Global vaccine confidence study – Expert Reaction

International research shows New Zealanders’ attitudes towards vaccines were relatively stable in the years before the pandemic.

The new study, published in The Lancet, maps global trends in vaccine confidence, based on surveys which asked if people thought vaccines were important, safe, and effective.

The SMC asked experts to comment on the study.

Dr Nikki Turner, Associate Professor, Department of General Practice and Primary Health Care, and Director of the Immunisation Advisory Centre, University of Auckland, comments:

“This study has some important and useful findings for overall trends internationally. However, a few important caveats. At the country level, for New Zealand and many other countries, the sample size is not large enough to be sure the answers are representative, hence there is a very wide range in how accurate the findings may be. However, it is comforting to note that there does not appear to be any large change in vaccine confidence between the two sample dates in 2015 and 2018.

“Overall, it is a mixed picture across the world. Many countries/regions continue to maintain good levels of confidence, some struggle and some have seen quite major shifts. I am frequently hearing doomsday scenarios of total loss of confidence widespread internationally in vaccination programmes, but this is not what this study is showing. For example there are signs that vaccine confidence is increasing for much of Europe.

“What is clear is that certain factors can significantly affect a community’s confidence in vaccination programmes, in positive or negative directions. The major trends come from issues that affect trust in programmes, and the magnitude of the effects are enhanced by the reach of social media connectivity. Trust clearly has many angles, but the one that is the most powerful and potentially most destructive is overall trust in government and authorities to offer sensible guidance and trustworthy care for all its population. With rapid nationalism on the rise in some of our most influential countries and outrageous examples of major international leadership that pays minimal or no attention to accuracy or honesty, the world feels currently a very unstable place. It is not surprising that some countries and regions reflect this in vaccine confidence issues.

“But we should also look hard at countries that have managed to improve and maintain their community confidence and what the ingredients of a positive well-received programme look like. Trust in front-line providers and high levels of science education in schools are highlighted as important starting points. Maintaining confidence within a country, is also what gives resilience, to recover from knock-backs as was seen in the Philippines with the Dengue vaccine safety issues, or how some countries have managed to overcome the negative damage from anti-vaccination social media campaigns against HPV vaccines.”

No conflict of interest.

Dr Jagadish Thaker, Senior Lecturer, School of Communication, Journalism & Marketing – Te Pou Aro Korero, Massey University, comments:

“It’s not vaccines, but vaccination that saves lives. Based on data from multiple surveys from 149 countries, this study shows attitudes of the New Zealand public has largely remained stable between 2015 to 2019, in line with other studies in New Zealand. Attitudes towards vaccine safety (45% in 2015 and 40% in 2019), importance (67% in 2015 and 2019), and effectiveness (58% in 2015 and 2019) barely changed. While New Zealanders generally say vaccines are important, about half of the public has consistently remained hesitant towards vaccine safety or vaccine effectiveness.

“Bungling on one vaccine, such as with Dengvaxia vaccine (for dengue) scare in Philippines in 2017 and HPV vaccine safety scare in Japan in 2013, can have a serious and long-term impact on uptake of even routine vaccines. The findings confirm that public confidence in vaccines is an important factor that shapes vaccine uptake. Trust in healthcare workers more than trust in one’s social circle and higher levels of education are other factors associated with vaccine uptake.

“The wide range of accuracy for the New Zealand data probably indicates an uncertainty of beliefs that the study does not capture well. It may also be a lack of good data or a result of modelling for different countries where vaccine hesitancy may mean different things.

“By focusing on the extreme categories of response (“strongly agree” and “strongly disagree”) and clubbing the middle categories as “neither,” the study misses out on a range of attitudes. It also misses the kind of vaccine and booster shots for adults that are necessary for some diseases. While some will definitely hold strong anti-vaccination attitudes equally across all vaccines, others may choose some vaccines and discard others as unimportant. Finally, the surveys are based on parent’s memory, not vaccination coverage data from government or health institutions.”

No conflict of interest.

Associate Professor Helen Petousis-Harris, Vaccinologist, University of Auckland, comments:

“The Vaccine Confidence Project has been tracking attitudes to vaccines for years now which allows us to better understand people’s concerns.

“For two years running, the WHO has highlighted the spread of health misinformation and vaccine hesitancy as major threats to public health. It is a matter we need to take very seriously yet it is not easy to tackle.

“New Zealand is no exception to changes in public attitudes around vaccination and it is not always good news. A recent New Zealand study found that Kiwis were becoming more polarised about vaccines and while most people retained strong confidence in vaccines, 30% were becoming more concerned.

“In this international survey, which includes New Zealand among 149 countries, there have been some changes between 2015 and 2019. In 2015, 44.6% of New Zealanders strongly agreed that vaccines were safe and this had dropped to 40.1% in 2019. However, there was really no change in the responses to ‘vaccines are important’ (67% to 67.5%), and ‘vaccines are effective’ (58.2% to 58.7%).

“I think the take home message is that there is a growing public perception globally that vaccines are not safe, even though they are incredibly safe. This sentiment is supported by many other studies too. It means that the health sector needs to do better at communicating – by using messages that resonate with a range of population groups, that are delivered by people who are trusted, and that use platforms that are relevant for people.”

No conflict of interest.