Issue: October 2016
Perspective from Paul A. Offit, MD

Larson HJ, et al. EBioMedicine. 2016;doi:10.1016/j.ebiom.2016.08.042.

September 13, 2016
3 min read

Global survey reveals Europeans most skeptical about vaccine safety

Issue: October 2016
Perspective from Paul A. Offit, MD

Larson HJ, et al. EBioMedicine. 2016;doi:10.1016/j.ebiom.2016.08.042.

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There is wide variability between countries and across world regions in public sentiment about vaccine safety, but people in Europe are the most skeptical, according to the largest ever global survey of public confidence in vaccines.

Researchers from the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine (LSHTM), along with researchers at Imperial College London and Saw Swee Hock School of Public Health, National University of Singapore, surveyed almost 66,000 people in 67 countries to gauge public trust in immunization on a global scale. The survey assessed perceptions of vaccine importance, safety, effectiveness and compatibility with religious values.

Overall, sentiment toward vaccines was positive, the researchers said, with 12% of those surveyed disagreeing that vaccines were safe. However, perceptions of vaccine safety varied widely by country. The most confident lived in Southeast Asia — especially Bangladesh, where only 0.2% of respondents did not think vaccines were safe. The European region, on the other hand, was home to seven of the 10 least confident countries — France being the most skeptical, with 41% of people disagreeing that vaccines were safe.

The researchers said the extreme negative sentiment toward vaccine safety in France, where there is widespread access to vaccines, can be linked to several national controversies over the past few decades.

“These include controversies relating to side effects of the hepatitis B vaccine; physician-led petitions disputing the hexavalent vaccine for infants and the HPV vaccine; and hesitancy amongst general practitioners with nearly one in four GPs responding that some vaccines recommended by the French public health authorities are not useful, and many reporting doubt in immunization programs,” they wrote.

Study researcher Heidi J. Larson, PhD, an anthropologist at LSHTM, and colleagues warned that the “transnational influences of vaccine sentiment” should not be underestimated.

“It’s striking that Europe stands out as the region most skeptical about vaccine safety,” Larson said in a press release. “And, in a world where the internet means beliefs and concerns about vaccines can be shared in an instant, we should not underestimate the influence this can have on other countries around the world.”

One concerning trend to emerge from the survey was that some countries, such as Bosnia and Herzegovina, France, Iran, Japan, Mongolia and Vietnam, had greater confidence in the importance of vaccines than in their safety.

“Our study suggests that the public largely understands the importance of vaccines, but safety is their primary concern,” Larson said in the release. “This could reflect a worrying confidence gap and shows that vaccine acceptance is precarious. The findings underline that the scientific and public health community needs to do much better at building public trust in the safety of vaccination.”

Those living in Bangladesh, Iran and Ecuador reported the highest agreement that vaccines are important, while Russia, Italy and Azerbaijan were the most skeptical about their value. Notably, the researchers found that education may restore public confidence in the importance and effectiveness of vaccines, but not safety.

In the United States, 8.8% of respondents strongly disagreed or tended to disagree that vaccines were important, while 13.5% felt that way about safety, 9.6% about effectiveness, and 10.5% had those feelings regarding compatibility with their religion.

The researchers also found those aged older than 65 years and Roman Catholics had more positive views about vaccines; respondents in the Western Pacific region were more likely to feel that immunization was incompatible with their religion.

Public mistrust and refusal of vaccines has been linked to several preventable outbreaks in the U.S. and abroad. According to the researchers, these data can be used to identify emerging concerns about vaccine safety before they develop into crises.

“Our findings give an insight into public opinion about vaccines on an unprecedented scale,” Larson said. “It is vital to public health that we regularly monitor attitudes toward vaccines so that we can quickly identify countries or groups with declining confidence. We can then act swiftly to investigate what is driving the shift in attitudes. This gives us the best chance of preventing possible outbreaks of diseases like measles, polio and meningitis, which can cause illness, life-long disability and death.” – by John Schoen

Disclosure: London School of Hygiene & Tropical Medicine, to which Larson and another researcher belong, has received funding from Novartis for maternal immunization acceptance research; funding from GlaxoSmithKline for advising on vaccine hesitancy issues; and funding from GlaxoSmithKline and Merck to convene research symposiums. Larson also reports having served on the Merck Vaccines Strategic Advisory Board.