10.1038/s41562-020-0889-7

Public opinion is shaped in significant part by online content, spread via social media and curated algorithmically. The current online ecosystem has been designed predominantly to capture user attention rather than to promote deliberate cognition and autonomous choice; information overload, finely tuned personalization and distorted social cues, in turn, pave the way for manipulation and the spread of false information. How can transparency and autonomy be promoted instead, thus fostering the positive potential of the web? Effective web governance informed by behavioural research is critically needed to empower individuals online. We identify technologically available yet largely untapped cues that can be harnessed to indicate the epistemic quality of online content, the factors underlying algorithmic decisions and the degree of consensus in online debates. We then map out two classes of behavioural interventions—nudging and boosting— that enlist these cues to redesign online environments for informed and autonomous choice.

How behavioural sciences can promote truth, autonomy and democratic discourse online

10.1177/1075547017731776

This study tests whether the number (1 vs. 2) and the source (another user vs. the Centers for Disease Control and Prevention [CDC]) of corrective responses affect successful reduction of misperceptions. Using an experimental design, our results suggest that while a single correction from another user did not reduce misperceptions, the CDC on its own could correct misinformation. Corrections were more effective among those higher in initial misperceptions. Notably, organizational credibility was not reduced when correcting misinformation, making this a low-cost behavior for public health organizations. We recommend that expert organizations like the CDC immediately and personally rebut misinformation about health issues on social media.

Using Expert Sources to Correct Health Misinformation in Social Media

A joint communiqué by the WHO Regional Office for the Eastern Mediterranean, the International Federation of Medical Students’ Associations, the International Association of Dental Students and the International Pharmaceutical Students Federation

Engaging young people in the response to COVID-19 in WHO’s Eastern Mediterranean Region

In several European countries, adolescents and young adults are among the worst affected by outbreaks of vaccine-preventable disease. Catchup campaigns are helping address immunisation gaps arising from low MMR uptake in the early years of the 21st century, but low vaccination rates may also stem from complacency about the need to stay up to date with vaccination schedules.

Vaccine Champions: Young people demand healthier future

Parents’ most frequently asked questions about vaccines.

Vaccines for children: Your questions answered

In February 2020 the U-Report for Humanitarian Action initiative, a joint effort of Office of Innovation , Programme division , Communication for development and Office of Emergency programmes developed a U-Report Information chatbot to support COVID-19 Risk Communication and Community Engagement (RCCE). As of 20th June 2020, U-Report’s Covid-19 bot has been  Accessed by over 6 million people Across 52 countries Over 7 million interactions Over 20 million young people and communities engaged on COVID-19 through U-Report

U-Report – COVID-19 outbreak response Facilitating the exchange of lifesaving information for millions of young people across 50 countries and counting

WHO Health Alert brings COVID-19 facts to billions via WhatsApp

Call for applicants for 1st WHO training in infodemic management

This is a short technical brief with important steps and resources on how country programs can track and address rumors around COVID-19 (as needed). The guide includes a number of great resources and links while also sharing nuggets from global, collective thinking around rumors.

COVID-19 RUMOR TRACKING

In May 2012, the Decade of Vaccines (DoV) (1) collaboration presented for ratification a Global Vaccination Action Plan to the World Health Assembly. This document acknowledges that all stakeholders must do better with public acceptance of vaccination. Here, we propose a comprehensive new framework for vaccination advocacy that calls for a better understanding of public perceptions to build and sustain individual and community acceptance of vaccines.

Listen, Understand, Engage

The Coronavirus disease (COVID-19) is the first pandemic in history in which technology and social media are being used on a massive scale to keep people safe, informed, productive and connected. At the same time, the technology we rely on to keep connected and informed is enabling and amplifying an infodemic that continues to undermine the global response and jeopardizes measures to control the pandemic.  

Managing the COVID-19 infodemic: Promoting healthy behaviours and mitigating the harm from misinformation and disinformation

/10.1080/17538068.2016.1235531

Anti-vaccine sentiment can be extremely resistant to change, making it difficult to promote childhood vaccines. Thus, there is a need for effective strategies to communicate the benefits of vaccination to vaccine hesitant parents. Understanding how anti-vaccine advocates successfully persuade parents against vaccinating their children can provide insight into communication tactics that could be incorporated into vaccine promotion efforts. The internet is an important source of vaccine information for many parents, and plays a role informing vaccine hesitancy. To understand what might make anti-vaccine websites so convincing, we used persuasion theory as a lens to examine what information was being presented, and the persuasive tactics being used to communicate the information. We conducted a content analysis of 480 anti-vaccine websites. Four trained coders coded sites for the content of the vaccine information being presented, types of persuasive tactics used, and values and lifestyle norms associated with anti-vaccine advocacy. Anti-vaccine websites contain a considerable amount of misinformation, most commonly that vaccines are dangerous, cause autism and brain injury. Websites used both scientific evidence and anecdotes to support these claims. Values such as choice, freedom, and individuality were linked to anti-vaccine beliefs. The most commonly co-promoted behaviors included the use of alternative medicine and homeopathy, and eating a healthy or organic diet. Anti-vaccine websites use a battery of effective persuasive techniques to forward their agenda. The use of similar persuasive techniques and tapping into parents’ values and lifestyles are potentially useful strategies for vaccine promotion communication.

What makes anti-vaccine websites persuasive? A content analysis of techniques used by anti-vaccine websites to engender anti-vaccine sentiment

 10.1371/journal.pone.0210746

Misinformation poses significant challenges to evidence-based practice. In the public health domain specifically, treatment misinformation can lead to opportunity costs or direct harm. Alas, attempts to debunk misinformation have proven sub-optimal, and have even been shown to “backfire”, including increasing misperceptions. Thus, optimized debunking strategies have been developed to more effectively combat misinformation. The aim of this study was to test these strategies in a real-world setting, targeting misinformation about autism interventions. In the context of professional development training, we randomly assigned participants to an “optimized-debunking” or a “treatment-as-usual” training condition and compared support for non-empirically-supported treatments before, after, and six weeks following completion of online training. Results demonstrated greater benefits of optimized debunking immediately after training; thus, the implemented strategies can serve as a general and flexible debunking template. However, the effect was not sustained at follow-up, highlighting the need for further research into strategies for sustained change.

Evaluation of a template for countering misinformation—Real-world Autism treatment myth debunking

It’s clear who loses from health misinformation. Mothers lose children after seeking advice in Facebook free-birth groups, measles break out in anti-vaxx communities, children with autism are poisoned from being fed bleach marketed as a miracle cure, and people die from misleading hope about a fake COVID-19 cure.

Who Benefits from Health Misinformation?

10.1136/bmj.c5347

How the case against the MMR vaccine was fixed

Two studies investigated the effectiveness of a self-affirmation exercise on vaccine safety beliefs and intent to vaccinate future children. In Study 1, a sample of 585 parents with at least one child under the age of 18 in the home participated through Amazon’s MTurk. Participants were randomly assigned to one of four conditions in a 2 x 2 design. Participants read either correcting information refuting a link between the measles, mumps, and rubella (MMR) vaccine and autism or a control passage about bird feeding. Additionally, participants either completed a self-affirmation exercise where they reflected on their personal values or in a control condition in which they reflected on least-personally-important values that might be important to others. Participants exposed to the correcting information were less likely to believe that vaccines cause serious side effects, but no less likely to believe that the MMR vaccine causes autism. For parents with initially positive vaccine attitudes, there was no effect of condition on intent to vaccinate a future child. For parents with initially negative vaccine attitudes, self-affirmation was ineffective in the presence of correcting information and resulted in less intention to vaccinate in the absence of correcting information. This effect was partially replicated in Study 2 (N = 576), which provided no correcting information but otherwise followed the same procedure as Study 1.

10.1371/journal.pone.0181368

A self-affirmation exercise does not improve intentions to vaccinate among parents with negative vaccine attitudes (and may decrease intentions to vaccinate)

10.1007/s10339-019-00919-w

The main objective of this study was to determine whether one of the most commonly employed pro-vaccination strategies based on the "myths vs. facts" format can be considered an effective tool to counter vaccines misinformation. Sixty parents were randomly presented with either a control message or a booklet confronting some common myths about vaccines with a number of facts. Beliefs in the autism/vaccines link and in vaccines side effects, along with intention to vaccinate one's child, were evaluated both immediately after the intervention and after a 7-day delay to reveal possible backfire effects. Data provided support for the existence of backfire effects associated with the use of the myths vs. facts format, with parents in this condition having stronger vaccine misconceptions over time compared with participants in the control condition. The myths vs. facts strategy proved to be ineffective. Efforts to counter vaccine misinformation should take into account the many variables that affect the parents' decision-making.

Parents' beliefs in misinformation about vaccines are strengthened by pro-vaccine campaigns

Internews first developed our rumour tracking methodology in 2014 in Liberia, in order to address the deadly Ebola outbreak. Since then, we’ve implemented rumour tracking as a way to address misinformation during humanitarian crises in numerous countries and contexts, reaching hundreds of thousands of beneficiaries. This guide was authored by Viviane Lucia Fluck, PhD, and produced with financial support from the United States Agency for International Development. The rumor tracking methodology, which is part of Internews’ Learning Collection, includes three parts: Context, Case Studies, and a How To Guide. The How To Guide is usually packaged separately for ease of use.

Managing Misinformation in a Humanitarian Context

The proliferation of disinformation online amidst the DRC’s outbreak of the Ebola virus is a serious threat to global health. Efforts to curb bad information and conspiracy theories on social media about the disease and other health issues have been no more successful in health than in other contexts.

Disinformation and Disease: Social Media and the Ebola Epidemic in the Democratic Republic of the Congo

Pakistan is one of just two countries where polio is still endemic (Afghanistan is the other). The global initiative to eradicate polio in Pakistan has experienced varying degrees of success, but has been complicated by ongoing distrust in the motives of global health authorities and recent spikes in polio-related misinformation on social media. 

Vaccine case study: Understanding the impact of polio vaccine disinformation in Pakistan

Misinformation about COVID-19 is a major threat to public health. Using five national samples from the UK (n= 1050 and n= 1150), Ireland (n = 700), the USA (n = 700), Spain (n= 700) and Mexico (n= 700), we examine predictors of belief in the most common statements about the virus that contain misinformation. We also investigate the prevalence of belief in COVID-19 misinformation across different countries and the role of belief in such misinformation in predicting relevant health behaviours. We find that while public belief in misinformation about COVID-19 is not particularly common, a substantial proportion views this type of misinformation as highly reliable in each country surveyed. In addition, a small group of participants find common factual information about the virus highly unreliable. We also find that increased susceptibility to misinformation negatively affects people's self-reported compliance with public health guidance about COVID-19, as well as people's willingness to get vaccinated against the virus and to recommend the vaccine to vulnerable friends and family. Across all countries surveyed, we find that higher trust in scientists and having higher numeracy skills were associated with lower susceptibility to coronavirus-related misinformation. Taken together, these results demonstrate a clear link between susceptibility to misinformation and both vaccine hesitancy and a reduced likelihood to comply with health guidance measures, and suggest that interventions which aim to improve critical thinking and trust in science may be a promising avenue for future research.

10.1098/rsos.201199

Susceptibility to misinformation about COVID-19 around the world

We identified the 2,000 most active Twitter accounts in the vaccine discourse from 2019, identifying both vaccine opponents and proponents. Only 17% of this sample appeared to be bots.  In addition to tweeting about vaccines, vaccine opponents also tweeted about conservative politics and conspiracy theories. Vaccine proponents tended to represent doctors, researchers, or health organizations, but also included non-medical accounts.On February 20, we collected the most recent tweets for each account and automatically extracted 35 distinct topics of conversation related to COVID-19 (roughly 80,000 tweets). Topics were categorized as: more reliable (public health updates & news), less reliable (discussion), and unreliable (misinformation). Misinformation included conspiracy theories, unverifiable rumors, and scams promoting untested prevention/cures.Vaccine opponents shared the greatest proportion (35.4%) of unreliable information topics including a mix of conspiracy theories, rumors, and scams.  Vaccine proponents shared a much lower proportion of unreliable information topics (11.3%). Across both vaccine proponents and vaccine opponents, the largest single topic of conversation was “Disease & Vaccine Narratives,” a discussion-based topic where users made comparisons between COVID-19 and other diseases—most notably influenza. These messages likely added to public confusion around the seriousness and nature of COVID-19 that endures months later. In the context of an ‘infodemic,’ efforts to address and correct misinformation are complicated by the high levels of scientific uncertainty. Focusing on only the most conspicuous forms of misinformation—blatant conspiracy theories, bot-driven narratives, and known communities linked by conspiracist ideologies—is one approach to addressing misinformation, but given the complexity of the current moment, this strategy may fail to address the more subtle types of falsehoods that may be shared more broadly. 

Not just conspiracy theories: Vaccine opponents and proponents add to the COVID-19 ‘infodemic’ on Twitter

ObjectiveUsing longitudinal methods to assess regional associations between social media posts about vaccines and attitudes and actual vaccination against influenza in the US.MethodsGeolocated tweets from U.S. counties (N = 115,330) were analyzed using MALLET LDA (Latent Dirichlet allocation) topic modeling techniques to correlate with prospective individual survey data (N = 3005) about vaccine attitudes, actual vaccination, and real-life discussions about vaccines with family and friends during the 2018–2019 influenza season.ResultsTen topics were common across U.S. counties during the 2018–2019 influenza season. In the overall analyses, two of these topics (i.e., Vaccine Science Matters and Big Pharma) were associated with attitudes and behaviors. The topic concerning vaccine science in November-February was positively correlated with attitudes in February-March, r = 0.09, BF10 = 3. Moreover, among respondents who did not discuss the influenza vaccine with family and friends, the topic about vaccine fraud and children in November-February was negatively correlated with attitudes in February-March and with vaccination in February-March, and April-May (rs = −0.18 to −0.25, BF10 = 4–146). However, this was absent when participants had discussions about the influenza vaccine with family and friends.DiscussionRegional vaccine content correlated with prospective measures of vaccine attitudes and actual vaccination.ConclusionsSocial media have demonstrated strong associations with vaccination patterns. When the associations are negative, discussions with family and friends appear to eliminate them. Programs to promote vaccination should encourage real-life conversations about vaccines.

10.1016/j.vaccine.2020.07.054

Prospective associations of regional social media messages with attitudes and actual vaccination: A big data and survey study of the influenza vaccine in the United States

Iranian media reports that at least 44 people have died from alcohol poisoning and hundreds have been hospitalized after consuming bootleg alcohol in an effort to treat the coronavirus. The Middle Eastern country, which has been especially hit hard by the coronavirus – with 8,042 confirmed cases and at least 291 deaths as of Tuesday – has struggled to prevent the spread of the virus.The majority of deaths attributed to the coronavirus in the Middle East are in Iran.A false rumor has circulated throughout the country that drinking alcohol can cure or prevent the coronavirus. Drinking alcohol is prohibited in the country.Some citizens, according to Iran Health Ministry official Ali Ehsanpour, drank alcohol that substituted toxic methanol for ethanol, using bleach to mask the color. Seven bootleggers have been arrested.In one part of the country, Khuzestan, more people have died from alcohol poisoning than from the coronavirus in that area, according to the state news agency IRNA. More than 30 people have died from poisoning, and 18 have died from the virus.The rumor also has circulated throughout Indian social media, reports NDTV and the Times of India, which the World Health Organization has debunked. One iteration of the rumor suggests that spraying alcohol or chlorine can prevent the coronavirus from entering the body.

At least 44 dead from drinking toxic alcohol in Iran after coronavirus cure rumor

People’s inability to update their memories in light of corrective information may have important public health consequences, as in the case of vaccination choice. In the present study, we compare three potentially effective strategies in vaccine promotion: one contrasting myths vs. facts, one employing fact and icon boxes, and one showing images of non-vaccinated sick children. Beliefs in the autism/vaccines link and in vaccines side effects, along with intention to vaccinate a future child, were evaluated both immediately after the correction intervention and after a 7-day delay to reveal possible backfire effects. Results show that existing strategies to correct vaccine misinformation are ineffective and often backfire, resulting in the unintended opposite effect, reinforcing ill-founded beliefs about vaccination and reducing intentions to vaccinate. The implications for research on vaccines misinformation and recommendations for progress are discussed.

10.1371/journal.pone.0181640

Misinformation lingers in memory: Failure of three pro-vaccination strategies

10.1073/pnas.2101386118

The 2020 US mortality totaled 2.8 million after early March, which is 17.3% higher than age-population–weighted mortality over the same time interval in 2017 to 2019, for a total excess death count of 413,592. We use data on weekly death counts by cause, as well as life tables, to quantify excess mortality and life years lost from both COVID-19 and non–COVID-19 causes by race/ethnicity, age, and gender/sex. Excess mortality from non–COVID-19 causes is substantial and much more heavily concentrated among males and minorities, especially Black, non-Hispanic males, than COVID-19 deaths. Thirty-four percent of the excess life years lost for males is from non–COVID-19 causes. While minorities represent 36% of COVID-19 deaths, they represent 70% of non–COVID-19 related excess deaths and 58% of non–COVID-19 excess life years lost. Black, non-Hispanic males represent only 6.9% of the population, but they are responsible for 8.9% of COVID-19 deaths and 28% of 2020 excess deaths from non–COVID-19 causes. For this group, nearly half of the excess life years lost in 2020 are due to non–COVID-19 causes.

Excess mortality from COVID and non-COVID causes in minority populations

The current climate surrounding childhood vaccination in the United States is one of confusion and vitriol. Despite the well-documented achievements of vaccines and extensive efforts by the public health community to ensure their safety, vocal critics of vaccination proffer a growing list of theories that link vaccines to an array of medical conditions, most prominently autism. Others question the necessity of newer vaccines, seeing their arrivals not as triumphs of medical research but as overreaches by a profit-obsessed pharmaceutical industry and an accommodating, financially conflicted medical establishment. In response to these charges, physicians, scientists, and government public health officials are routinely on the defensive, refuting allegations of unconfirmed risks, justifying the value of recommended vaccines, and striving to preserve public trust in vaccination overall. While national data suggest that a strong foundation of support for vaccination remains, regional clusters of unvaccinated children and increases in nonmedical exemptions from state school-entry vaccination requirements are causes for alarm among advocates of vaccines. Even more worrisome is research suggesting that the safety of vaccines is a growing concern among many parents [1]. The contours of the current debate regarding vaccination may be notable for their novelty—new vaccines, new recommendations, new research evidence, and new trends in diagnoses, to name a few examples. Just as striking, however, are the echoes in contemporary vaccine debates of the history of such movements. At the heart of these conflicts are the complex, long-contested relationships among citizens, science, and the state and their implications for public health policy and practice. The historical antecedents of contemporary vaccine hesitancy and refusal reveal that the present state of affairs is not an unprecedented crisis but an opportunity for renewed education, dialogue, and consensus-building regarding the value of vaccines.

New Media, Old Messages: Themes in the History of Vaccine Hesitancy and Refusa

The phenomenon known as vaccine hesitancy (a term that includes the concepts of indecision, uncertainty, delay and reluctance) is complex, closely linked to social contexts, and has different determinants: historical period, geographical area, political situation, complacency, convenience and confidence in vaccines. The World Health Organization (WHO) recommends that vaccine hesitancy and any proxy of it should be constantly monitored. Given the growing importance and pervasiveness of information and communication technologies (ICTs), the new media could be exploited in order to track lay-people's perceptions of vaccination in real time, thereby enabling health-care workers to actively engage citizens and to plan ad hoc communication strategies. Analysis of so-called "sentiments" expressed through the new media (such as Twitter) and the real-time tracking of web-related activities enabled by Google Trends, combined with the administration of specific online "surveys" on well-defined themes to target groups (such as health-care workers), could constitute a "Fast data monitoring system" that yields a snapshot of perceptions of vaccination in a given place and at a specific time. This type of dashboard could be a strategic tool that enables public services to organize targeted communication actions aimed at containing vaccine hesitancy.

The old and the new: vaccine hesitancy in the era of the Web 2.0. Challenges and opportunities

10.1093/infdis/jiz024

Influenza vaccines have a long history of safety and demonstrated efficacy; however, they are seldom used in low- and middle-income countries (LMICs). Although reasons for underuse are multifactorial and differ from country to country, the need for up to twice-annual reformulation and yearly vaccination are obstacles to influenza prevention in LMICs. Major efforts are underway to produce next-generation influenza vaccines that provide durable protection against drifted strains, and such vaccines could address these unmet needs. However, additional information is required to influence immunization policies in most LMICs. Better estimates of vaccine impact on important public health outcomes, more affordable vaccines, improved programmatic suitability, and strengthened immunization delivery infrastructures are needed and must be considered early during the development of new vaccines if widespread adoption in LMICs is to be achieved.

Influenza Immunization in Low- and Middle-Income Countries: Preparing for Next-Generation Influenza Vaccines

10.1177/2333721419870345

Background: Despite the availability of a universal influenza vaccination program in the United States and Canada, seasonal influenza vaccine (SIV) uptake among the elderly remains suboptimal. Understanding the factors that determine SIV uptake in this important population subgroup is essential for designing effective interventions to improve seasonal influenza vaccination among the elderly. We evaluated the determinants of SIV uptake in the elderly in the United States and Canada. Methods: We systematically searched relevant bibliographic databases and websites from 2000 to 2017 for population-based clinical trials or observational studies conducted in community-based elderly individuals in the United States or Canada, irrespective of health status. Two reviewers independently screened the identified citations for eligibility using a two-stage sifting approach to review the title/abstract and full-text article. We gathered data on determinants of uptake (any vaccine receipt) and adherence (receipt of vaccine in more than one season) to seasonal influenza vaccination. Where possible, we pooled the data using inverse variance methods to minimize the variance of the weighted average. Results: Five cross-sectional studies on SIV uptake (none on adherence) from the United States met our eligibility criteria. Being older (pooled odds ratio [POR] = 1.44, 95% Confidence Interval [CI] = 1.11, 1.86); White (POR = 1.33, 95% CI = [1.10, 1.64]); and having higher income (POR = 1.06, 95% CI = [1.04, 1.09]); and health insurance (POR = 1.40, 95% CI = [1.25, 1.55]) were associated with increased SIV uptake. Conclusion: Older, ethnically White, higher income elderly individuals with access to health insurance coverage and a regular health care provider have higher SIV uptake in the United States. There was limited evidence for other socioeconomic and health-related determinants. Further studies are needed to provide an evidence base for planning more effective influenza vaccination programs in the United States.

Determinants of Seasonal Influenza Vaccine Uptake Among the Elderly in the United States: A Systematic Review and Meta-Analysis

An annual influenza (flu) vaccination is recommended by the Advisory Committee on Immunization Practices (ACIP) for all people 6 months and older who do not have contraindications to vaccination; vaccination is the primary way to prevent sickness and death caused by flu.[1] The Centers for Disease Control and Prevention (CDC) analyzed data from two telephone surveys, the National Immunization Survey-Flu (NIS-Flu) and the Behavioral Risk Factor Surveillance System (BRFSS), to estimate flu vaccination coverage for the U.S. population during the 2018–19 flu season. Vaccination coverage with ≥1 dose of flu vaccine was 62.6% among children 6 months through 17 years, an increase of 4.7 percentage points from the 2017–18 flu season and 3.6 percentage points higher than coverage in the 2016–17 season. Flu vaccination coverage among adults ≥18 years was 45.3%, an increase of 8.2 percentage points from the 2017–18 flu season and 2.0 percentage points higher than the 2016–17 season. Vaccination coverage varied by state, ranging from 46.0%–81.1% among children and from 33.9%–56.3% among adults, and of the ten states with the lowest coverage for children eight were also among the ten states with the lowest coverage for adults. Interpretation of the estimates in this report should take into account limitations of the surveys, including reliance on self-report/parental-report of vaccination status, low response rates, and level of consistency with findings from other surveys and data sources. CDC is exploring the use of administrative data sources to track flu vaccination coverage. To improve flu vaccination coverage, healthcare providers are encouraged to offer influenza vaccination during routine health care visits and hospitalizations, continuing to offer vaccination as long as influenza viruses are circulating. For people who cannot visit a doctor’s office during the flu season, there are alternative and convenient places available for flu vaccinations. Improvements in vaccination coverage could provide greater benefit; in a recently published study, CDC estimated that increasing coverage by five percentage points could have prevented another 4,000 to 11,000 hospitalizations, depending on the severity of the season.[2]

Flu Vaccination Coverage, United States, 2018–19 Influenza Season

Over half (52%) of GP practice staff have received threats of physical abuse while working on the covid-19 vaccination programme, a survey has found.The poll of 222 GP practice staff by the Medical Protection Society (MPS) also found that over half (53%) of staff said that their surgery or vaccination centre had been defaced by anti-vaccination material. The survey included GPs, nurses, …

10.1136/bmj.n1665

Covid-19: GP staff have faced threats and abuse during vaccination programme, poll finds

Despite evidence in support of the benefits of wearing masks, attitudes about mask-wearing during the COVID-19 pandemic became politicized, and therefore tied with political values and group identities. When communicating about political issues, messages targeted to resonate with the core values of the receiver may be effective, an approach known as moral reframing. We first tested the relationships between moral values and mask-wearing in a sample (N=540) of self-identified liberals, conservatives, and moderates in the United States. Anti-mask attitudes were stronger in conservatives, and were associated with increased concerns for in-group loyalty, national identity, and personal liberty. We then crafted messages about the benefits of mask-wearing framed to resonate with these moral concerns, and in a pre-registered study of N=597 self-identified U.S. conservatives, tested the effect of moral reframing on anti-mask attitudes and behaviors. We found that messages framed in terms of loyalty, with appeals to the protection of the community and America, were effective in reducing anti-mask beliefs, compared with unrelated control messages and messages delivering purely scientific information, and that these changes in belief persisted for at least one week. Exploratory analyses showed that participants who saw loyalty-framed messages reported wearing masks in public more frequently in the subsequent week. These data provide evidence that moral reframing of messages about politicized issues can be effective, and specifically that framing messages about health behaviors in terms of group loyalty may be the most productive way of communicating with conservative audiences.

10.31234/osf.io/gfa5r

Moral reframing of messages about mask-wearing during the COVID-19 pandemic

10.31234/osf.io/dsf67

A significant paradigm shift is underway in communication research as open science practices (e.g., preregistration, open materials) are becoming more prevalent. The current work identified how much the field has embraced such practices and evaluated their impact on authors (e.g., citation rates). We collected 10,517 papers across 26 journals from 2010-2020, observing that 5.1% of papers used or mentioned open science practices. Communication research has seen the rate of non-significant p-values (ps > .055) increasing with the adoption of open science over time, but p-values just below p < .05 have not reduced with open science adoption. Open science adoption was unrelated to citation rate at the article level; however, it was inversely related to the journals’ h-index. Our results suggest communication organizations and scholars have important work ahead to make open science more mainstream. We close with suggestions to increase open science adoption for the field at large.

Tracing the Adoption and Effects of Open Science in Communication Research

10.1038/s41586-021-03754-2

Following the first wave of SARS-CoV-2 infections in spring 2020, Europe experienced a resurgence of the virus starting in late summer 2020 that was deadlier and more difficult to contain1. Relaxed intervention measures and summer travel have been implicated as drivers of the second wave2. Here, we build a phylogeographic model to evaluate how newly introduced lineages, as opposed to the rekindling of persistent lineages, contributed to the COVID-19 resurgence in Europe. We inform this model using genomic, mobility and epidemiological data from 10 European countries and estimate that in many countries over half of the lineages circulating in late summer resulted from new introductions since June 15th. The success in onward transmission of newly introduced lineages was negatively associated with local COVID-19 incidence during this period. The pervasive spread of variants in summer 2020 highlights the threat of viral dissemination when restrictions are lifted, and this needs to be carefully considered by strategies to control the current spread of variants that are more transmissible and/or evade immunity. Our findings indicate that more effective and coordinated measures are required to contain spread through cross-border travel even as vaccination begins to reduce disease burden. Download PDF

Untangling introductions and persistence in COVID-19 resurgence in Europe

Systematic review of the efficacy, effectiveness and safety of newer and enhanced seasonal influenza vaccines for the prevention of laboratory-confirmed influenza in individuals aged 18 years and over

Background Seasonal influenza is an infectious respiratory disease which circulates annually and is associated with a considerable health and economic burden globally. The most effective means of preventing seasonal influenza is through strain-specific vaccination. For many decades, only trivalent influenza vaccines (that include two influenza A strains and one influenza B strain) have been available. In recent years, quadrivalent (two influenza A strains and two influenza B strains) have been authorised and are increasingly available. Traditional influenza vaccines have limitations in terms of immune response and the substrate used in their manufacturing which can reduce overall effectiveness. Newer and enhanced influenza vaccines have been developed, both in trivalent and quadrivalent forms, in an attempt to counteract these limitations. Objective The objective of this systematic review is to assess and synthesise the literature on the efficacy, effectiveness and safety of newer and enhanced inactivated seasonal influenza vaccines for the prevention of laboratory-confirmed influenza in individuals aged 18 years or older, namely: MF59® adjuvanted, cell-based, high-dose, and recombinant haemagglutinin (HA) influenza vaccines. MethodsA systematic literature search was conducted in electronic databases (MEDLINE, Embase, CINAHL and The Cochrane Library) and grey literature sources up to 7 February 2020. No restrictions were placed on date or language. Randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) were eligible for inclusion. Returned records were screened for relevance and the full-text of potentially relevant articles assessed, applying predefined eligibility criteria. Two reviewers independently extracted data, and pooling was considered where two or more studies reported an outcome. Study results were pooled using both fixed and random effects meta-analysis. Two reviewers independently assessed the risk of bias of included studies using standardised tools. Certainty of evidence for key outcomes was assessed using the GRADE methodology.Main results The collective search returned 28 846 records. Removal of duplicates and screening resulted in 868 full-texts being assessed for relevance with 110 studies being included. Of these 110 studies, 48 possessed results relevant to adjuvanted influenza vaccines, 36 to high-dose influenza vaccines, 19 to cell-based influenza vaccines, and 10 to recombinant HA influenza vaccines. The primary outcomes of interest to this review are presented below, with consideration towards the hierarchy of evidence whereby only the highest available level is presented. No studies were identified which compared any, or all, of these newer and enhanced vaccines to each other. No efficacy data were identified for adjuvanted influenza vaccines for any comparator (another vaccine, placebo or ‘no vaccination’). In terms of relative vaccine effectiveness, there was no significant difference in vaccine effectiveness reported by included studies that compared adjuvanted trivalent vaccine with either non-adjuvanted trivalent or quadrivalent vaccines in adult or older adult (aged ≥65 years) populations. Adjuvanted trivalent influenza vaccines displayed a significant effect in preventing laboratory-confirmed influenza in older adults (aged ≥65 years) when compared with no vaccination for any influenza subtype (vaccine effectiveness (VE) = 45%, 95% CI 23 to 61, five NRSIs across three influenza seasons, random effects model (REM), I2=63%, low-certainty evidence), influenza A(H1N1) (VE=61%, 95% CI 44 to 73, four NRSIs across two influenza seasons, REM, I2=14.5%, low-certainty evidence) and influenza B (VE=29%, 95% CI 5 to 46, five NRSIs across three influenza seasons, REM, I2=0%, low-certainty evidence), but not for influenza A(H3N2) (VE=11%, 95% CI -25 to 36, 8 NRSIs across five influenza seasons, REM, I2=49%, very-low certainty evidence).

Pooled analyses of effectiveness data comparing adjuvanted with non-adjuvanted vaccines was restricted by limited study numbers and statistical and clinical heterogeneity. Compared with traditional trivalent influenza vaccines, adjuvanted trivalent influenza vaccines were associated with a greater number of combined local adverse events (risk ratio (RR)= 1.90, 95% CI 1.50 to 2.39, four RCTs, REM, I2=0%, moderate-certainty evidence), pain at injection site (RR=2.02, 95% CI 1.53 to 2.67, 12 RCTs, REM, I2=75%, moderate-certainty evidence), combined systemic reactions (RR=1.18, 95% CI 1.02 to 1.38, five RCTs, REM, I2=8%, moderate-certainty evidence), myalgia (RR=1.71, 95% CI 1.09 to 2.69, 10 RCTs, REM, I2=31%, moderate-certainty evidence), fever (RR=1.97, 95% CI 1.07 to 3.61, nine RCTs, REM, I2=31%, low-certainty evidence) and chills (RR=1.70, 95% CI 1.20 to 2.40, seven RCTs, REM, I2=0%, moderate-certainty evidence). High-dose trivalent influenza vaccination was shown to have higher relative vaccine efficacy in preventing influenza compared with standard-dose trivalent influenza vaccines in older adults aged 65 years and over (VE=24%, 95% CI 10 to 37, one RCT, moderate-certainty evidence). One NRSI demonstrated significant effect for high-dose trivalent vaccine against influenza B (VE=89%, 95% CI 47 to 100), but not for influenza A(H3N2) (VE=22%, 95% CI -82 to 66) when compared with no vaccination in older adults (aged ≥65 years). Based on pooled estimates, high dose trivalent and quadrivalent vaccines were associated with significantly higher rates of a range of local and systemic adverse events compared with their standard dose trivalent and quadrivalent equivalents. Specifically, they were associated with significantly higher rates of combined local reactions (RR=1.40, 95% CI 1.20 to 1.64, three RCTs, FEM, I2=25%, low-certainty evidence), pain at injection site (RR=1.56, 95% CI 1.26 to 1.93, seven RCTs, REM, I2=57%, moderate-certainty evidence), swelling (RR=2.20, 95% CI 1.12 to 4.32, I2=46%, six RCTs, low-certainty evidence), induration (RR=1.63 95% CI 1.10 to 2.39, FEM, I2=68%, two RCTS, low-certainty evidence), headache (RR=1.35, 95% CI 1.02 to 1.77, REM, I2=0%, seven RCTs, moderate-certainty evidence), chills (RR=1.73, 95% CI 1.07 to 2.81, REM, I2=0%, four RCTs, low-certainty evidence), and malaise (RR=1.28, 95% CI 1.08 to 1.51, REM, I2=0%, seven RCTs, moderate-certainty evidence). No relative efficacy data were identified for the direct comparison of cell-based vaccines compared with traditional vaccines. Efficacy data were available comparing cell-based trivalent influenza vaccines with placebo in adults (aged 18-49 years), against any influenza (VE=70%, 95% CI 61% to 77%, two RCTS, fixed effects model (FEM), I2=0%, moderate-certainty evidence), influenza A(H1N1) (VE=82%, 95% CI 71% to 89%, two RCTs, FEM, I2=62%, moderate-certainty evidence), influenza A(H3N2) (VE=72%, 95% CI 39% to 87%, two RCTs, FEM, I2= 0%, moderate-certainty evidence) and influenza B (VE=52%, 95% CI 30% to 68%, two RCTs, FEM I2=0%, moderate-certainty evidence). Limited and heterogeneous data were presented for effectiveness when compared with no vaccination. One NRSI compared cell-based trivalent and quadrivalent vaccination with traditional trivalent and quadrivalent influenza vaccines which highlighted no significant difference in effect for any influenza or specific strains in older adults. The safety profile of cell-based trivalent vaccines was comparable to traditional trivalent influenza vaccines with higher rates of ecchymosis in cell-based vaccine recipients being the only significant difference (RR=1.27, 95% CI 1.03 to 1.56, three RCTs, FEM, I2=47%, low-certainty evidence).One study found that the quadrivalent recombinant HA influenza vaccine had higher relative vaccine efficacy in preventing influenza compared with traditional quadrivalent influenza vaccination in adultsaged ≥50 years (VE=30%, 95% CI 10 to 47, one RCT, moderate-certainty evidence). Another study found that the trivalent recombinant HA vaccine had higher efficacy compared with placebo (VE=45%, 95% CI 19 to 63, one RCT) in adults aged 18-55 years. No effectiveness data were identified for comparison with no vaccination or traditional influenza vaccines. Pooled estimates indicate that, with the exception of a higher rate of chills (RR=1.33, 95% CI 1.03 to 1.72, three RCTs, FEM, I2=46%, low-certainty evidence), the safety profile of the recombinant HA trivalent and quadrivalent influenza vaccines was comparable to that of their traditional trivalent and quadrivalent vaccine equivalents.Conclusions The evidence base for the efficacy and effectiveness of newer and enhanced influenza vaccines is limited at present. Based on reviewed evidence, it is probable that these vaccines provide greater protection than no vaccination. Evidence regarding the comparability of these vaccines with traditional seasonal influenza vaccines is uncertain due to a dearth of available literature, clinical and statistical heterogeneity. A large body of evidence was presented for the safety of these influenza vaccines, with the safety profiles found to be largely in keeping with that expected when considering their individual compositions. Reporting within individual studies limited the data coverage of this review. Recommendations are provided to enhance research conduct and reporting regarding these newer and enhanced influenza vaccines which are anticipated to improve data coverage overall. A large number of potentially relevant studies were identified as ongoing, highlighting a need for this review to be updated in the near future.

20 million children worldwide – more than 1 in 10 – missed out on lifesaving vaccines such as measles, diphtheria and tetanus in 2018, according to new data from WHO and UNICEF. Globally, since 2010, vaccination coverage with three doses of diphtheria, tetanus and pertussis (DTP3) and one dose of the measles vaccine has stalled at around 86 percent. While high, this is not sufficient. 95 percent coverage is needed – globally, across countries, and communities - to protect against outbreaks of vaccine-preventable diseases.

20 million children miss out on lifesaving measles, diphtheria and tetanus vaccines in 2018

Routine childhood vaccines are among the most cost-effective life-saving interventions. In addition, vaccines have been linked with reduced stunting and improved health and other outcomes in later life. However, evidence on such long-term benefits remain inadequate. In this study, we examined the associations between the initiation and implementation of the Universal Immunization Programme (UIP) in India and schooling attainment among adults. We obtained district-level data on the rollout of the UIP in 1985–1990 and matched those with data from the National Family Health Survey of India, 2015–2016. Adults who were born in the five years before and after the rollout period (1980–1995) and always lived in the same location were included in the analysis (n=109,908). We employed household, village or city ward, district, and state fixed-effects linear regression models, which incorporated a wide range of socioeconomic and demographic indicators and community-level infrastructure, amenities, and access to healthcare. We compared schooling attainment in years among individuals who were born during or after the UIP was implemented in their districts (intervention group) with those who were born before UIP implementation (control group). In household fixed-effects analysis, intervention group adults attained 0.18 (95% confidence interval [CI]: 0.02, 0.33; p<0.05) more schooling grades as compared with control group adults from the same household. In village or city ward, district, and state fixed-effects analysis, intervention group adults attained 0.23 (95% CI: 0.13, 0.32; p<0.001), 0.29 (95% CI: 0.19, 0.38; p<0.001), and 0.25 (95% CI: 0.1, 0.39; p<0.01) additional schooling grades, respectively, compared to the control group. In subgroup analyses, positive associations between UIP implementation and schooling grades were observed among women and among rural, urban, and richer households. Our results support the association of vaccines with improved school attainment.

10.1016/j.socscimed.2020.112885

Childhood vaccinations and adult schooling attainment: Long-term evidence from India's Universal Immunization Programme

Immunization is one of modern medicine’s greatest success stories. Time and again, the international community has endorsed the value of vaccines and immunization to prevent and control a large number of infectious and, increasingly, cancers and other chronic diseases. Expanding access to immunization is crucial to achieving the Sustainable Development Goals (SDGs). Not only do vaccinations prevent sickness and death associated with infectious diseases such as diarrhoea, measles, pneumonia, polio and whooping cough, they also hold up broader gains in education and economic development.

Immunization

10.1080/10410236.2016.1266574

Suboptimal vaccination rates are a significant problem in many countries today, in spite of improved access to vaccine services. As a result, there has been a recent expansion of research on how best to communicate about vaccines. The purpose of the present article is to provide an updated review of published, peer-reviewed empirical studies that examined the effectiveness of gain versus loss framing (i.e., goal framing) in the context of vaccine communication. To locate studies, we examined the reference list from the previous meta-analytic review (O’Keefe & Nan, 2012), and we conducted systematic searches across multiple databases. We included 34 studies in the qualitative synthesis. The relative effectiveness of goal-framed vaccine messages was often shown to depend on characteristics of the message recipient, perceived risk, or situational factors, yet most effects were inconsistent across studies, or simply limited by an insufficient number of studies. Methodological characteristics and variations are noted and discussed. The review points to several directions concerning moderators and mediators of framing effects where additional rigorous studies would be needed.

Message Framing in Vaccine Communication: A Systematic Review of Published Literature

10.1111/bjhp.12340

PurposeThere is good evidence that for many behaviours, increasing risk appraisal can lead to a change in behaviour, heightened when efficacy appraisals are also increased. The present systematic review addressed whether interventions presenting a risk message increase risk appraisal and an increase in vaccination intentions and uptake.MethodA systematic search identified randomized controlled trials of interventions presenting a risk message and measuring risk appraisal and intentions and uptake post‐intervention. Random‐effects meta‐analyses investigated the size of the effect that interventions had on vaccination risk appraisal and on vaccination behaviour or intention to vaccinate, and the size of the relationship between vaccination risk appraisal and vaccination intentions and uptake.ResultsEighteen studies were included and 16 meta‐analysed. Interventions overall had small significant effects on risk appraisal (d = 0.161, p = .047) and perceptions of susceptibility (d = 0.195, p = .025), but no effect on perceptions of severity (d = −0.036, p = .828). Interventions showed no effect on intention to vaccinate (d = 0.138, p = .195) and no effect on vaccination behaviour (d = 0.043, p = .826). Interventions typically did not include many behaviour change techniques (BCTs), with the most common BCT unique to intervention conditions being ‘Information about Health Consequences’. Few of the included studies attempted to, or successfully increased, efficacy appraisals.ConclusionsOverall, there is a lack of good‐quality primary studies, and existing interventions are suboptimal. The inclusion of additional BCTs, including those to target efficacy appraisals, could increase intervention effectiveness. The protocol (CRD42015029365) is available from http://www.crd.york.ac.uk/PROSPERO/.

Do interventions containing risk messages increase risk appraisal and the subsequent vaccination intentions and uptake? – A systematic review and meta‐analysis

ST PETERSBURG, June 4 (Reuters) - Argentina and Serbia gave an official start to the industrial production of Russia's Sputnik V vaccine against coronavirus, Russian state TV channel Rossiya 24 reported on Friday.Russian President Vladimir Putin was shown on TV watching the start of vaccine production in both countries via videolink.The Russian vaccine produced in Argentina and Serbia will meet their domestic needs first and is expected to be exported at a later stage, the Russian Direct Investment Fund (RDIF) which is marketing the vaccine said in a statement.

Serbia and Argentina start producing Russia's Sputnik V vaccine

Covid-19 research made it painfully clear that the scandal of poor medical research, as denounced by Altman in 1994, persists today. The overall quality of medical research remains poor, despite longstanding criticisms. The problems are well known, but the research community fails to properly address them. We suggest most problems stem from an underlying paradox: although methodology is undeniably the backbone of qualitative and responsible research, science consistently undervalues methodology. The focus remains more on the destination (research claims and metrics) than on the journey. Notwithstanding, research should serve society more than the reputation of those involved. While we notice that many initiatives are being established to improve components of the research cycle, these initiatives are too disjointed. The overall system is monolithic and slow to adapt. We assert that a top-down action is needed from journals, universities, funders and governments to break the cycle and put methodology first. These actions should involve the widespread adoption of registered reports, balanced research funding between innovative, incremental and methodological research projects, full recognition and demystification of peer review, mandatory statistical review of reports, adherence to reporting guidelines, and investment in methodological education and research. Currently, the scientific enterprise is doing a major disservice to patients and society.

10.1016/j.jclinepi.2021.05.018

Methodology over metrics: Current scientific standards are a disservice to patients and society