REVIEW

Communicating Benefits from Vaccines BeyondPreventing Infectious Diseases

Emma-Pascale Chevalier-Cottin . Hayley Ashbaugh . Nicholas Brooke .

Gaetan Gavazzi . Mauricio Santillana . Nansa Burlet . Myint Tin Tin Htar

Received: May 21, 2020� The Author(s) 2020

ABSTRACT

Despite immunisation being one of the greatestmedical success stories of the twentieth century,there is a growing lack of confidence in somevaccines. Improving communication about thedirect benefits of vaccination as well as its

benefits beyond preventing infectious diseasesmay help regain this lost confidence. A confer-ence was organised at the Fondation Merieux inFrance to discuss what benefits could be com-municated and how innovative digital initia-tives can used for communication. During thismeeting, a wide range of indirect benefits ofvaccination were discussed. For example, influ-enza vaccination can reduce hospitalisationsand deaths in older persons with diabetes by45% and 38%, respectively, but the linkbetween influenza and complications fromunderlying chronic non-communicable diseasessuch as diabetes is frequently underestimated.Vaccination can reduce antimicrobial resistance(AMR), which is growing, by reducing the inci-dence of infectious disease (though direct andindirect or herd protection), by reducing thenumber of circulating AMR strains, and byreducing the need for antimicrobial use. Diseasemorbidity and treatment costs in the elderlypopulation are likely to rise substantially, withthe ageing global population. Healthy ageingand life-course vaccination approaches canreduce the burden of vaccine-preventable dis-eases, such as seasonal influenza and pneumo-coccal diseases, which place a significant burdenon individuals and society, while improvingquality of life. Novel disease surveillance sys-tems based on information from Internet searchengines, mobile phone apps, social media,cloud-based electronic health records, andcrowd-sourced systems, contribute to improved

Digital Features To view digital features for this articlego to https://doi.org/10.6084/m9.figshare.12482654.

E.-P. Chevalier-Cottin (&)Sanofi Pasteur, Lyon, Francee-mail: pascale.cottin@sanofi.com

H. AshbaughDepartment of Epidemiology, UCLA Fielding Schoolof Public Health, UCLA Fielding School of PublicHealth, South, Los Angeles, CA, USA

N. BrookeThe Synergist.org, Brussels, Belgium

G. GavazziGeriatric Clinic, Grenoble-Alpes UniversityHospital, GREPI EA, Grenoble-Alpes University,7408 Grenoble, France

M. SantillanaHarvard Medical School/Boston Children’s Hospital,Boston, USA

N. BurletGlobal head Patient Insights Innovation, SanofiPasteur, Lyon, France

M. Tin Tin HtarMedical Development and Scientific/ClinicalAffairs, Pfizer Inc., Paris, France

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https://doi.org/10.1007/s40121-020-00312-7

awareness of disease burden. Examples of therole of new techniques and tools to process datagenerated by multiple sources, such as artificialintelligence, to support vaccination pro-grammes, such as influenza and dengue, werediscussed. The conference participants agreedthat continual efforts are needed from allstakeholders to ensure effective, transparentcommunication of the full benefits and risks ofvaccination.

Keywords: Communication; Direct benefits;Indirect benefits; Vaccination; Vaccines

Key Summary Points

Communication about vaccinationbenefits often concentrates on directbenefits (disease prevention), but there is awide range of indirect effects.

Communicating the full benefits ofvaccination could help to regain publicconfidence in vaccines and vaccination.

The meeting participants agreed thatcontinual efforts are needed from allstakeholders to ensure effective,transparent communication of the fullbenefits and risks of vaccination.

INTRODUCTION

Vaccination is still, by far, the safest and mosteffective way of preventing infectious diseases,and is acknowledged to be one of the greatestglobal health achievements, with an estimated2–3 million deaths averted every year [1]. Overthe last two centuries, vaccination has enabledsmallpox to be eradicated, and it has reducedglobal child mortality rates and preventedcountless birth defects and lifelong disabilities,such as paralysis from polio [2].

However, the benefits from vaccines andvaccination programmes go beyond preventing

infections. There is a growing body of scientificevidence about indirect benefits, but thesebenefits and their impact are often underesti-mated and poorly communicated. They includethe reduction of the medical and socioeco-nomic disease burden and the synergy betweenvaccination and disease prevalence. The pro-tection offered by many vaccines can beextended, through herd protection, to unvac-cinated individuals in the community, includ-ing those in vulnerable populations who areeither too young to be vaccinated, have waningimmune systems (i.e., the elderly), or areimmunosuppressed due to medical conditionsor treatment. Also, vaccination can prevent thenegative impact on quality of life that isobserved in some individuals who have sufferedfrom a preventable disease. In addition, veteri-nary vaccines not only improve animal healthbut they can also have a positive impact onhuman infections for certain diseases by reduc-ing the use of antimicrobials in food-producinganimals, and thus control the development ofantibiotic resistance in pathogens, such asCampylobacter, Salmonella, Escherichia coli andStaphylococcus aureus, that can infect humans[3, 4].

Communication on vaccine effectivenessand safety should be proactive, implemented atthe early stages of the implementation of vac-cination programmes and continued routinely.This communication increase awareness aboutthe overall benefits of vaccines and vaccinationprogrammes, including their indirect benefits aswell as their direct benefits. Confidence in vac-cines and vaccination programmes has beennegatively affected by well-publicised scaresabout vaccine safety, such as the debunkedstudy linking autism and measles–mumps–ru-bella (MMR) vaccination [5]. This increasingglobal and specific vaccine hesitancy needs tobe addressed by proactive communication onvaccines and vaccination programmes.

As with any communication, it is importantto ensure that the target audience receives andunderstands the information. New technolo-gies, such as mobile phones, websites and socialmedia could be used to ensure that the com-munication is accessible. However, it is alsonecessary to ensure that the information is

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actually received by the target audience, andthat it is understandable, in order to help regainand maintain public trust in vaccination and itsbenefits.

A two-day meeting was organised by theFondation Merieux in December 2017 at theirconference centre in Veyrier-du-Lac, France, todiscuss these issues and illustrate them throughexamples [6]. This meeting brought together 44experts from 12 countries who shared theirexperiences about the full benefits from vacci-nation, both direct and indirect, and methodsfor effective communication about vaccinebenefits and how innovative digital initiativescould be effectively used in communication.

A medical writer attended the meeting andprepared an outline of this paper based on thepresentations and discussion during the meet-ing. This was completed and validated by theauthors who were consenting members of theScientific Committee, who then worked withthe medical writer to develop the completepaper. The conference presentations and dis-cussions are summarised under four mainthemes:

1. Indirect benefits of vaccines andvaccination.

2. Improving vaccination uptake to increasebenefits from vaccination.

3. Disease surveillance and epidemiologicalforecasting.

4. Public health communication strategies.

This paper reports the presentations andensuing discussion during the meeting, and weacknowledge that not all aspects of thesethemes were covered in the meeting. This arti-cle is based on previously conducted studies anddoes not contain any studies with human par-ticipants or animals performed by any of theauthors.

INDIRECT BENEFITS OF VACCINESAND VACCINATION

The indirect benefits of vaccines and vaccina-tion are numerous and often underestimated.Examples of some of these benefits are sum-marised in Fig. 1 and Table 1 [7–20].

Conjugate pneumococcal vaccines (PCV)provide a powerful illustration of numerousindirect benefits. Antimicrobial resistancedevelops naturally over time, usually throughgenetic changes, but the misuse and overuse ofantibiotics have accelerated this process. As therate of resistance grows, fewer effective antibi-otics are available to treat common infectiousdiseases which can then become untreatable.Since the introduction of the first PCV vaccinecontaining antigens from seven pneumococcalstrains (PCV7), the incidence of penicillin non-susceptible disease, particularly due to vaccine-type strains, has decreased, not only in vacci-nated children but also in unvaccinated indi-viduals, particularly the elderly [22]. This isthought to be due to a reduction in nasopha-ryngeal carriage, and thus the presence of fewerpathogens leading to less severe diseases whichresulted in fewer antibiotics being prescribed.One study showed a decrease in antibiotic pre-scriptions of 18% (95% CI 6; 38) from 2000 to2010 for children and adolescents, with nochange in adults and an increase of 30% in theelderly [23]. Other vaccines, such as diphtheria,pertussis, Hib, meningococcal, influenza,measles and varicella, also have the potential toreduce antibiotic use and the development ofantimicrobial resistance [10, 24]. The full ben-efits of PCV vaccines include a reduction inhospital visits for acute otitis media, reducedincidences of community-acquired pneumonia(CAP), invasive pneumococcal disease (IPD),and pleural effusion, CAP- and IPD-associatedhospitalisation in vaccinated and unvaccinatedpopulations [25, 26]. In addition, the incidenceof any bacteraemia decreased from[ 100/100,000 children aged 3–36 months in 1998to\20/100,000 children in 2014 [27].

It is estimated that about 16% of humancancers globally are caused by infectious agents,although data from reliable registries in Africasuggests that 30–50% of cancers could be causedby infectious agents. A number of oncogenicviruses have been identified, and these includehuman papilloma virus (HPV), hepatitis B and Cviruses (HBV, HCV), Epstein–Barr virus (EBV),Human T-Lymphotropic Virus Type 1 (HTLV-1),human herpesvirus-8 (HHV-8) and Merkle cellpolyomavirus (MCV) [28, 29]. Cancer is not a

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primary feature of the disease process and thetumours do not contain replicative virus. How-ever, cancer can occur in chronically infectedindividuals and, therefore, prevention of theinitial infection, which will also preventchronic infection, will reduce cancer incidencedue to oncogenic viruses. Vaccines for HPVhave been shown to prevent HPV infections andto reduce the incidence of pre-cancerouslesions. Although vaccines are not currentlyavailable for all oncogenic viruses, there is hopethat when they do become available and areshown to prevent initial infection, and there-fore chronic infection, they will also have animpact on cancer incidence.

Over the past two decades, much progresshas been made towards global measles control,as uptake of the first dose of measles-containingvaccine (MCV1) increased worldwide between2000 and 2017 from 72 to 85%, and measlesmortality decreased an estimated 80% (from545,174 to 109,638) during the same time per-iod [30]. While this reduction in mortality isencouraging, even in a healthy child, infectionwith measles virus is associated with a short(approximately 1 week) lymphopenia and amore prolonged period of immune suppression[31, 32]. Some studies suggest that there is a loss

of immunological memory due to measles virus’preferential infection of CD150 ? memorylymphocytes and their subsequent depletion[31, 33]. A recent study in the Netherlands hasconfirmed that measles virus infection canreduce pre-existing protective antibodies [34].The association of measles infection withincreased morbidity and mortality due to non-measles infectious disease has been shown inpopulations of children from wealthy countries,and this increased mortality rate appears to lastfor 2–3 years after the infection [35, 36].

This potential prolonged immune suppres-sion is particularly important in countries suchas the Democratic Republic of the Congo (DRC)where malnutrition, associated with dysfunc-tion of cell-mediated immunity, is widespreadand may result in increased measles mortality,relative to wealthy countries [37–39]. A study of2350 children between 9 and 59 months of agein the DRC showed that children with a repor-ted history of measles infection were morelikely to have had a fever in the 2 weeks pre-ceding parental interview (OR: 1.80, 95% CI1.25; 2.60) compared with children who did nothave a history of measles [40]. In the samestudy, receipt of measles vaccination was pro-tective against recent fever (OR: 0.53, 95% CI

Fig. 1 Examples of benefits from vaccines and vaccinology

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0.38; 0.73), and similar work examining chil-dren in the DRC suggests that measles may havea long-term negative impact on pre-existing,

vaccine-induced immunity to tetanus [41].These studies suggest that measles vaccinationprogrammes are important in both resource-poor and resource-wealthy countries, not onlyfor the prevention of measles infection but alsofor the indirect prevention of other infectiousdiseases.

In Libya, the first vaccination programmewas set up in the 1960s, and it has been updatedconstantly and now covers both children andadults. Vaccination, which is enforced by law, isfree of charge to everyone, including those liv-ing in war zones and displaced persons, and haspromoted equity in the country and reducedpoverty [42]. This is considered to be thecornerstone of the healthcare system, and pub-lic support is crucial for the success of the vac-cination programme. The programme hascontributed to reductions in infant morbidityand mortality rates, in congenital disease rates,in sequelae from vaccine-preventable diseases,such as permanent disability, and in rates ofdiseases related to infection, such as cancer.Although it is expensive, the annual return-on-investment is estimated to be about 12–18%,although the full economic benefits of theimproved health of the population continue tobe largely underestimated.

Vaccination, as a prevention strategy, shouldbe viewed as part of an age-based approach tohealth throughout all phases of life [43].Although many people view vaccination as justa childhood intervention, it is also importantfor adults and the elderly, the so-called ‘life-course vaccination’ [44]. Vaccination in adultsand, in particular, the elderly, goes beyondprevention of infectious diseases. The elderlyoften have chronic diseases such as diabetes andcardiovascular and renal disease and theseconditions can be aggravated by infections,which can require hospitalisation, worsening ofchronic diseases and lead to disability and death(Fig. 2) [16–18, 45–47]. Waiting until adults are‘old’ before vaccinating can be too late due toimmunosenescence, i.e., the ageing of theimmune system, leading to poor immuneresponses [48, 49]. Preventing infections canpreserve quality of life in the elderly, and canhelp prevent catastrophic disability in theelderly population [50].

Table 1 Examples of indirect benefits provided by specificvaccines

Vaccines Indirect benefits

Pneumococcal conjugate

vaccines

Prevention of

nasopharyngeal carriage

[7, 8]

Reduction of diseases in

unvaccinated populations

(herd or indirect effect)

[9]

Reduction of antimicrobial

resistance and

antimicrobial use [10]

Haemophilus influenzaetype B, meningococcal

disease, measles; viral

vaccines, such as

influenza, respiratory

syncytial virus, and

measles

Reduced antimicrobial use,

including use for

secondary infections, and

reduced antimicrobial

resistance [11–13]

Reducing inappropriate

antibiotic prescriptions

[14]

Influenza Reduced antimicrobial use

and antimicrobial

resistance [15]

Decrease in cardiovascular

events, i.e. myocardial

infarction, stroke, cardiac

insufficiency [16–18]

Hepatitis B Cirrhosis and liver cancer

(due to prevention of

chronic carriage) [19]

Human papilloma virus

(HPV)

HPV-related cancers (due to

prevention of chronic

carriage) in both female

and male [20]

Vertical transmission

(neonatal) [21]

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Indirect benefits from vaccination can beeconomic. For example, it has been estimatedthat, for children born in the US during1994–2013, vaccination will have prevented322 million illnesses, 21 million hospitalisa-tions and 732,000 premature deaths, resultingin a saving of $295 billion in direct medicalcosts and $1.38 trillion in total societal costs[51]. In Finland, it was reported that 195 days ofparental work are lost for every 100 influenza-infected children aged\3 years [52]. A mod-elling study for 27 European countries esti-mated that the overall costs averted forinfluenza with a 44% influenza vaccinationcoverage in eligible populations was €248 mil-lion; if coverage were to be increased to 75%,there would be an additional €190 millionaverted [53].

IMPROVING VACCINATIONUPTAKE TO INCREASE BENEFITSFROM VACCINATION

Vaccines by themselves do not prevent infec-tions but vaccination does, and thus it is crucialto reach an optimal vaccine coverage rate toachieve the full benefits of vaccination in a

population. The reasons for non-vaccinationmay vary for different individuals and can alsobe either for specific vaccines or for vaccinationin general, leading to refusal of all vaccines [54].In the context of growing vaccine hesitancy,constantly changing population dynamic, dis-ease epidemiology and communication chan-nels around the world, developing specific,strategic communication is a crucial element ofvaccination policies to ensure high vaccineuptake to enable the full benefits of vaccinationto be achieved. This communication should bebased on public or audience listening throughformal research or monitoring Internet andsocial media, understanding audience profile,interacting and trust-building [55].

The ADVANCE consortium, a European ini-tiative funded by the Innovative MedicinesInitiative, was composed of public and privatepartners, including regulatory agencies, publichealth institutions, research institutes and vac-cine manufacturers. ADVANCE developed rec-ommendations for strategies for thecommunication of the benefits and risk ofmarketed vaccines to inform decision-making[56]. The ADVANCE consortium recommendthat a comprehensive communication strategyshould be developed, using a multi-stakeholder

Fig. 2 Impact of influenza, zoster and pneumococcal diseases on the frailty syndrome in the elderly

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approach, early in any post-marketing vaccineproject. They recommend a step-wise approach,with, first, the definition of the goal andobjectives of the communication; second, themapping of stakeholders; third, the develop-ment of content and core component such asaudience identity, communication channelsand message and engagement strategy; andfinally, the development of an implementationand monitoring plan. They stress the need fortransparency, both for the evidence generationprocess and the involvement and role of dif-ferent partners, which is of particular impor-tance when a public–private collaboration isinvolved [57].

Education of the communication targets andthe development of confidence in the source ofthe information (e.g., vaccine manufacturers,health authorities) are essential for ensuring theeffectiveness of the communication. In addi-tion, the communication dissemination routeshould be adapted to each audience. The vastarray of communication tools, ranging fromone-to-one conversations with healthcare pro-viders, print media, television and Internet,with the increasing number of social mediatools, need to be matched with the informationbeing communicated and the audience beingtargeted to ensure effective communication.

One example of the importance of commu-nication is the 2014 ‘Fluad crisis’ in Italy [58].Following the death of three elderly people, twobatches of Fluad were recalled and vaccinationwith Fluad was suspended by the ItalianMedicines Agency as a precautionary measure.Following investigation, it was concluded thatthe batches were not contaminated and thenature of the deaths (cardiovascular) in theelderly people ruled out an infectious cause[59]. However, the disproportionate amount ofmedia coverage given to the decision to suspendvaccination with Fluad, compared with thatgiven to the conclusions of non-association,resulted in a 7% decrease of influenza vaccina-tion uptake in the elderly and reduced vaccineconfidence in the general population[58, 60, 61]. This crisis emphasised the impor-tance of having data on background rates forevents, such as death, in the populations tar-geted by the different vaccines in order to be

able to distinguish legitimate safety concernsfrom events that could have a temporal associ-ation with vaccination, particularly for massvaccination programmes [62]. Negative events,in this case, death, create more ‘buzz’ thanpositives ones; in this case, the non-associationof vaccination with the deaths. This crisis is oneexample of how information is readily dissem-inated via the press and social media and howquickly reports can become ‘viral’, withouthaving the complete story presented in a bal-anced manner [63]. Hence, improving commu-nication on vaccines should proactively notonly concentrate on safety but should also beaccompanied by communication on vaccinebenefits, both direct and indirect, with the aimof restoring confidence in vaccination, reducingvaccine hesitancy and improving vaccinationuptake.

DISEASE SURVEILLANCEAND EPIDEMIOLOGICALFORECASTING

Disease surveillance and epidemiological fore-casting systems are improving with advances inInternet tools. These are important, as they canprovide estimates of disease activity and vaccineeffectiveness in near-real time. Examples ofsuch systems include HealthMap, which pro-vides content that is aggregated from diverse,freely available information sources covering abroad range of emerging infectious diseases[64, 65]. Another example is Break Dengue,which has been set up by a non-profit organi-sation to connect different initiatives address-ing the issue of dengue around the world, sothat together they can have a bigger impact[66]. Break Dengue uses ‘crowd surveillance’ asone of its data sources. Both healthcare profes-sionals and members of the public can reportdengue cases via the Break Dengue website. Thesystem does not collect symptoms or proposetreatment, it only asks several questions fol-lowing a decisions tree to understand the con-text of the visitor, including if the diagnosis hasbeen confirmed by a doctor for a scenarioinvolving reporting cases. At the end of thedecision tree, tailored advice is offered to

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inform the visitor and help reduce the spread ofthe disease. This crowd surveillance, coupledwith data from internet search engines andsocial media reports of new cases, provideshigh-quality, close to real-time, disease surveil-lance [67–69]. Although the website does notpromote vaccination, it connects interdepen-dent stakeholders, and raises disease awarenessand the understanding that vaccination is thesolution for prevention. Close to real-timesurveillance integrated with stakeholder-speci-fic user interfaces have the potential to connectinterdependent stakeholders, such as healthauthorities, physicians, patients and otherstakeholders in the field, and help improve allaspects of immunisation, from prevention andsurveillance to vaccination campaigns. It isplanned to develop similar systems for otherdiseases in the future.

In addition, the data collected by this systemcan be used to feed into quantitative models ofepidemiological prediction which can be usedto support public health decision-making. In2014, the American Centers for Disease Controland Prevention (CDC) started the EpidemicPrediction Initiative (EPI) that aims to improvethe science and usability of epidemic forecastsby facilitating open forecasting projects withspecific public health objectives [70]. SinceJanuary 2016, influenza forecasts from partici-pating teams in real time have been publishedon their website. Although these forecasts haveconsistently outperformed historical expecta-tions, they are actively developing and testingnew models. In Europe, epidemiological dataare collected and owned by each country andare generally not publicly available. Surveillancestrategies are exploring the combination ofdigital data through ensemble modelling andfurther participative approaches with all stake-holders, looking at increasing forecasting per-formance and actionability of surveillance data.Hence, other approaches for sharing real-timedata, particularly vaccine effectiveness andpost-marketing safety surveillance, are beingexplored in projects such as ADVANCE,VAC4EU and DRIVE in Europe [71–73].

During the ADVANCE project, the impor-tance of reinforcing credibility of vaccine-re-lated information and building sustainable

confidence in vaccines and vaccination for allstakeholders were emphasised [57]. Organisa-tions such as CDC and WHO provide on-linevaccine information services that are accessibleby the general public as well as by healthcareprofessionals [1, 74]. Transparency and inde-pendence are crucial characteristics for anyinformation source for ensuring public trust.

PUBLIC HEALTHCOMMUNICATION STRATEGIES

The challenges for the delivery and communi-cation of information about vaccines and vac-cination to parents and other members of thelay public include having the right informationat the right time and providing reliable infor-mation to improve the perception of the bene-fits and safety of vaccines and vaccination. Oneway of doing this could be to expand the role ofthe different vaccine providers (e.g. pharma-cists/pharmacy assistants, nurses), who willneed access to the information that they willcommunicate, and also training to allow themto deliver the information effectively. Oneexample of this is the use of SMS messages toremind parents and other individuals that theirvaccination is due, which was shown toimprove the completion of HPV vaccinationseries [75, 76]. Educational messages that fostervaccine health literacy can also be transmittedvia SMS by healthcare professionals.

It has been reported that school settings offera unique opportunity to reach important targetgroups with comprehensive health informationand to promote positive behaviour change forchildren and their families [77]. In some set-tings, the current efforts to promote parentalvaccine acceptance are insufficient, as shown bybelow-target vaccination uptake rates. Onesolution could be to look at a longer-termstrategy in which children, who are the futuregenerations of parents, are taught to be moreaware of all the benefits of vaccines and vacci-nation, and therefore more likely to acceptvaccination and be less prone to react nega-tively to vaccine safety scares. This could beachieved by targeting school children to createan understanding of vaccines and vaccination

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at an early age and, thereby, encourage them toaccept vaccination when they are adults. Ide-ally, education about vaccines and vaccinationcould become an integral part of school curric-ular, in the same way as other health topics,such as preventive behaviours. A game-basedmodule on vaccines, designed to provide expe-rienced-based learning, which is more effectivethan passive learning with second-handknowledge, has been developed. In a game, it ispossible to convert theoretical knowledge intopractical knowledge, i.e. learning by doing.Learning games are ideal for schools becausethey engage and motivate students, which arethe most important factors when learning. Also,games create an environment in which indi-viduals can develop relevant skills and knowl-edge to enable them to react in an evidence-informed manner and to test their knowledgewithout fear of failure. Classroom Games is agamified educational platform, but it is not acomputer game, as the students spend most oftheir time solving tasks in an analogue envi-ronment and not on a computer. The WHOEuropean Regional Office is developing andpilot-testing a game-based education module onimmunisation and vaccination for school chil-dren aged 10–11 years, with the aim of pro-moting durable positive behavioural changes inchildren and their families, and building pop-ulation resilience against vaccine safety scaresin Europe.

DISCUSSION AND CONCLUSIONS

The participants at the workshop all agreed thatit is important to continue to share experiencesabout communicating the whole range of vac-cine and vaccination benefits to increase theirimpact and to improve vaccination uptake.How this information is obtained must beclearly and transparently explained to guaran-tee its credibility. In addition to communicat-ing the benefits of vaccines and vaccination, itis important that information about any safetyissues are rapidly communicated to show thatall organisations, both public and private, areactively collecting safety data using validatedscientific methods. The overall aim of

communicating this information is to promoteinformed decision-making using evidence-based benefit/risk ratios at all levels, includinghealth authorities, with the goal of improvingvaccination uptake, and therefore all citizens’health. This is increasingly important, as wehave moved away from childhood vaccinationtowards the paradigm of life-course vaccinationwith the aim of not just preventing infantilemorbidity and mortality but also promotinghealthy ageing.

While communication needs to be transver-sal, we must ensure that correct and pertinentinformation is delivered to the target audiencein a format that they can readily access,understand, and use at the right time. Advancesin communication technologies should be usedto facilitate this and to enable timely deliverableof the right information to the right audience.Alert systems, such as SMS, which can be usedto remind individuals about their next vacci-nation, as well as provide information aboutvaccines and vaccination, can contribute to thetimely delivery of information.

Education of all target audiences will beessential to ensure that the communicatedinformation can be correctly used. In additionto educating healthcare professionals aboutvaccines and vaccination, they must also betrained in communication, as they remain animportant source of information for manyindividuals. Education of the general publiccould start in schools. Although this requires along-term investment, it will produce membersof the public who are knowledgeable about theimportance of vaccines, vaccination, and thefull benefits of vaccines, and who will beequipped to respond in an informed manner tovaccine safety scares. We should also educatejournalists about the importance of providingbalanced reporting of vaccine safety concerns.They need to report not only on vaccine safetyscares as they occur but they also need to reportthe findings from the ensuing investigations soas to provide the full story to the public. TheFluad incident in Italy and the debunked linkbetween MMR vaccination and autism, men-tioned earlier, are examples in which reportingon the initial scare far outweighed reporting onthe results from the subsequent investigations,

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which led to loss of public confidence andimportant reductions in vaccination uptake.

This conference report highlights the widespectrum of indirect benefits of vaccinationbeyond the well-known direct benefits in vac-cinated populations. It also emphasises theimportance of transparent and effective com-munication strategies and the need to buildmutual trust and understanding between allpublic and private vaccine organisations andthe lay public. We need to improve our under-standing of the various social behaviours ofparents and other individuals that influencedecision-making processes for vaccines andvaccination. We also need to improve ourunderstanding of healthcare professionals’motivation to provide impartial, credible infor-mation about vaccination and its full benefits,and to build on this to train them to commu-nicate to, and install an effective dialogue with,parents and other individuals. The conferenceparticipants called for continual efforts from allstakeholders to ensure effective, transparentcommunication of the full benefits and risks ofvaccines and vaccination with the aim ofimproving health for all individuals. To achievethis, all stakeholders, including the lay public,must continue to dialogue and collaborate.

ACKNOWLEDGEMENTS

The authors would like to thank the speakers, inparticular Robert Cohen, Michael Johansson,Louise Letley, Siff Malue Nielsen, David Sinclair,Melissa Stockwell, Alberto Tozzi for their inputin earlier versions of this paper, and the partic-ipants at the meeting for their active involve-ment in discussions during the meeting. Theviews and information presented are those ofthe authors and do not represent the officialposition of the U.S. Army Medical Center ofExcellence, the U.S. Army Training and Doc-trine Command, or the Departments of Army,Department of Defense, or U.S. Government.

Funding. The meeting was funded by theFondation Merieux who received an unre-stricted grant from Sanofi Pasture. Funding for

the Rapid Service Fees incurred was provided bySanofi Pasteur.

Medical Writing and Editorial Assis-tance. Medical writing and editorial assistancefor this manuscript was provided by MargaretHaugh, MediCom Consult, Villeurbanne,France, and was funded by Sanofi Pasteur.

Authorship. All named authors meet theInternational Committee of Medical JournalEditors (ICMJE) criteria for authorship for thisarticle, take responsibility for the integrity ofthe work as a whole, and have given theirapproval for this version to be published.

Disclosures. Emma-Pascale Chevalier-Cottinand Nansa Burlet are employed by Sanofi Pas-teur. Myint Tin Tin Htar is employed by Pfizer.Hayley Ashbaugh, Nicholas Brooke, GaetanGavazzi and Mauricio Santillana declare thatthey have no conflict of interest.

Compliance with Ethics Guidelines. Thisarticle is based on previously conducted studiesand does not contain any studies with humanparticipants or animals performed by any of theauthors.

Open Access. This article is licensed under aCreative Commons Attribution-NonCommer-cial 4.0 International License, which permitsany non-commercial use, sharing, adaptation,distribution and reproduction in any mediumor format, as long as you give appropriate creditto the original author(s) and the source, providea link to the Creative Commons licence, andindicate if changes were made. The images orother third party material in this article areincluded in the article’s Creative Commonslicence, unless indicated otherwise in a creditline to the material. If material is not includedin the article’s Creative Commons licence andyour intended use is not permitted by statutoryregulation or exceeds the permitted use, youwill need to obtain permission directly from thecopyright holder. To view a copy of this licence,visit http://creativecommons.org/licenses/by-nc/4.0/.

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