Pediatrics

Ève Dubé, PhD, on Best Practices for Reducing Vaccine Hesitancy

Vaccine hesitancy is considered a threat to global health in 2019, according to the World Health Organization (WHO).1 WHO estimates that vaccines prevent 2 to 3 million deaths per year and could prevent more if vaccine hesitancy was not so high.

A session at IDWeek 2019 focused on vaccine hesitancy countermeasures for health care providers.2 Speaker Ève Dubé, PhD, answered our questions via email about these best practices.

Dr Dubé is a researcher in the infectious and immune diseases axis at the Research Center of the University Hospital at Laval University in Quebec, QC, Canada.

Infectious Diseases Consultant: What communication strategies influence vaccine coverage? What are the best practices?

Ève Dubé: Recommendation for vaccination from a health care provider is a main driver of vaccine acceptance. When health care providers communicate effectively with parents about the value of vaccines, their safety, benefits, and risks, parents are more confident in their decisions. Most parents, including vaccine-hesitant parents, consider their health care provider to be the most trusted source for vaccine information. Studies consistently have shown that the majority of parents look to their provider for information and advice on vaccine-preventable diseases, vaccines, and the recommended schedule.

Given health care providers’ critical role in influencing vaccine acceptance, it is essential to support health care provider communication with vaccine-hesitant parents, a task that many providers perceive as time-consuming and not reliably effective. To date, the educational intervention of promoting vaccinations based on motivational interviewing (MI) techniques is among one of the rarest strategies that have demonstrated effectiveness in increasing infants’ vaccine coverage and curb parents’ vaccine hesitancy.

MI is an interviewing technique that aims to reinforce the motivation and commitment of the person. It is less about the health care professional talking to the patient/caregiver and more about working with the patient/caregiver. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.

ID CON: What research has been done in this area that support these best practices?

ÈD: A summary of the findings from 15 published literature reviews or meta-analyses that examined the effectiveness of interventions to reduce vaccine hesitancy and/or to enhance vaccine acceptance has shown that simply providing information and education, and communicating evidence of vaccine safety and efficacy to those who are vaccine-hesitant has done little to stem the growth of hesitancy-related beliefs and fears.

Addressing vaccine hesitancy requires tailored strategies that are tested and evidence-informed, and that take into account that vaccine hesitancy is complex and context specific, varying across time, place, and vaccine type. In this context, MI is a very effective strategy to address vaccine hesitancy.

In Canada, Arnaud Gagneur, MD, PhD, and colleagues developed an educational intervention based on the MI approach for parents in maternity wards during their postpartum stay (the PromoVac strategy).3 This strategy has been validated during a regional pilot study; results showed an increase of 15% in mothers’ intention to vaccinate, an increase of 7.3% in infants’ vaccine coverage rates at 7 months, and a 9% greater chance of having a complete immunization status during the 0 to 2-year period among infants whose parents received the intervention in the maternity ward.

The strategy was also validated in a provincial randomized controlled trial,4 which showed a reduction of 40% in vaccine hesitancy scores. In the United States, Amanda F. Dempsey, MD, PhD, MPH, and colleagues5 also demonstrated the effectiveness of a vaccination promotion strategy using MI to increase human papillomavirus (HPV) vaccine uptake in adolescents.

ID CON: What is the key take-home message for health care providers in general and ID specialists specifically?

ÈD: “Trust in health care providers’ recommendations” is a leading reason why vaccine-hesitant parents vaccinate their child. Parents who received information from health care providers are less vaccine hesitant than those who receive information from other sources. Communication about vaccination can be emotional for both parents and health care providers, especially when their opinions about vaccines are not congruent. In this context, motivational interviewing techniques can be very helpful.

References:

  1. Ten threats to global health in 2019. World Health Organization. Accessed September 20, 2019. https://www.who.int/emergencies/ten-threats-to-global-health-in-2019.
  2. Dube E. Vaccine hesitancy countermeasures for providers: best practices. Talk presented at: IDWeek 2019; October 2-6; Washington, DC. https://www.eventscribe.com/2019/IDWeek/fsPopup.asp?Mode=presInfo&PresentationID=552223.
  3. Lemaitre T, Carrier N, Farrands A, Gosselin V, Petit G, Gagneur A. Impact of a vaccination promotion intervention using motivational interview techniques on long-term vaccine coverage: the PromoVac strategy. Hum Vaccin Immunother. 2019;15(3):732-739. https://doi.org/10.1080/21645515.2018.1549451.
  4. Gagneur A, Battista MC, Boucher FD, et al. Promoting vaccination in maternity wards─motivational interview technique reduces hesitancy and enhances intention to vaccinate, results from a multicentre non-controlled pre- and post-intervention RCT-nested study, Quebec, March 2014 to February 2015. Euro Surveill. 2019;24(36). https://doi.org/10.2807/1560-7917.ES.2019.24.36.1800641.
  5. Dempsey AF, Pyrznawoski J, Lockhart S, et al. Effect of a health care professional communication training intervention on adolescent human papillomavirus vaccination: a cluster randomized clinical trial. JAMA Pediatr. 2018;172(5):e180016. https://doi.org/10.1001/jamapediatrics.2018.0016.