Global Experts Call for Action on Vaccination Apathy, and More Protection for Older Adults Against Infectious Diseases

- At the recent 2017 World Health Summit - one of the world's most prestigious strategic forums on global health - a group of prominent global experts participated in a panel discussion on vaccination apathy, assessing the extent of influence it has on vaccination uptake, its causes, the role of healthcare providers, and how behavioural economics can help understand and address it. The expert panel called on policymakers and the healthcare community to take action to address vaccination apathy - an increasing challenge which threatens to jeopardize community protection against infectious disease. With a focus on adult vaccination, the panel discussed the issue in the context of the globally ageing population and the need to protect older adults against diseases, such as pneumococcal disease and influenza. Vaccination apathy, or hesitancy, as it is also referred to, is defined as the delay in acceptance or refusal of vaccines despite availability of vaccination services.[4] It varies across time, place and vaccine, and incorporates factors such as complacency, convenience and confidence. Vaccination apathy is not only limited to the general public but has also been identified in healthcare providers.[5] Session Chair, and leading authority on vaccination confidence, Dr Heidi Larson, Director of The Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine, UK said, "Whilst the majority of the research on vaccination apathy has focused on its prevalence among the general public, studies also show that groups of healthcare professionals, varying across geography and vaccine, may themselves be 'vaccine hesitant'. This is important in light of the high degree of trust patients place in their doctors' opinions and advice. It is important to realise that just as the general public may be influenced by rumours and concerns around vaccines, so may some healthcare providers." Dr Larson was joined by experts across the fields of immunology and infectious disease, health policy and management, and ageing. Value of vaccination   Professor Horst von Bernuth, Head of Pediatric Immunology and Infectious Diseases at Charité - Universitätsmedizin, Berlin, Germany said, "Vaccination is one of the most successful and cost-effective health interventions ever. It has saved countless lives and improved health and well-being around the globe. Despite this, for a multitude of reasons, vaccination apathy is a widespread global issue and a key barrier to protecting the community against infectious disease." The need for a life-course approach to vaccination   Dr Jane Barratt, Secretary General of the International Federation on Ageing, Canada highlighted the importance of a life-course approach to immunisation in the context of the ageing population said, "By 2060, 30% of Europeans will be aged 65 years or over. We know that as we age, our immune systems becomes less effective, which places older people at an increased risk of infections. This results in an increased burden of disease, higher rates of hospitalisation, and increasing pressure on health services. A life-course approach to immunisation, which includes adult vaccination is a cost-effective method for achieving better health outcomes across the life course, and managing the societal impact of ageing." Dr Barratt further discussed a recent study[6] that estimated burden of community acquired pneumonia (CAP) in the United States to be substantial, with more than 1.5 million adults hospitalized annually of whom 100,000 die. "Overall, approximately one in three patients hospitalized with CAP die within a year of admission," said Dr Barratt. Applying behavioural economics to understanding and addressing vaccination apathy   Dr. Douglas Hough, Associate Scientist and Director at the Johns Hopkins Bloomberg School of Public Health, USA, explored how the application of behavioural economics can assist in both understanding and addressing emotional and cognitive biases affecting vaccination decision-making. He discussed cognitive biases such as omission bias - the tendency, under conditions of uncertainty, to take no action, in preference to taking an action that might be regretted later[7], placing them in the context of vaccination decision-making. A concept related to this is the nocebo effect - the tendency to experience exaggerated side effects after having read or seen material that creates negative expectations[8]. He said, "It is evident that vaccination decision-making is not purely based on rational choice. Public health interventions and patient-doctor interactions around vaccination need to take this into account. Behavioural economics lends itself to the further understanding of vaccination apathy among both the general public and healthcare professionals, and helping to inform vaccination programmes which address it." The panel discussion concluded with a lively debate around the issues raised and covered the following points: As a final rallying cry, the panellists, led by Dr Heidi Larson called for global action: "With the pace of global ageing gathering momentum, the need to protect older adults against infectious diseases is coming increasingly to the fore. Vaccination apathy is a global issue and a key barrier to protecting the community against infectious disease. Healthcare professionals, policy makers and public health bodies should consider how they can address vaccination apathy through traditional, and novel approaches and strategies."   About the World Health Summit   The World Health Summit is the annual conference of the M8 Alliance of Academic Health Centers, Universities and National Academies. Through the Inter Academy Partnership (IAP) for Health, it is organized in collaboration with national academies of science in 97 countries. The World Health Summit aims to improve health all over the planet, catalysing that process through collaboration and open dialogue, and steering tomorrow's agenda to improve research, education, healthcare, and policy outcomes. Visit the website for further information: https://www.worldhealthsummit.org. 1. European Parliamentary Research Service. Older people in Europe: EU policies and programmes. 2014;p. 1-8. 2. Garau J, Hodin M, Kalache A. Life-Course Immunization: A Driver of Healthy Aging [Internet]. Global Coalition on Aging; 2017 [cited October 2017]. Available from: http://www.globalcoalitiononaging.com/v2/data/uploads/documents/life-course-immunization_gcoa-for-web.pdf 3. Voyer B. 'Nudging' behaviours in healthcare: Insights from behavioural economics. British Journal of Healthcare Management. 2015;21(3):130-135. 4. Report of the SAGE Working Group on vaccine hesitancy [Internet]. WHO; 2014 [cited October 2017]. Available from: http://www.who.int/immunization/sage/meetings/2014/october/SAGE_working_group_revised_report_vaccine_hesitancy.pdf?ua=1 5. Dubé E. Addressing vaccine hesitancy: the crucial role of healthcare providers. Clinical Microbiology and Infection. 2017;23(5):279-280. 6. Ramirez JA, Peyrani P et al. Adults Hospitalized with Pneumonia in the United States: Incidence, Epidemiology & Mortality. Clin Infect Dis. 2017. 7. Connolly T, Reb J. Omission bias in vaccination decisions: Where's the "omission"? Where's the "bias"?. Organizational Behavior and Human Decision Processes. 2003;91(2):186-202. 8. Colloca L, Miller F. The Nocebo Effect and Its Relevance for Clinical Practice. Psychosomatic Medicine. 2011;73(7):598-603.