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Larson H.J.,London School of Hygiene and Tropical Medicine | Jarrett C.,London School of Hygiene and Tropical Medicine | Schulz W.S.,London School of Hygiene and Tropical Medicine | Chaudhuri M.,India | And 16 more authors.
Vaccine | Year: 2015

In March 2012, the SAGE Working Group on Vaccine Hesitancy was convened to define the term "vaccine hesitancy", as well as to map the determinants of vaccine hesitancy and develop tools to measure and address the nature and scale of hesitancy in settings where it is becoming more evident. The definition of vaccine hesitancy and a matrix of determinants guided the development of a survey tool to assess the nature and scale of hesitancy issues. Additionally, vaccine hesitancy questions were piloted in the annual WHO-UNICEF joint reporting form, completed by National Immunization Managers globally. The objective of characterizing the nature and scale of vaccine hesitancy issues is to better inform the development of appropriate strategies and policies to address the concerns expressed, and to sustain confidence in vaccination. The Working Group developed a matrix of the determinants of vaccine hesitancy informed by a systematic review of peer reviewed and grey literature, and by the expertise of the working group. The matrix mapped the key factors influencing the decision to accept, delay or reject some or all vaccines under three categories: contextual, individual and group, and vaccine-specific. These categories framed the menu of survey questions presented in this paper to help diagnose and address vaccine hesitancy. © 2015.


MacDonald N.E.,Dalhousie University | MacDonald N.E.,Dal housie University | Eskola J.,Finnish National Institute for Health and Welfare | Liang X.,Chinese Center for Disease Control | And 12 more authors.
Vaccine | Year: 2015

The SAGE Working Group on Vaccine Hesitancy concluded that vaccine hesitancy refers to delay in acceptance or refusal of vaccination despite availability of vaccination services. Vaccine hesitancy is complex and context specific, varying across time, place and vaccines. It is influenced by factors such as complacency, convenience and confidence. The Working Group retained the term 'vaccine' rather than 'vaccination' hesitancy, although the latter more correctly implies the broader range of immunization concerns, as vaccine hesitancy is the more commonly used term. While high levels of hesitancy lead to low vaccine demand, low levels of hesitancy do not necessarily mean high vaccine demand. The Vaccine Hesitancy Determinants Matrix displays the factors influencing the behavioral decision to accept, delay or reject some or all vaccines under three categories: contextual, individual and group, and vaccine/vaccination-specific influences. © 2015.


Nowak G.J.,University of Georgia | Gellin B.G.,Health-U | MacDonald N.E.,Dalhousie University | MacDonald N.E.,Dal housie University | And 15 more authors.
Vaccine | Year: 2015

Many countries and communities are dealing with groups and growing numbers of individuals who are delaying or refusing recommended vaccinations for themselves or their children. This has created a need for immunization programs to find approaches and strategies to address vaccine hesitancy. An important source of useful approaches and strategies is found in the frameworks, practices, and principles used by commercial and social marketers, many of which have been used by immunization programs. This review examines how social and commercial marketing principles and practices can be used to help address vaccine hesitancy. It provides an introduction to key marketing and social marketing concepts, identifies some of the major challenges to applying commercial and social marketing approaches to immunization programs, illustrates how immunization advocates and programs can use marketing and social marketing approaches to address vaccine hesitancy, and identifies some of the lessons that commercial and non-immunization sectors have learned that may have relevance for immunization. While the use of commercial and social marketing practices and principles does not guarantee success, the evidence, lessons learned, and applications to date indicate that they have considerable value in fostering vaccine acceptance. © 2015.


Dube E.,Institute National Of Sante Publique Du Quebec | Gagnon D.,Institute National Of Sante Publique Du Quebec | MacDonald N.E.,Dalhousie University | MacDonald N.E.,Dal housie University | And 13 more authors.
Vaccine | Year: 2015

When faced with vaccine hesitancy, public health authorities are looking for effective strategies to address this issue. In this paper, the findings of 15 published literature reviews or meta-analysis that have examined the effectiveness of different interventions to reduce vaccine hesitancy and/or to enhance vaccine acceptance are presented and discussed. From the literature, there is no strong evidence to recommend any specific intervention to address vaccine hesitancy/refusal. The reviewed studies included interventions with diverse content and approaches that were implemented in different settings and targeted various populations. Few interventions were directly targeted to vaccine hesitant individuals. Given the paucity of information on effective strategies to address vaccine hesitancy, when interventions are implemented, planning a rigorous evaluation of their impact on vaccine hesitancy/vaccine acceptance will be essential. © 2015.


Butler R.,Health Security and Environment | MacDonald N.E.,Dalhousie University | MacDonald N.E.,Dal housie University | Eskola J.,Finnish National Institute for Health and Welfare | And 13 more authors.
Vaccine | Year: 2015

Despite relatively high vaccination coverage rates in the European Region, vaccine hesitancy is undermining individual and community protection from vaccine preventable diseases. At the request of its European Technical Advisory Group of Experts on Immunization (ETAGE), the Vaccine-preventable Diseases and Immunization Programme of the WHO Regional Office for Europe (WHO/EURO) developed tools to help countries address hesitancy more effectively. The Guide to Tailoring Immunization Programmes (TIP), an evidence and theory based behavioral insight framework, issued in 2013, provides tools to (1) identify vaccine hesitant population subgroups, (2) diagnose their demand- and supply-side immunization barriers and enablers and (3) design evidence-informed responses to hesitancy appropriate to the subgroup setting, context and vaccine. The Strategic Advisory Group of Experts on Immunization (SAGE) through its Working Group on Vaccine Hesitancy has closely followed the development, implementation, use and evolution of TIP concluding that TIP, with local adaptation, could be a valuable tool for use in all WHO regions, to help address countries' vaccine hesitancy problems. The TIP principles are applicable to communicable, noncommunicable and emergency planning where behavioral decisions influence outcomes. © 2015.


Goldstein S.,University of Witwatersrand | Goldstein S.,Soul City Institute for Health and Develop ment Communication | MacDonald N.E.,Dalhousie University | MacDonald N.E.,Dal housie University | And 13 more authors.
Vaccine | Year: 2015

Health communication is an evolving field. There is evidence that communication can be an effective tool, if utilized in a carefully planned and integrated strategy, to influence the behaviours of populations on a number of health issues, including vaccine hesitancy. Experience has shown that key points to take into account in devising and implementing a communication plan include: (i) it is necessary to be proactive; (ii) communication is a two-way process; (iii) knowledge is important but not enough to change behaviour; and (iv) communication tools are available and can be selected and used creatively to promote vaccine uptake. A communication strategy, incorporating an appropriate selection of the available communication tools, should be an integral part of every immunization programme, addressing the specific factors that influence hesitancy in the target populations. © 2015.


Eskola J.,Finnish National Institute for Health and Welfare | Duclos P.,World Health Organization | Schuster M.,World Health Organization | MacDonald N.E.,Dalhousie University | And 12 more authors.
Vaccine | Year: 2015

Based on the concerns about vaccine hesitancy and its impact on vaccine uptake rates and the performance of national immunization programmes, the Strategic Advisory Group of Experts (SAGE) on Immunization Working Group on Vaccine Hesitancy [1], carried out a review, and proposed a set of recommendations directed to the public health community, to WHO and its partners, and to the World Health Organization (WHO) member states. The final recommendations issued by SAGE in October 2014 fall into three categories: (1) those focused on the need to increase the understanding of vaccine hesitancy, its determinants and the rapidly changing challenges it entails; (2) those focused on dealing with the structures and organizational capacity to decrease hesitancy and increase acceptance of vaccines at the global, national and local levels; (3) and those focused on the sharing of lessons learnt and effective practices from various countries and settings as well as the development, validation and implementation of new tools to address hesitancy. © 2015.


Schuster M.,World Health Organization | Eskola J.,Finnish National Institute for Health and Welfare | Duclos P.,World Health Organization | Liang X.,Chinese Center for Disease Control | And 11 more authors.
Vaccine | Year: 2015

Despite a wide array of safe and effective vaccines in use globally, with major impacts on health worldwide, the WHO Strategic Advisory Group of Experts (SAGE) on Immunization has been repeatedly confronted with reports of hesitancy towards accepting specific vaccines or vaccination programmes. This paper summarizes the rationale for a SAGE review of the issue of vaccine hesitancy, its impact and ways to address it, and the convening of a Vaccine Hesitancy Working Group in March 2012 to prepare for the SAGE review. It describes the methods used and mode of operations, and advances in the relatively new field of research on vaccine hesitancy. It further elaborates and references the work conducted, including a series of products, conclusions and recommendations that emerged from the SAGE review in October 2014. © 2015.


Jarrett C.,London School of Hygiene and Tropical Medicine | Wilson R.,London School of Hygiene and Tropical Medicine | O'Leary M.,London School of Hygiene and Tropical Medicine | Eckersberger E.,London School of Hygiene and Tropical Medicine | And 17 more authors.
Vaccine | Year: 2015

The purpose of this systematic review is to identify, describe and assess the potential effectiveness of strategies to respond to issues of vaccine hesitancy that have been implemented and evaluated across diverse global contexts. Methods: A systematic review of peer reviewed (January 2007-October 2013) and grey literature (up to October 2013) was conducted using a broad search strategy, built to capture multiple dimensions of public trust, confidence and hesitancy concerning vaccines. This search strategy was applied and adapted across several databases and organizational websites. Descriptive analyses were undertaken for 166 (peer reviewed) and 15 (grey literature) evaluation studies. In addition, the quality of evidence relating to a series of PICO (population, intervention, comparison/control, outcomes) questions defined by the SAGE Working Group on Vaccine Hesitancy (WG) was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria; data were analyzed using Review Manager. Results: Across the literature, few strategies to address vaccine hesitancy were found to have been evaluated for impact on either vaccination uptake and/or changes in knowledge, awareness or attitude (only 14% of peer reviewed and 25% of grey literature). The majority of evaluation studies were based in the Americas and primarily focused on influenza, human papillomavirus (HPV) and childhood vaccines. In low- and middle-income regions, the focus was on diphtheria, tetanus and pertussis, and polio. Across all regions, most interventions were multi-component and the majority of strategies focused on raising knowledge and awareness. Thirteen relevant studies were used for the GRADE assessment that indicated evidence of moderate quality for the use of social mobilization, mass media, communication tool-based training for health-care workers, non-financial incentives and reminder/recall-based interventions.Overall, our results showed that multicomponent and dialogue-based interventions were most effective. However, given the complexity of vaccine hesitancy and the limited evidence available on how it can be addressed, identified strategies should be carefully tailored according to the target population, their reasons for hesitancy, and the specific context. © 2015.


Padma A.,Vsb Engineering College | Giridharan N.,Dal Housie University
International Journal of Imaging Systems and Technology | Year: 2016

A computer software system is designed for the segmentation and classification of benign and malignant tumor slices in brain computed tomography images. In this paper, we present a texture analysis methods to find and select the texture features of the tumor region of each slice to be segmented by support vector machine (SVM). The images considered for this study belongs to 208 benign and malignant tumor slices. The features are extracted and selected using Student's t-test. The reduced optimal features are used to model and train the probabilistic neural network (PNN) classifier and the classification accuracy is evaluated using k fold cross validation method. The segmentation results are also compared with the experienced radiologist ground truth. Quantitative analysis between ground truth and segmented tumor is presented in terms of quantitative measure of segmentation accuracy and the overlap similarity measure of Jaccard index. The proposed system provides some newly found texture features have important contribution in segmenting and classifying benign and malignant tumor slices efficiently and accurately. The experimental results show that the proposed hybrid texture feature analysis method using Probabilistic Neural Network (PNN) based classifier is able to achieve high segmentation and classification accuracy effectiveness as measured by Jaccard index, sensitivity, and specificity. © 2016 Wiley Periodicals, Inc.

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