AIM Recommendations to Tackle Vaccine Hesitancy in the EU

"Behavioural change is complex and related to cultural factors, to personal experiences, to social norms, etc. Furthermore, the emotional link to personal health (especially when talking about children) cannot be neglected if media frenzy is to be avoided and openness, transparency and comprehensibility ensured."

The International Association of Mutual Benefit Societies (AIM) is an organisation gathering non-profit healthcare mutuals and health insurance funds from Europe and all over the world. To support its objective to develop and defend universal access to high-quality, affordable healthcare along with social protection based on solidarity and democracy, AIM has created this position paper highlighting strategies for dealing with vaccine hesitancy in the European Union (EU).

As author Jessica Carreño Louro explains, vaccination is one of the most successful and cost-effective interventions to improve health outcomes. However, the last decade has been characterised by outbreaks of resurgence of measles, mumps, or polio in some countries where those diseases had previously been controlled. If vaccines work at both individual and community levels, the reluctance to be immunised also negatively affects both levels. Among the underlying determinants contributing to hesitancy: contextual influences including media, politics, and perceptions of the pharmaceutical industry; individual and group influences such as personal or family experiences, people's knowledge and experience with healthcare systems as a whole and with providers in particular, and social norms; and vaccine-specific issues, such as the balance between risks and benefits, the mode of administration, the strength of recommendations and the attitudes of healthcare professionals, the reliability on the vaccination equipment, or the costs of vaccines.

In this context, the impetus for the paper was a decision on the part of the European Commission to adopt, by mid-2018, a proposal for a Council Recommendation on Strengthened Cooperation against Vaccine Preventable Diseases. In order to collect the views and input of citizens, administrations, associations, and other relevant organisations, it launched a public consultation at the end of 2017. In this paper, AIM presents recommendations to the European Commission, other EU institutions, Member States, and relevant stakeholders.

Here is a brief summary of the recommendations for stakeholders:

1. Provide citizens with tailored and comprehensive information that describes the risk-benefits balance to enable them to make well-informed decisions and to avoid unreasonable fear of side effects. This reflects AIM's conviction that hesitancy can partly be tackled by an improvement in the health literacy of the general population, particularly of parents and children.
2. When communicating about immunisation, keep in mind that scientific data is important but will not make people act. Communication campaigns should include all relevant arguments in their narrative.
3. Involve all stakeholders in the development of communication strategies and campaigns about vaccination, which should be tailored to the populations they seek to reach. Depending on the context and on the audience, one actor or the other will take the lead in efficiently communicating around vaccination. The pharmaceutical industry should not be engaged in communicating to the public.
4. Provide guidance on the requirements for healthcare professionals in charge of immunisation and on their specific role in addressing vaccine hesitancy.
5. Expand the availability of vaccines beyond clinical settings under the condition that vaccines are administered by continuously trained professionals and vaccines are properly registered. Such trainings should include courses on how to communicate on immunisation.
6. Build a relationship of trust with journalists and bloggers in order to ensure an effective working relationship for vaccine communication. Non-specialised press should also be engaged, as they are the ones covering health issues in times of crisis. It is also important to use social media to foster dialogue with the public in order to refute anti-vaccine groups' allegations and increase trust around immunisation.
7. Harmonise vaccination programmes across the EU in order to help recover trust in immunisation.
8. Encourage and facilitate the exchange of comparable data between Member States on vaccine hesitancy, interventions, and prevention. Member States should share information on communication plans at the European level in order to coordinate activities but also to align communication of public health authorities. Improvement of EU e-health networks and an increase of the interoperability of information systems would also help better monitor hesitancy and vaccination rates in general and would allow to better respond in times of crisis.