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The biggest pandemic risk? Viral misinformation
A century after the world’s worst flu epidemic, rapid spread of misinformation is undermining trust in vaccines crucial to public health, warns Heidi Larson.
A century after the world’s worst flu epidemic, rapid spread of misinformation is undermining trust in vaccines crucial to public health, warns Heidi Larson.
Journal Article
Best American short stories 2017
Presents a selection of the best works of short fiction of the past year from a variety of acclaimed sources.
BOOK
Blocking information on COVID-19 can fuel the spread of misinformation
Governments need to think twice before they suppress messages related to COVID-19.
Governments need to think twice before they suppress messages related to COVID-19.
Journal Article
A lack of information can become misinformation
On Twitter, there have been 113 million unique authors sharing everything from messages from news reports and commentary on COVID-19, to views on quarantining measures, speculation on the source of the virus and details of home-brewed cures. (Neither works.) As scientists rushed to investigate the new virus, conspiracy theories started to circulate about whether it was a naturally evolved new pathogen, one that inadvertently slipped out of a high-security laboratory in Wuhan, China, or one that was deliberately created for biowarfare - an idea deemed plausible by some in the current context of geopolitics and deepening tensions between the United States and China. On 30 December, Li Wenliang, a young ophthalmologist in Wuhan posted a message to colleagues that tried to call attention to a severe acute respiratory syndrome (SARS)-like illness that was brewing in his hospital.
Journal Article
Mapping global trends in vaccine confidence and investigating barriers to vaccine uptake: a large-scale retrospective temporal modelling study
There is growing evidence of vaccine delays or refusals due to a lack of trust in the importance, safety, or effectiveness of vaccines, alongside persisting access issues. Although immunisation coverage is reported administratively across the world, no similarly robust monitoring system exists for vaccine confidence. In this study, vaccine confidence was mapped across 149 countries between 2015 and 2019.
In this large-scale retrospective data-driven analysis, we examined global trends in vaccine confidence using data from 290 surveys done between September, 2015, and December, 2019, across 149 countries, and including 284 381 individuals. We used a Bayesian multinomial logit Gaussian process model to produce estimates of public perceptions towards the safety, importance, and effectiveness of vaccines. Associations between vaccine uptake and a large range of putative drivers of uptake, including vaccine confidence, socioeconomic status, and sources of trust, were determined using univariate Bayesian logistic regressions. Gibbs sampling was used for Bayesian model inference, with 95% Bayesian highest posterior density intervals used to capture uncertainty.
Between November, 2015, and December, 2019, we estimate that confidence in the importance, safety, and effectiveness of vaccines fell in Afghanistan, Indonesia, Pakistan, the Philippines, and South Korea. We found significant increases in respondents strongly disagreeing that vaccines are safe between 2015 and 2019 in six countries: Afghanistan, Azerbaijan, Indonesia, Nigeria, Pakistan, and Serbia. We find signs that confidence has improved between 2018 and 2019 in some EU member states, including Finland, France, Ireland, and Italy, with recent losses detected in Poland. Confidence in the importance of vaccines (rather than in their safety or effectiveness) had the strongest univariate association with vaccine uptake compared with other determinants considered. When a link was found between individuals' religious beliefs and uptake, findings indicated that minority religious groups tended to have lower probabilities of uptake.
To our knowledge, this is the largest study of global vaccine confidence to date, allowing for cross-country comparisons and changes over time. Our findings highlight the importance of regular monitoring to detect emerging trends to prompt interventions to build and sustain vaccine confidence.
European Commission, Wellcome, and Engineering and Physical Sciences Research Council.
Journal Article
An epidemic of uncertainty: rumors, conspiracy theories and vaccine hesitancy
The COVID-19 ‘infodemic’ continues to undermine trust in vaccination efforts aiming to bring an end to the pandemic. However, the challenge of vaccine hesitancy is not only a problem of the information ecosystem and it often has little to do with the vaccines themselves. In this Perspective, we argue that the epidemiological and social crises brought about by COVID-19 have magnified widely held social anxieties and trust issues that, in the unique circumstances of this global pandemic, have exacerbated skepticism toward vaccines. We argue that trust is key to overcoming vaccine hesitancy, especially in a context of widespread social uncertainty brought about by the pandemic, where public sentiment can be volatile. Finally, we draw out some implications of our argument for strategies to build vaccine confidence.
In this Perspective, the authors discuss the new digital communications landscape in relation to vaccines and argue that trust is key to overcoming vaccine hesitancy.
Journal Article
Understanding factors influencing vaccination acceptance during pregnancy globally: A literature review
Maternal vaccination has been evaluated and found to be extremely effective at preventing illness in pregnant women and new-borns; however, uptake of such programmes has been low in some areas.
To analyse factors contributing to uptake of vaccines globally, a systematic review on vaccine hesitancy was carried out by The Vaccine Confidence Project in 2012. In order to further analyse factors contributing to uptake of maternal immunisation, a further search within the broader systematic review was conducted using the terms ‘Pregnan*’ or ‘Matern*’. Forty-two articles were identified. Pregnancy-related articles were further screened to identify those focused on concerns, trust and access issues regarding maternal vaccination reported by pregnant women and healthcare workers. Thirty-five relevant articles were included which were then searched using the snowballing technique to identify additional relevant references cited in these articles. A search alert was also conducted from February to April 2015 in PubMed to ensure that no new relevant articles were missed. A total of 155 relevant articles were included.
Most of the literature which was identified on hesitancy surrounding vaccination during pregnancy reports on determinants of influenza vaccine uptake in North America. Research conducted in low-income countries focused primarily on tetanus vaccine acceptance. The main barriers cited were related to vaccine safety, belief that vaccine not needed or effective, not recommended by healthcare worker, low knowledge about vaacines, access issues, cost, conflicting advice. From the point of view of healthcare workers, barriers included inadequate training, inadequate reimbursement and increased workload. Twenty-seven out of 46 (59%) articles mentioning ethnicity reported lower rates of coverage among ethnic minorities.
Barriers to vaccination in pregnancy are complex and vary depending on context and population. There are wide gaps in knowledge regarding the attitudes of healthcare workers and how ethnicity and gender dynamics influence a pregnant woman's decision to vaccinate.
Journal Article
The state of vaccine confidence
[...]investment is needed for piloting and implementing strategies to find out what works best. [...]dialogue, including through social media, is important. [...]more support is needed for those on the front line of questioning.
Journal Article
COVID-SCORE: A global survey to assess public perceptions of government responses to COVID-19 (COVID-SCORE-10)
Understanding public perceptions of government responses to COVID-19 may foster improved public cooperation. Trust in government and population risk of exposure may influence public perception of the response. Other population-level characteristics, such as country socio-economic development, COVID-19 morbidity and mortality, and degree of democratic government, may influence perception.
We developed a novel ten-item instrument that asks respondents to rate key aspects of their government's response to the pandemic (COVID-SCORE). We examined whether the results varied by gender, age group, education level, and monthly income. We also examined the internal and external validity of the index using appropriate predefined variables. To test for dimensionality of the results, we used a principal component analysis (PCA) for the ten survey items. We found that Cronbach's alpha was 0.92 and that the first component of the PCA explained 60% of variance with the remaining factors having eigenvalues below 1, strongly indicating that the tool is both reliable and unidimensional. Based on responses from 13,426 people randomly selected from the general population in 19 countries, the mean national scores ranged from 35.76 (Ecuador) to 80.48 (China) out of a maximum of 100 points. Heterogeneity in responses was observed across age, gender, education and income with the greatest amount of heterogeneity observed between countries. National scores correlated with respondents' reported levels of trust in government and with country-level COVID-19 mortality rates.
The COVID-SCORE survey instrument demonstrated satisfactory validity. It may help governments more effectively engage constituents in current and future efforts to control COVID-19. Additional country-specific assessment should be undertaken to measure trends over time and the public perceptions of key aspects of government responses in other countries.
Journal Article