020

42.

Helps C, Leask J, Barclay L, Carter S. Understanding non-vaccinating parents’ views to inform and improve clinical encounters: a qualitative study in an Australian community. BMJ Open. 2019;9(5). doi:https://doi.org/https://doi.org/10.1136/bmjopen-2018-026299.

43.

Wiley KE, Leask J, Attwell K, Helps C, Degeling C, Ward P, Carter SM Parenting and the vaccine refusal process: a new explanation of the relationship between lifestyle and vaccination trajectories. Soc Sci Med 2020;263. doi:https://doi.org/https://doi.org/10.1016/j.socscimed.2020.113259, 113259.

44.

Dean L. Bosses want to fire staff who refuse coronavirus vaccine. 2020. https://au.news.yahoo.com/covid19-vaccine-bosses-call-for-firing-rights-215320807.html?guccounter=1. Accessed 14/09/2020.

45.

Steffens MS, Dunn AG, Wiley KE, Leask J. How organisations promoting vaccination respond to misinformation on social media: a qualitative investigation. BMC Public Health 2019;19(1):1–12. doi:https://doi.org/https://doi.org/10.1186/s12889-019-7659-3.

46.

Leask J. Target the fence-sitters. Nature. 2011;473(7348):443–5. https://doi.org/10.1038/473443a.CrossRefPubMed

47.

Randall S, Leask J, Robinson P, Danchin M, Kinnersley P, Witteman H, Trevena L, Berry N Underpinning of the sharing knowledge about immunisation (SKAI) communication approach: a qualitative study using recorded observations. Patient Educ Couns 2020;103(6):1118–1124. doi:https://doi.org/https://doi.org/10.1016/j.pec.2019.12.014.

48.

Berry NJ, Danchin M, Trevena L, Witteman HO, Kinnersley P, Snelling T, Robinson P, Leask J Sharing knowledge about immunisation (SKAI): an exploration of parents' communication needs to inform development of a clinical communication support intervention. Vaccine 2018. doi:https://doi.org/https://doi.org/10.1016/j.vaccine.2017.10.077, 36, 44, 6480, 6490.

49.

SKAI. Sharing Knowledge About Immunisation website. Australia: NCIRS; 2020. http://www.talkingaboutimmunisation.org.au. Accessed 30th September 2020 2020

50.

National Centre for Immunisation Research and Surveillance. Sharing Knowledge About Immunisation ELearning Module. Australia: NPS MedicineWise Learning; 2020. https://learn.nps.org.au/mod/page/view.php?id=11018. Accessed 28th October 2020

51.

Attwell K, Leask J, Meyer SB, Rokkas P, Ward P. Vaccine rejecting parents’ engagement with expert systems that inform vaccination programs. J Bioethical Inquiry 2017;14(1):65–76. doi:https://doi.org/https://doi.org/10.1007/s11673-016-9756-7.

52.

Attwell K, Meyer SB, Ward PR. The social basis of vaccine questioning and refusal: a qualitative study employing Bourdieu’s concepts of ‘capitals’ and ‘habitus. Int J Environ Res Public Health 2018;15(5):1044. doi:https://doi.org/https://doi.org/10.3390/ijerph15051044.

53.

Nyhan B, Reifler J, Richey S, Freed GL. Effective messages in vaccine promotion: a randomized trial. Pediatrics. 2014;133(4):e835. doi:https://doi.org/https://doi.org/10.1542/peds.2013-2365, e842.

54.

Wiley KE, Steffens M, Berry N, Leask J. An audit of the quality of online immunisation information available to Australian parents.(Report). BMC Public Health. 2017;17(1). doi:https://doi.org/https://doi.org/10.1186/s12889-016-3933-9.

Title: Public health practitioner perspectives on dealing with measles outbreaks if high anti-vaccination sentiment is present
Authors: Penelope Robinson
Kerrie Wiley
Chris Degeling
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Public Health
Vaccination
Published in: BMC Public Health / Issue 1/2021
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-021-10604-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Public health practitioner perspectives on dealing with measles outbreaks if high anti-vaccination sentiment is present

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Association between cigarette smoking status and voting intentions: Cross sectional surveys in England 2015-2020

Do sexual expectancies and inhibitions predict high-risk sexual behaviours? Evidence from a cross-sectional survey among young psychoactive substance users in informal settlements in Kampala, Uganda

Concurrent and discriminant validity of ActiGraph waist and wrist cut-points to measure sedentary behaviour, activity level, and posture in office work

Sociodemographic factors and social media use in 9-year-old children: the Generation R Study

Childhood immunisation timeliness and vaccine confidence by health information source, maternal, socioeconomic, and geographic characteristics in Albania

Racial and socioeconomic disparities in multimorbidity and associated healthcare utilisation and outcomes in Brazil: a cross-sectional analysis of three million individuals