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New tool to measure confidence in vaccination launched

Relatives of a Pakistani female polio vaccination worker, who was killed by unknown gunmen, mourn her death in Karachi, Pakistan. While vaccine distrust has sparked debates amid a measles outbreak in the United States, Pakistan is in a deadly battle to wipe out polio. AP Jan 2014

As the Disneyland measles outbreak in the United States demonstrated – if not the two-to-three million child deaths from easily preventable diseases or the ongoing murders of polio vaccine volunteers in Pakistan – there’s often a tragic and sometimes deadly cost to loss of public confidence in immunization.

But why vaccines? Why is immunization, compared to other, often much more ineffective or risky health interventions, so prone to public suspicion or concern?

A new initiative, called the Vaccine Confidence Project, aims to answer such questions.  The project, officially announced today by researchers at the London School of Hygiene and Tropical Medicine, has begun monitoring and documenting trends in vaccine confidence, or the lack of it, with a tool they dub the Vaccine Confidence Index.

Heidi Larson

Heidi Larson

“Vaccine hesitancy is a highly varied, global challenge,” said project leader Heidi Larson, a medical anthropologist who, prior to her academic exploits, led a number of immunization advocacy programs for UNICEF.

The public debate that erupted following the outbreak measles, which can be deadly and once had been eliminated from the U.S. due to better rates of child immunization, largely featured vaccine advocates – and the media, in a switch from its former role – beating up on parents who don’t vaccinate as anti-scientific morons who endanger their children and the rest of us. Calls for mandatory vaccination, or at least tightening up the rules that allow personal exemptions for vaccination, abounded.

Such a simplistic, hostile and narrow view of this problem likely won’t help improve things, Larson said.

In a February Humanosphere podcast, she explained that the reasons people or communities shun vaccines are often complex, not necessarily anti-scientific and encouraging greater acceptance of this powerful public health tool will require a much more nuanced approach that respects the cultural, social, psychological and even economic motivations behind vaccine refusal.

To better evaluate what drives public acceptance or rejection of vaccination, Larson and her colleagues, including Gallup International’s Global Public Health Polling Network, will interview parents of young children to detect the level of community confidence in immunization and what’s driving it. The first set of results from this new tool called the Vaccine Confidence Index was based on surveying parents in five select countries – Nigeria, Pakistan, India, Georgia and the UK.

How polio spread out of Nigeria following community boycott of the vaccine. Global Polio Eradication Initiative

How polio spread out of Nigeria following community boycott of the vaccine. Global Polio Eradication Initiative

This first evaluation of vaccine confidence in these five countries found:

“Reported reasons for hesitancy in all countries were classified as being due to either confidence (do not trust vaccine or provider), convenience (access) or complacency (do not perceive a need or value of vaccine). Issues of confidence were found to be the main reason for hesitancy in all countries surveyed.”

As Larson explains in a statement accompanying the launch of the Vaccine Confidence Index, the key to progress is about building public trust in both government and health institutions in a way that encourages, not browbeats, parents into making the right choice for protecting their children and the community.

“Public confidence is vital,” Larson said. “Our Vaccine Confidence Index will provide insights for policy makers and health professionals, to help them understand public sentiment about vaccinations, identify issues early, and act appropriately to ensure immunization programs are not disrupted.”


About Author

Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at] or follow him on Twitter @tompaulson.