CHARACTERIZATION OF CURRENT AND FUTURE VACCINATION CHALLENGES IN THE UNITED STATES: INFLUENZA AND THE POLICY IMPLICATIONS OF VACCINOMICS
GERBER-DISSERTATION-2020.pdf (4.802Mb) (embargoed until: 2023-05-01)
Gerber, Jennifer E
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Background: Vaccine concerns are common. Influenza vaccine coverage is poor despite high safety and moderate effectiveness. Vaccinomics aims to improve influenza and other vaccines' safety and effectiveness by applying genomics to vaccine development and use. We characterized vaccine confidence, influenza vaccination prevalence, and public values through a qualitative-quantitative mixed-methods study. Methods: Community meetings (N=94; themes identified based on Grounded Theory) informed a subsequent online panel survey (N=1,925). Vaccine hesitancy, vaccination, sociodemographic factors, personal health history, and vaccinomics were cross-tabulated. Bivariate and multivariable log binomial and Poisson regression models identified associations with influenza vaccination and vaccinomics opposition, respectively. Results: In-person participants supported vaccinomics' potential for increased personalization, but worried about inequitable implementation. The survey population was 50.6% female, 61.8% White, non-Hispanic, 62.9% had a child<18 years old, 47.1% had a ≤high school education, and 19.7% perceived vaccine reaction experience. Most respondents had ≥1 vaccine concern, and belief that children receive too many vaccines was common (51.1%). Most (75.8%) respondents expected vaccinomics to increase their vaccine confidence. In multivariable models, ≥college education versus ≤high school and complementary/alternative medicine (CAM) use versus nonuse were associated with vaccination. High versus low vaccine hesitancy was associated with lower vaccination prevalence. Vaccinomics support was associated with serious reaction experience, low vaccine hesitancy (in all but parents of young children), and higher education, income, and trust in public health authorities. Opposition to vaccinomics was associated with low trust in public health and perceived reaction experience. Discussing vaccinomics and adverse events following immunization did not impact vaccine safety perceptions. Discussion: Vaccine concerns, CAM use, and perceived vaccine reactions were common. Influenza vaccination coverage was associated with CAM use and ≥college education. Most respondents expected vaccinomics to improve their vaccine confidence. Low trust in public health authorities and experience with serious reactions were associated with vaccinomics opposition. Increased awareness of federal vaccine safety oversight might improve confidence. Conclusion: Federal agencies should 1) tailor influenza interventions by education-level, 2) collaborate with complementary/alternative medicine providers, 3) research strategies to reach disadvantaged populations, 4) allocate funding for vaccinomics-related research, and 5) implement policies to bolster public trust.
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