Explore the vast range of titles available.

Elderly adults hold different beliefs regarding vaccination and are at higher risks for COVID-19 related illnesses and deaths. The current study aims to explore elderly (aged 65 or above) Chinese adults’ intentions to get vaccinated against COVID-19 and the facilitators and barriers to vaccination intentions. We conducted in-depth interviews with 35 elderly adults in China through the lens of the integrative model of behavioral prediction. The results identified a number of facilitators, including convenience (both individual and collective), psychological and physiological wellbeing, collective wellbeing, supportive normative referents, and trust in the government, and some barriers, including vaccine ineffectiveness, side effects, safety, unsupportive normative referents, and the accessibility, affordability, and availability of COVID-19 vaccines. In addition, the results revealed participants’ decision-making process: collective wellbeing and trust in the government overrode perceived barriers and perceived individual-level risks, which eventually overwhelmingly led to a high level of intentions to get vaccinated. Practical implications related to vaccine promotion and trust in the government were discussed.

Encouraging vaccination is a pressing policy problem. To assess whether text-based reminders can encourage pharmacy vaccination and what kinds of messages work best, we conducted a megastudy. We randomly assigned 689,693 Walmart pharmacy patients to receive one of 22 different text reminders using a variety of different behavioral science principles to nudge flu vaccination or to a business-as-usual control condition that received no messages. We found that the reminder texts that we tested increased pharmacy vaccination rates by an average of 2.0 percentage points, or 6.8%, over a 3-mo follow-up period. The most-effective messages reminded patients that a flu shot was waiting for them and delivered reminders on multiple days. The top-performing intervention included two texts delivered 3 d apart and communicated to patients that a vaccine was “waiting for you.” Neither experts nor lay people anticipated that this would be the best-performing treatment, underscoring the value of simultaneously testing many different nudges in a highly powered megastudy

Background HPV vaccine is a prophylactic vaccine to prevent HPV infections. Recommended by the World Health Organization, this vaccine is clinically proven to be one of the most effective preventive measures against the prevalence of cervical cancer and other HPV-associated cancers and chronic genital conditions. However, its uptake rate among women in Hong Kong is insignificant—only approximately 2.9% adolescent girls and 9.7% female university students received HPV vaccination in 2014. With the notion of Critical Medical Anthropology, we aimed to identify if different influential factors, ranging from individual, societal, and cultural, are involved in the decision-making process of whether to receive HPV vaccination. Methods We adopted a qualitative approach and conducted in-depth individual semistructured interviews with 40 women in Hong Kong between May and August 2017. Results We noted that the following factors intertwined to influence the decision-making process: perceptions of HPV and HPV vaccine; perceived worthiness of HPV vaccines, which was in turn influenced by vaccine cost, marriage plans, and experiences of sexual activities; history of experiencing gynecological conditions, stigma associated with HPV vaccination, acquisition of information on HPV vaccines, distrust on HPV vaccines, and absence of preventive care in the healthcare practice. Conclusions HPV vaccination is promoted in a manner that is “feminized” and “moralized” under the patriarchal value system, further imposing the burden of disease on women, and leading to health inequality of women in pursuing the vaccination as a preventive health behaviour as a result. We believe that this ultimately results in an incomplete understanding of HPV, consequently influencing the decision-making process. The “mixed-economy” medical system adopting capitalist logic also molds a weak doctor–patient relationship, leading to distrust in private practice medical system, which affects the accessibility of information regarding HPV vaccination for participants to make the decision.

Background Several economic obstacles can deter the development and use of vaccines. This can lead to limited product options for some diseases, delays in new product development, and inequitable access to vaccines. Although seemingly distinct, these obstacles are actually interrelated and therefore need to be addressed through a single over-arching strategy encompassing all stakeholders. Methods To help overcome these obstacles, we propose a new approach, the Full Value of Vaccines Assessments (FVVA) framework, to guide the assessment and communication of the value of a vaccine. The FVVA framework is designed to facilitate alignment across key stakeholders and to enhance decision-making around investment in vaccine development, policy-making, procurement, and introduction, particularly for vaccines intended for use in low- and middle-income countries. Results The FVVA framework has three key elements. First, to enhance assessment , existing value-assessment methods and tools are adapted to include broader benefits of vaccines as well as opportunity costs borne by stakeholders. Second, to improve decision-making , a deliberative process is required to recognize the agency of stakeholders and to ensure country ownership of decision-making and priority setting. Third, the FVVA framework provides a consistent and evidence-based approach that facilitates communication about the full value of vaccines, helping to enhance alignment and coordination across diverse stakeholders. Conclusions The FVVA framework provides guidance for stakeholders organizing global-level efforts to promote investment in vaccines that are priorities for LMICs. By providing a more holistic view of the benefits of vaccines, its application also has the potential to encourage greater take-up by countries, thereby leading to more sustainable and equitable impacts of vaccines and immunization programmes. Highlights 1. What is already known on this subject? While existing ‘pull’ and ‘push’ mechanisms to incentivize new vaccine development can enhance coordination across multiple stakeholders with different agendas, these mechanisms have not fully addressed interrelated obstacles for the optimal development, use, and impact of vaccines and immunization programmes in an integrated and holistic way. 2. What this study adds? This paper presents a conceptual framework, the Full Value of Vaccine Assessments (FVVA), which outlines coherent, organizing principles to guide the assessment of the value of vaccines, promote communication across stakeholders, and facilitate more informed country ownership of decision-making. Application of the FVVA approach has the potential to expand the sustainable and equitable impact of vaccines and immunization programmes. 3. Policy implications The FVVA approach outlined here will inform global-level efforts to enhance coordination among diverse stakeholders involved in policy- and decision-making related to the development and implementation of new vaccines.

The evidence base for vaccine hesitancy communication is generally confined to research focused on the content of the message rather than the process of communication. This has important consequences, because shifting focus to encompass the process of communicating, and not just on the content of content message being conveyed; opens the possibility of greater insight and understanding regarding the conversation health care workers have with those who are vaccine hesitant, creating increased chances of acceptance.

•About 20 % of people > 50 years sampled in England (N = 2,004) had not yet decided to have the COVID-19 booster vaccine.•Stage theory captures qualitative differences in those who have not had the COVID-19 booster vaccine.•Improving knowledge of vaccine safety and effectiveness is a priority in the vaccine hesitant.•Less financial security and less social pressure is associated with being unengaged in decision to have booster vaccine.•More negative vaccine attitudes, vaccine type, and not being of white British ethnicity is associated with being undecided. COVID-19 continues to pose a threat to public health. Booster vaccine programmes are critical to maintain population-level immunity. Stage theory models of health behaviour can help our understanding of vaccine decision-making in the context of perceived threats of COVID-19. To use the Precaution Adoption Process Model (PAPM) to understand decision-making about the COVID-19 booster vaccine (CBV) in England. An online, cross-sectional survey informed by the PAPM, the extended Theory of Planned Behaviour and Health Belief Model administered to people over the age of 50 residing in England, UK in October 2021. A multivariate, multinomial logistic regression model was used to examine associations with the different stages of CBV decision-making. Of the total 2,004 participants: 135 (6.7%) were unengaged with the CBV programme; 262 (13.1%) were undecided as to whether to have a CBV; 31 (1.5%) had decided not to have a CBV; 1,415 (70.6%) had decided to have a CBV; and 161 (8.0%) had already had their CBV. Being unengaged was positively associated with beliefs in their immune system to protect against COVID-19, being employed, and low household income; and negatively associated with CBV knowledge, a positive COVID-19 vaccine experience, subjective norms, anticipated regret of not having a CBV, and higher academic qualifications. Being undecided was positively associated with beliefs in their immune system and having previously received the Oxford/AstraZeneca (as opposed to Pfizer/BioNTech) vaccine; and negatively associated with CBV knowledge, positive attitudes regarding CBV, a positive COVID-19 vaccine experience, anticipated regret of not having a CBV, white British ethnicity, and living in East Midlands (vs London). Public health interventions promoting CBV may improve uptake through tailored messaging directed towards the specific decision stage relating to having a COVID-19 booster.

•Awareness of HPV is only just over 50% in parents whose children will soon be eligible for vaccination.•More parents of girls than boys said they would vaccinate their child against HPV.•Fathers, and parents of boys were more likely to be undecided about HPV vaccination.•Potentially modifiable HPV vaccine attitudes were strong predictors of intention to vaccinate. School-based HPV vaccination in the UK will soon be extended to boys. Based on other countries’ experience, uptake may initially be lower in boys than girls. We assessed HPV vaccine attitudes and decision-making in parents of boys and girls, to explore sex differences and inform public health messages. We carried out a cross-sectional population-based survey using home-based interviews in spring 2019. Participants were adults in England and Wales, with a child in school years 5–7 (aged 9–12 and eligible for HPV vaccination within 3 years). Measures included awareness of HPV and the vaccine, demographic factors, previous vaccine refusal and (after exposure to brief information) whether participants would allow their child to have the HPV vaccine (decided to vaccinate; decided not to vaccinate; undecided). We also assessed vaccine attitudes. Data were weighted to adjust for non-response. Multinomial logistic regression was used to explore predictors of deciding to (or not to) vaccinate compared with being undecided. Among 1049 parents (weighted n = 1156), 55% were aware of HPV and the girls’ vaccination programme, but only 23% had heard of plans to vaccinate boys. After information exposure, 62% said they would vaccinate their child, 10% would not, and 28% were undecided. Parents of girls were more willing to vaccinate than parents of boys (adjusted odds ratio: 1.80 (1.32–2.45)). Positive attitudes and HPV/vaccine awareness were significantly independently associated with deciding to vaccinate. Previous vaccine refusal for a child was the strongest predictor of not wanting the HPV vaccine. Our findings suggest a need for public health campaigns to raise awareness of plans to extend HPV vaccination to boys. Reassuringly only 10% of all parents were unwilling to vaccinate and our data suggest further information, including about safety and efficacy, may be important in supporting undecided parents to make the decision to vaccinate.

The clinical and economic impact of cervical cancer consistently become a serious burden for all countries, including Indonesia. The implementation of HPV vaccination policy for a big country such as Indonesia requires a strong commitment from several decision-makers. The aim of this study was to provide a comprehensive description on cost-effectiveness and the budget-impact of HPV vaccination policy in Indonesia. A cohort Markov model was used to evaluate the cost and the clinical impact of HPV vaccination for 10 years old girls in Indonesia. The researchers consider two doses of all three available HPV vaccines adjusted with the HPV infection profilewith 95% vaccination coverage to estimate the national cervical cancer incidence and mortality. The Budget impact analysis explores three different scenarios covering (1) Two districts per year expansion, (2) oneprovince per year expansion and (3) achieving the National Immunization Program in 2024. Upon fully vaccinating almost 2.3 million 10-year-old girls, 34,723; 43,414; and 51,522 cervical cancer cases were prevented by Quadrivalent, Bivalent and Nonavalent vaccines, consecutively. Furthermore, the highest (591 cases) and lowest (399 cases) mortality were prevented by Nonavalent and Quadrivalent vaccines, respectively. Most of the vaccines were considerably cost-effective and only the Bivalent vaccine with the GAVI/UNICEF price which will be considered a cost-saving strategy.To provide national coverage of HPV vaccination in Indonesia, the government has to provide an annual budget of about US$49 million and US$22 million using the government contract price and GAVI/UNICEF price, respectively. HPV vaccination shows a cost-effective strategy and the budget required to provide this policy is considerably affordable for Indonesia.

To promote informed decision-making and maternal pertussis vaccination (MPV) uptake, we systematically developed an interactive, web-based decision aid for pregnant users. Intervention reach (the percentage of participants in the intervention group who used the intervention), use (how much and how long those participants used the intervention), and acceptability (how positively they evaluated the intervention) are essential for it to be effective and should be reported to assess which intervention components may have been effective. This is a process evaluation aiming to evaluate (1) the reach and (2) the use, and (3) the acceptability of the intervention. We analyzed the reach and use of the intervention among participants in the intervention group of a randomized controlled trial (RCT) that assessed the effects of an online tailored decision aid in the form of a web app. Participants were recruited via social media and midwifery clinics and invited via email to use the intervention at 18 weeks of pregnancy. Reach was measured objectively by assessing the number of participants who visited the intervention at least once. Use of the intervention was logged and included time spent on the decision aid, the number of times clicked, pages visited, and answers given in interactive components. Data from the baseline survey (at <18 wk of pregnancy) were used to measure sociodemographics, informed decision-making, MPV uptake, and determinants of uptake. A posttest survey (20-22 weeks of pregnancy) was used to evaluate the acceptability of the decision aid. We report the findings descriptively and assess baseline differences between those who used versus those who did not use the intervention. Of the 586 participants in the intervention group, 463 (79%) reached the home page of the intervention. Intervention reach appeared higher among those in their first pregnancy (8.35% difference, P=.11), those recruited via their midwife rather than via social media (10.56% difference, P=.04), and those who had completed a higher educational level (7.35% difference, P=.06). On average, participants spent 4.25 (SD 4.39) minutes on the decision aid. Most participants used the decision aid once (56.2% of those who reached it, n=260) or twice (26.6%, n=123). The average number of clicks was 27.24 (SD 25.08) and varied widely. Regarding acceptability, participants evaluated the decision aid positively with an overall grade of 8.0 out of 10 (SD 1.01). In total, 38.9% (180/463) of participants who used the intervention indicated that the decision aid helped them with their MPV decision-making. The reach of the decision aid was successful with 79%, and participants were very positive about the decision aid. The use of the intervention (eg, time spent on the intervention) leaves room for improvement and should be improved to maximize intervention effects.

•NITAG recommendation is critical for vaccine market access.•Comparison of NITAG policies was performed in 13 selected developed countries.•Vaccine processes are heterogeneous, less structured, less transparent than HTA for other drugs.•There is a need for improving the decision framework for NITAG recommendations. Vaccines are specific medicines characterized by two country-specific market access processes: (1) a recommendation by National Immunization Technical Advisory Group (NITAG), and (2) a funding policy decision. The objective of this study was to compare and analyze NITAGs of 13 developed countries by describing vaccination committees’ bodies and working processes. Information about NITAGs bodies and working processes was searched from official sources from June 2011 to November 2012. Retrieved information was completed from relevant articles identified through a systematic literature review and by information provided by direct contact with NITAGs or parent organizations. An expert panel was also conducted to discuss, validate, and provide additional input on obtained results. While complete information, defined as 100%, was retrieved only for the UK, at least 80% of data was retrieved for 9 countries out of the 13 selected countries. Terms of references were identified in 7 countries, and the main mission for all NITAGs was to provide advice for National immunization programs. However, these terms of references did not fully encompass all the actual missions of the NITAGs. Decision analysis frameworks were identified for 10 out of the 13, and all NITAGs considered at least four criteria for decision-making: disease burden, efficacy/effectiveness, safety and cost-effectiveness. Advices were published by most NITAGs, but few NITAGs published meeting agendas and minutes. Only the United States had open meetings. This study supports previous findings about the disparities in NITAGs processes which could potentially explain the disparity in access to vaccinations and immunization programs across Europe. With NITAGs recommendations being used by policy decision makers for implementation and funding of vaccine programs, guidances should be well-informed and transparent to ensure National Immunization Programs’ (NIP) credibility among the public and health care professionals.