HPV vaccination in a context of public mistrust and uncertainty: a systematic literature review of determinants of HPV vaccine hesitancy in Europe

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ABSTRACT

Europe is increasingly described as the region in the world with the least confidence in vaccination, and particularly in the safety of vaccines. The aim of this systematic literature review was to gather and summarise all peer-reviewed and grey literature published about determinants of Human Papillomavirus (HPV) vaccine hesitancy in Europe. Ten thematic categories were identified across the 103 articles which were included in the review. Participants from European studies most commonly reported issues with the quantity and quality of information available about HPV vaccination; followed by concerns about potential side effects of the vaccine; and mistrust of health authorities, healthcare workers, and new vaccines. Comparative analyses indicated that confidence determinants differed by country and population groups. This evidence supports the need to develop context-specific interventions to improve confidence in HPV vaccination and design community engagement strategies aiming to build public trust.

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The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey

Heidi Larson, Alexandre de Figueiredo, Zhao Xiahong … (2016)

Background Public trust in immunization is an increasingly important global health issue. Losses in confidence in vaccines and immunization programmes can lead to vaccine reluctance and refusal, risking disease outbreaks and challenging immunization goals in high- and low-income settings. National and international immunization stakeholders have called for better monitoring of vaccine confidence to identify emerging concerns before they evolve into vaccine confidence crises. Methods We perform a large-scale, data-driven study on worldwide attitudes to immunizations. This survey – which we believe represents the largest survey on confidence in immunization to date – examines perceptions of vaccine importance, safety, effectiveness, and religious compatibility among 65,819 individuals across 67 countries. Hierarchical models are employed to probe relationships between individual- and country-level socio-economic factors and vaccine attitudes obtained through the four-question, Likert-scale survey. Findings Overall sentiment towards vaccinations is positive across all 67 countries, however there is wide variability between countries and across world regions. Vaccine-safety related sentiment is particularly negative in the European region, which has seven of the ten least confident countries, with 41% of respondents in France and 36% of respondents in Bosnia & Herzegovina reporting that they disagree that vaccines are safe (compared to a global average of 13%). The oldest age group (65+) and Roman Catholics (amongst all faiths surveyed) are associated with positive views on vaccine sentiment, while the Western Pacific region reported the highest level of religious incompatibility with vaccines. Countries with high levels of schooling and good access to health services are associated with lower rates of positive sentiment, pointing to an emerging inverse relationship between vaccine sentiments and socio-economic status. Conclusions Regular monitoring of vaccine attitudes – coupled with monitoring of local immunization rates – at the national and sub-national levels can identify populations with declining confidence and acceptance. These populations should be prioritized to further investigate the drivers of negative sentiment and to inform appropriate interventions to prevent adverse public health outcomes.

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Strategies intended to address vaccine hesitancy: Review of published reviews.

Eve Dubé, Dominique Gagnon, Noni MacDonald (2015)

When faced with vaccine hesitancy, public health authorities are looking for effective strategies to address this issue. In this paper, the findings of 15 published literature reviews or meta-analysis that have examined the effectiveness of different interventions to reduce vaccine hesitancy and/or to enhance vaccine acceptance are presented and discussed. From the literature, there is no strong evidence to recommend any specific intervention to address vaccine hesitancy/refusal. The reviewed studies included interventions with diverse content and approaches that were implemented in different settings and targeted various populations. Few interventions were directly targeted to vaccine hesitant individuals. Given the paucity of information on effective strategies to address vaccine hesitancy, when interventions are implemented, planning a rigorous evaluation of their impact on vaccine hesitancy/vaccine acceptance will be essential.

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RAMESES publication standards: meta-narrative reviews

Geoff Wong, Trish Greenhalgh, Gill Westhorp … (2013)

Background Meta-narrative review is one of an emerging menu of new approaches to qualitative and mixed-method systematic review. A meta-narrative review seeks to illuminate a heterogeneous topic area by highlighting the contrasting and complementary ways in which researchers have studied the same or a similar topic. No previous publication standards exist for the reporting of meta-narrative reviews. This publication standard was developed as part of the RAMESES (Realist And MEta-narrative Evidence Syntheses: Evolving Standards) project. The project's aim is to produce preliminary publication standards for meta-narrative reviews. Methods We (a) collated and summarized existing literature on the principles of good practice in meta-narrative reviews; (b) considered the extent to which these principles had been followed by published reviews, thereby identifying how rigor may be lost and how existing methods could be improved; (c) used a three-round online Delphi method with an interdisciplinary panel of national and international experts in evidence synthesis, meta-narrative reviews, policy and/or publishing to produce and iteratively refine a draft set of methodological steps and publication standards; (d) provided real-time support to ongoing meta-narrative reviews and the open-access RAMESES online discussion list so as to capture problems and questions as they arose; and (e) synthesized expert input, evidence review and real-time problem analysis into a definitive set of standards. Results We identified nine published meta-narrative reviews, provided real-time support to four ongoing reviews and captured questions raised in the RAMESES discussion list. Through analysis and discussion within the project team, we summarized the published literature, and common questions and challenges into briefing materials for the Delphi panel, comprising 33 members. Within three rounds this panel had reached consensus on 20 key publication standards, with an overall response rate of 90%. Conclusion This project used multiple sources to draw together evidence and expertise in meta-narrative reviews. For each item we have included an explanation for why it is important and guidance on how it might be reported. Meta-narrative review is a relatively new method for evidence synthesis and as experience and methodological developments occur, we anticipate that these standards will evolve to reflect further theoretical and methodological developments. We hope that these standards will act as a resource that will contribute to improving the reporting of meta-narrative reviews. To encourage dissemination of the RAMESES publication standards, this article is co-published in the Journal of Advanced Nursing and is freely accessible on Wiley Online Library (http://www.wileyonlinelibrary.com/journal/jan). Please see related articles http://www.biomedcentral.com/1741-7015/11/21 and http://www.biomedcentral.com/1741-7015/11/22

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Author and article information

Journal

Journal ID (nlm-ta): Hum Vaccin Immunother

Journal ID (iso-abbrev): Hum Vaccin Immunother

Journal ID (publisher-id): KHVI

Journal ID (publisher-id): khvi20

Title: Human Vaccines & Immunotherapeutics

Publisher: Taylor & Francis

ISSN (Print): 2164-5515

ISSN (Electronic): 2164-554X

Publication date Collection: 2019

Publication date (Electronic): 20 February 2019

Publication date PMC-release: 20 February 2019

Volume: 15

Issue: 7-8 , HPV vaccination: from seroprevalence to public health policy and everything in between

Pages: 1615-1627

Affiliations

[a ]Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM) , London, UK

[b ]Swiss Centre for International Health, Swiss Tropical and Public Health Institute , Basel, Switzerland

[c ]Universität Basel , Basel, Switzerland

[d ]Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection , Marseille, France

[e ]ORS PACA, Southeastern Health Regional Observatory , Marseille, France

[f ]Aix Marseille Université, UMR_S 912, IRD , Marseille, France

[g ]INSERM, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), GH Cochin Broca Hôtel Dieu , Paris, France

[h ]INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Department of Social Epidemiology , Paris, France

[i ]INSERM CIC 1417, F-CRIN, I-REIVAC , Paris, France

[j ]Assistance Publique Hopitaux de Paris (AP-HP), Hôpital Cochin, CIC Cochin , Pasteur, Paris, France

[k ]Vaccine Preventable Disease Programme, European Centre for Disease Prevention and Control , Stockholm, Sweden

[l ]Centre for Social Sciences, Hungarian Academy of Sciences , Budapest, Hungary

[m ]Department of Global Health, Institute for Health Metrics and Evaluation, University of Washington , Seattle, USA

Author notes

CONTACT Emilie Karafillakis emilie.karafillakis@ 123456lshtm.ac.uk

Article

Publisher ID: 1564436

DOI: 10.1080/21645515.2018.1564436

PMC ID: 6783136

PubMed ID: 30633623

SO-VID: 915c3cd8-6dea-40f6-a0ef-4dec196428c6

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.

History

Date received : 12 September 2018

Date revision received : 3 December 2018

Date accepted : 18 December 2018

Page count

Figures: 3, References: 132, Pages: 13

Funding

Funded by: European Centre for Disease Prevention and Control (ECDC)

Award ID: OCS-2016-0UT-2050-MCTeFo

This study was supported by the European Centre for Disease Prevention and Control (ECDC) under Service Contract OCS-2016-0UT-2050-MCTeFo.

HPV vaccination in a context of public mistrust and uncertainty: a systematic literature review of determinants of HPV vaccine hesitancy in Europe

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Network and Systems Medicine

Most cited references 102

The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey

Strategies intended to address vaccine hesitancy: Review of published reviews.

RAMESES publication standards: meta-narrative reviews

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