Risks, Controversies & Vaccinations – RISCOVAC

During the last two centuries, vaccination has greatly contributed to the spectacular increase in life expectancy observed in developed countries. However, according to many public health experts, vaccines are losing public confidence. This growing confidence gap can be seen in the rising amount of individual questioning and hesitancy around vaccines, in the resurgence of organized anti-vaccination movements, especially visible on the internet as well as by the decline of vaccination coverage for some vaccines and target populations (and the resulting outbreaks in vaccine-preventable diseases, such as measles in several European countries).
In the current context characterized both by the persistence of well-known infectious diseases (measles, seasonal flu...) and by the emergence of new infectious risks (H1N1 influenza, the Ebola virus), such a confidence crisis and the correlated behaviours constitute a critical challenge for public health. In order to manage such risks successfully, it is necessary to better understand lay people’s beliefs, attitudes and behaviours regarding vaccination.
Researchers investigating this field have been increasingly using a new term “vaccine hesitancy” to describe the spread of vaccine reluctance, leading to vaccine delays and sometimes refusals. Vaccine-hesitant people are described as a heterogeneous category regrouping many people who share varying degrees and motives for indecision about specific vaccines. Vaccine hesitancy deserves a critical appraisal. It strongly echoes some key structural features of contemporary societies, namely ‘healthism’ and the ‘disenchantment of science’. Indeed, some authors describe vaccine hesitant people as very committed in vaccination issues and prone to information seeking and balanced decision-making. But people who decide to take their health in hand are confronted to discordant sources of knowledge, and they may distrust ‘official’ experts and rather put their faith in ‘alternative’ sources or medical practice.
Physicians, and especially general practitioners (GPs), are traditionally the main interlocutors of lay people regarding vaccination issues. But they may feel increasingly uncomfortable regarding vaccination issues and when encouraging their patients to get vaccinated. Several authors claimed that the media, and especially the Internet, play a key role in spreading the views of anti-vaccination movements and vaccine-critical groups, and in fuelling vaccine controversies and vaccine hesitancy.
We propose a research program based on a multidisciplinary approach, aiming at a better understanding of lay people’s beliefs, attitudes and behaviours regarding vaccination issues. We will consider various kinds of vaccines, including children vaccines, and various kinds of populations within the French context. The specific objectives of the program will be the following:
I. Building and testing empirically a conceptual framework for understanding lay people’s vaccine hesitancy and its social differentiation, for different vaccines, and with various data sources.
II. Investigating physicians’ beliefs, attitudes and behaviours concerning vaccination issues, for themselves and for their patients, including their level of confidence regarding various information sources. We will consider GPs as well as specialists, whose role can be crucial regarding immunization among people living with a chronic disease. We will also investigate the interaction between physicians and their patients, especially regarding vaccine hesitancy.
III. Studying the conditions under which vaccine-related controversies emerge in the media and on the Internet. Using tools and concepts developed in the sociology of controversies as well as the latest advances in web analysis, we will identify the main factors (technological, institutional, political, cultural) that facilitate the diffusion of vaccine-critical information.