The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey.
The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey.
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DOI：
10.1016/j.ebiom.2016.08.042
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发表时间：
2016-10
期刊：
影响因子：
11.1
通讯作者：
Jones, Nick S.
中科院分区：
文献类型：
--
作者：
Larson, Heidi J.;de Figueiredo, Alexandre;Zhao Xiahong;Schulz, William S.;Verger, Pierre;Johnston, Iain G.;Cook, Alex R.;Jones, Nick S.
公众对免疫的信任是一个日益重要的全球卫生问题。对疫苗和免疫规划失去信心可能导致不愿和拒绝接种疫苗，有可能导致疾病暴发，并对高收入和低收入环境中的免疫目标构成挑战。国家和国际免疫利益攸关方呼吁更好地监测疫苗信心，以便在新出现的问题演变为疫苗信心危机之前发现它们。我们对全世界对免疫接种的态度进行了大规模的数据驱动研究。我们认为，这项调查是迄今为止关于免疫信心的最大规模调查，调查了67个国家65,819人对疫苗重要性、安全性、有效性和宗教兼容性的看法。分层模型被用来探索个人和国家层面的社会经济因素和疫苗态度之间的关系，通过四个问题，李克特量表调查。所有67个国家对疫苗接种的总体看法都是积极的，但国家之间和世界各区域之间存在很大差异。与疫苗安全相关的情绪在欧洲区域尤其消极，在十个最缺乏信心的国家中有七个在欧洲，法国41%的答复者和波斯尼亚和黑塞哥维那36%的答复者报告说，他们不同意疫苗是安全的（相比之下，全球平均水平为13%）。年龄最大的年龄组（65岁以上）和罗马天主教徒（在接受调查的所有信仰中）对疫苗的看法持积极态度，而西太平洋区域报告的宗教与疫苗的不相容程度最高。受教育程度高和获得保健服务便利的国家，积极情绪的比例较低，这表明对疫苗的看法与社会经济地位之间正在出现反比关系。在国家和国家以下各级对疫苗态度的定期监测——加上对地方免疫率的监测——可以确定信心和接受程度下降的人群。应优先考虑这些人群，以进一步调查消极情绪的驱动因素，并告知适当的干预措施，以防止不利的公共卫生结果。尽管各国的反应不同，但总体上对疫苗的信心是积极的。欧洲地区对疫苗安全的信心最低，法国是全球信心最低的。孟加拉国、厄瓜多尔和伊朗对疫苗重要性的认同程度最高。阿塞拜疆、俄罗斯和意大利对疫苗重要性的怀疑最多。教育提高了对疫苗重要性和有效性的信心，但不是安全性。这项全球调查建立在先前对疫苗的重要性、安全性、有效性和宗教兼容性的研究基础上。这项全球调查以前所未有的规模调查了人们对疫苗的态度，采访了67个国家的65819名受访者。通过强调国家和区域对疫苗态度的差异，这有助于为公共卫生议程提供信息；例如，欧洲区域是对疫苗安全最不自信的区域。世界各国共有的一种模式是，在对疫苗重要性的高度信任与对安全性的较低信任之间存在令人担忧的差距，从而确定了疫苗接受程度可能比以前认为的更为不稳定的风险国家。与此同时，过去的研究表明在某些亚人群中至关重要的宗教等因素在全球范围内没有显示出一致的模式，这强调了未来研究更详细地了解疫苗信心的当地驱动因素的重要性。
Public trust in immunization is an increasingly important global health issue. Losses in confidence in vaccines and immunization programmes can lead to vaccine reluctance and refusal, risking disease outbreaks and challenging immunization goals in high- and low-income settings. National and international immunization stakeholders have called for better monitoring of vaccine confidence to identify emerging concerns before they evolve into vaccine confidence crises. We perform a large-scale, data-driven study on worldwide attitudes to immunizations. This survey – which we believe represents the largest survey on confidence in immunization to date – examines perceptions of vaccine importance, safety, effectiveness, and religious compatibility among 65,819 individuals across 67 countries. Hierarchical models are employed to probe relationships between individual- and country-level socio-economic factors and vaccine attitudes obtained through the four-question, Likert-scale survey. Overall sentiment towards vaccinations is positive across all 67 countries, however there is wide variability between countries and across world regions. Vaccine-safety related sentiment is particularly negative in the European region, which has seven of the ten least confident countries, with 41% of respondents in France and 36% of respondents in Bosnia & Herzegovina reporting that they disagree that vaccines are safe (compared to a global average of 13%). The oldest age group (65+) and Roman Catholics (amongst all faiths surveyed) are associated with positive views on vaccine sentiment, while the Western Pacific region reported the highest level of religious incompatibility with vaccines. Countries with high levels of schooling and good access to health services are associated with lower rates of positive sentiment, pointing to an emerging inverse relationship between vaccine sentiments and socio-economic status. Regular monitoring of vaccine attitudes – coupled with monitoring of local immunization rates – at the national and sub-national levels can identify populations with declining confidence and acceptance. These populations should be prioritized to further investigate the drivers of negative sentiment and to inform appropriate interventions to prevent adverse public health outcomes. Overall vaccine confidence is positive, though responses differ between countries. The European region has the lowest confidence in vaccine safety with France the least confident globally. Bangladesh, Ecuador, and Iran reported highest agreement that vaccines are important. Azerbaijan, Russia, and Italy reported most skepticism around vaccine importance. Education increases confidence in vaccine importance and effectiveness but not safety. This global survey builds on previous studies of vaccines' perceived importance, safety, effectiveness, and religious compatibility. The worldwide survey investigates attitudes towards vaccines on an unprecedented scale, interviewing 65,819 respondents across 67 countries. This can help inform public health agendas by highlighting national and regional variations in attitudes towards vaccines; for example, that the European region is the least confident region towards vaccine safety. One pattern shared by diverse countries worldwide is a worrying gap between high confidence in vaccine importance yet lower confidence in safety, identifying at-risk countries whose vaccine acceptance may be more precarious than previously thought. Meanwhile, factors such as religion, which past research shows to be crucial in some sub-populations, display no consistent pattern at the global scale, emphasizing the importance for future research of understanding the local drivers of vaccine confidence in more detail.
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