Declining Vaccination Rates Research Articles

The Increasing Occurrence of Infectious Diseases in Childhood: Is It Linked with Declining Vaccination Rates Across Society?

Introduction. Childhood infectious diseases have been a significant medical problem, with a global increase in recent years. Modern diagnostic methods and new vaccinations are available. Poland is part of the WHO-coordinated global measles and rubella elimination program. Controversy surrounds mandatory and recommended vaccinations in Poland. There has been a concerning increase in the abandonment of vaccinating children, leading to a resurgence of infectious diseases. In 2024, the WHO reported a significant increase in measles cases in the European region, including in Poland. It's crucial to remind people of these diseases and warn them about the complications they bring. Aim of study. The aim of this study is to investigate the increasing occurrence of infectious diseases in childhood and examine the correlation with declining vaccination rates across society. Materials and methods. An unsystematic review of scientific literature was conducted, employing specific keywords such as „measles,” „pertussis,” „rubella,” „infectious diseases,” „vaccination,” and „hib.” The review was executed on the PubMed database, analyzing a total of 59 sources published until the conclusion of 2024. Conclusions. To control and eliminate infectious diseases, it is vital to maintain and improve vaccination rates. Policymakers and healthcare providers should prioritize immunization programs and address barriers to vaccine access. Further research is crucial to develop comprehensive strategies for increasing vaccination coverage and understanding vaccine-preventable diseases in modern public health challenges.

Childhood vaccination trends during 2019 to 2022 in Tanzania and the impact of the COVID-19 pandemic

ABSTRACT The COVID-19 pandemic has significantly disrupted healthcare systems at all levels globally, notably affecting routine healthcare services, such as childhood vaccination. This study examined the impact of these disruptions on routine childhood vaccination programmes in Tanzania. We conducted a longitudinal study over four years in five Tanzanian regions: Mwanza, Dar es Salaam, Mtwara, Arusha, and Dodoma. This study analyzed the trends in the use of six essential vaccines: Bacille Calmette-Guérin (BCG), bivalent Oral Polio Vaccine (bOPV), Diphtheria Tetanus Pertussis, Hepatitis-B and Hib (DTP-HepB-Hib), measles-rubella (MR), Pneumococcal Conjugate Vaccine (PCV), and Rota vaccines. We evaluated annual and monthly vaccination trends using time-series and regression analyses. Predictive modeling was performed using an autoregressive integrated moving average (ARIMA) model. A total of 32,602,734 vaccination events were recorded across the regions from 2019 to 2022. Despite declining vaccination rates in 2020, there was a notable rebound in 2021, indicating the resilience of Tanzania’s immunization program. The analysis also highlighted regional differences in vaccination rates when standardized per 1000 people. Seasonal fluctuations were observed in monthly vaccination rates, with BCG showing the most stable trend. Predictive modeling of BCG indicated stable and increasing vaccination coverage by 2023. These findings underscore the robustness of Tanzania’s childhood immunization infrastructure in overcoming the challenges posed by the COVID-19 pandemic, as indicated by the strong recovery of vaccination rates post-2020. We provide valuable insights into the dynamics of vaccination during a global health crisis and highlight the importance of sustained immunization efforts to maintain public health.

Strategies to increase vaccine coverage in brazilian territory

The Brazilian National Immunization Program (PNI), created in 1973, is a comprehensive and successful vaccination program, providing vaccines free of charge to all citizens, regardless of age, income, or place of residence. It maintains a vaccination schedule aimed at achieving high immunization rates against various diseases. However, it faces challenges such as misinformation, anti-vaccine movements, distrust in health authorities, difficulties in access, and interruptions in vaccine distribution, which have led to a decline in vaccination rates. To reverse this trend, several strategies can be adopted, adapted to the local context. This includes knowledge of the territory, vaccination campaigns, vaccination units, home visits and active patient outreach, Health Education in the school environment, public-private partnerships, effective communication, electronic records, ongoing education for healthcare professionals, identification of high-risk groups, and awareness campaigns. These strategies should be implemented in coordination, taking into account the characteristics of each territory. Collaboration between the government, healthcare professionals, schools, and the community is essential to ensure the protection of the population against infectious diseases. Strengthening vaccination is crucial for promoting public health and preventing outbreaks of preventable diseases in Brazil.

Is Vaccination Approaching a Dangerous Tipping Point?

This Viewpoint discusses declining vaccination rates in the US, specifically against COVID-19, and the ways in which clinicians and the Food and Drug Administration can counter the current large volume of vaccine misinformation.

1798. Vaccine Ambassadors: An Educational Model to Spread Awareness About Vaccines in Detroit

Abstract Background Since the COVID-19 pandemic, national vaccination rates show a dangerous decline with Detroit being amongst the lowest with only 41.3% of adolescents completing the vaccine series. The Vaccine Ambassador program was created to mitigate the decline in vaccination rates through the education and empowerment of youth via train-the-trainer model of education. Methods The program was implemented with eleven high school students who received education on the history and mechanism of vaccines, herd immunity, and how to effectively communicate. The program was created in collaboration with physicians in Infectious Diseases and a professor of communication at Wayne State University. Ambassadors aimed to spread this knowledge to youth in Detroit communities through outreach events. The impact of the program was measured through a two-pronged approach—through a pre- and post-survey given to the Vaccine Ambassadors and through a pre- and post-test given to the youth at the events. The survey for the Ambassadors included thirty-one items that measured their knowledge about vaccines and immunity and were evaluated through a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). The test for the youth at the outreach events included seven items that tested knowledge about vaccines. Results The following prompt is an example from the survey given to the ambassadors: Inactive vaccines create a better immune response than live vaccines. Compared to the pre-survey, six participants (54.5%) indicated a less agreeable response. With regards to the youth outreach events, twenty-five youth participated in the pre- and post-test, and nineteen youth (76.0%) improved their score after the presentation. Post-test scores improved across all seven questions (Figure 1). Comparison of Pre and Post Test Responses During Outreach Events Representation of the percent correct questions before and after the Vaccine Ambassador presentation Conclusion Based on both pre-test responses, it is apparent that Detroit’s youth lack knowledge regarding vaccines. The Vaccine Ambassador program increased the ambassador’s depth of knowledge and reaffirmed their positive attitudes about vaccines. Not only are youth able to learn, but they are able to apply their knowledge and teach others. By teaching their peers, youth can make informed decisions when older and enact behavioral changes that promote healthier living. Disclosures All Authors: No reported disclosures

Impacts of the COVID-19 pandemic on immunization with pneumococcal vaccines in children and older adults in Brazil

The COVID-19 pandemic has profoundly impacted individuals, resulting in long-lasting consequences. One of the effects has been a decline in vaccine adherence attributed to physical distancing measures, potentially contributing to the resurgence of preventable diseases, and posing diagnostic challenges. Consequently, monitoring immunization rates becomes crucial as an indicator for health promotion campaigns and to mitigate the strain on healthcare systems. This study aims to assess the effects of the COVID-19 pandemic on immunization with pneumococcal vaccines in children and older adults in Brazil from 2018 to 2021. Data was collected from the Department of Informatics of the Unified Health System, focusing on the number of doses administered and vaccination coverage with pneumococcal vaccines across the country. A total of 21,780,450 doses were administered, with a decline of 19.97% in vaccine coverage throughout the evaluation period. An overall negative trend was observed in the time series analysis for all states in Brazil. However, not all showed a statistically significant change associated with the pandemic. Therefore, it is essential for states that experienced a decline in vaccination rates during the COVID-19 pandemic to closely monitor changes in pneumococcal vaccination. Failure in the process may lead to an increase in pneumococcal infections and place an additional burden on the healthcare system.

The pattern from the first three rounds of vaccination: declining vaccination rates.

Vaccination rates for the COVID-19 vaccine have recently been stagnant worldwide. We aim to analyze the potential patterns of vaccination development from the first three doses to reveal the possible trends of the next round of vaccination and further explore the factors influencing vaccination in the selected populations. On July 2022, a stratified multistage random sampling method in the survey was conducted to select 6,781 people from 4 provinces China, who were above the age of 18 years. Participants were divided into two groups based on whether they had a chronic disease. The data were run through Cochran-Armitage trend test and multivariable regression analyses. A total of 957 participants with chronic disease and 5,454 participants without chronic disease were included in this survey. Vaccination rates for the first, second and booster doses in chronic disease population were93.70% (95% CI: 92.19-95.27%), 91.12% (95%CI: 94.43-95.59%), and 83.18% (95%CI: 80.80-85.55%) respectively. By contrast, the first, second and booster vaccination rates for the general population were 98.02% (95% CI: 97.65-98.39%), 95.01% (95% CI: 94.43-95.59%) and 85.06% (95% CI: 84.11-86.00%) respectively. The widening gap in vaccination rates was observed as the number of vaccinations increases. Higher self-efficacy was a significant factor in promoting vaccination, which has been observed in all doses of vaccines. Higher education level, middle level physical activity and higher public prevention measures play a positive role in vaccination among the general population, while alcohol consumption acts as a significant positive factor in the chronic disease population (p < 0.05). As the number of vaccinations increases, the trend of decreasing vaccination rate is becoming more pronounced. In future regular vaccinations, we may face low vaccination rates as the increasing number of infections and the fatigue associated with the prolonged outbreak hamper vaccination. Measures need to be found to counter this downward trend such as improving the self-efficacy of the population.

PSYCHOMETRIC PROPERTIES OF THE VACCINE CONSPIRACY BELIEFS SCALE, THE EPISTEMIC BELIEFS QUESTIONNAIRE, AND THE CYNICAL DISTRUST SCALE IN A UKRAINIAN SAMPLE

The current issues in Ukraine, such as declining vaccination rates, increasing belief in conspiracy theories, and rising levels of hostility, necessitate the use of effective tools for assessment. The Vaccine Conspiracy Beliefs Scale (VCBS), Epistemic Beliefs Questionnaire, and Cook-Medley Cynical Hostility Scale (Ho) offer valuable instruments to collect reliable data and facilitate necessary interventions. The Vaccine Conspiracy Belief Scale (VCBS) is a 7-item instrument that assesses an individual's tendency to believe in deceptive information regarding vaccination and related health conditions. The Epistemic Beliefs Questionnaire measures an individual's ability to reason about the political or scientific world. It consists of three subscales, evaluating intuitive understanding of facts, willingness to examine evidence to analyze facts, and belief in the relationship between facts and policy. The questionnaire comprises 12 statements. The Cook-Medley Cynical Hostility Scale (50 items) provides a general assessment of a person's cynicism, hostility, and aggressive reactions. The Cynical Distrust subscale includes 5 statements representing hypothetical views on the actions, behavior, or opinions of others. Our study aimed to test the psychometric properties of the Vaccine Conspiracy Beliefs Scale, the Epistemic Beliefs Questionnaire, and the Cynical Distrust subscale of the Cook-Madley Cynical Hostility Scale (Ho), translated into Ukrainian. We recruited 392 Ukrainian-speaking respondents for the study. The scales underwent evaluation and statistical analysis using Cronbach's alpha, correlation analysis, principal components analysis, exploratory, and confirmatory factor analyses. The components of the Vaccine Conspiracy Beliefs Scale demonstrated a high level of reliability and internal consistency (Cronbach's alpha &gt; 0.95). Principal components analysis, exploratory factor analysis (EFA), and Comparative Fit Index (CFI) indicated a one-factor structure of the scale with a high degree of item fit. The Epistemic Beliefs Questionnaire showed good internal consistency and reliability (α = 0.84) and displayed a three-factor structure. The Cynical Distrust subscale of the Cook-Madley Cynical Hostility Scale demonstrated acceptable indicators of reliability and internal consistency (Cronbach's alpha &gt; 0.73) and showed a one-factor structure with a high degree of fit. The Vaccine Conspiracy Beliefs Scale, the Epistemic Beliefs Questionnaire, and the Cynical Distrust subscale of the Cook-Madley Hostility Scale (Ho) are effective assessment tools and can be used with the Ukrainian population.

Individual Empowerment, Institutional Confidence, and Vaccination Rates in Cross-National Perspective, 1995 to 2018

In the past decade, before the onset of the Covid-19 pandemic, rates of childhood vaccination against diseases such as measles, diphtheria, pertussis, and tetanus declined worldwide. An extensive literature examines the correlates and motives of vaccine hesitancy—the reluctance or refusal to vaccinate despite the availability of vaccines—among individuals, but little macrosociological theory or research seeks to explain changes in country-level vaccine uptake in global and comparative perspective. Drawing on existing research on vaccine hesitancy and recent developments in world society theory, we link cross-national variation in vaccination rates to two global cultural processes: the dramatic empowerment of individuals and declining confidence in liberal institutions. Both processes, we argue, emerged endogenously in liberal world culture, instigated by the neoliberal turn of the 1980s and 1990s. Fixed- and random-effects panel regression analyses of data for 80 countries between 1995 and 2018 support our claim that individualism and lack of institutional confidence contributed to the global decline in vaccination rates. We also find that individualism is itself partly responsible for declining institutional confidence. Our framework of world-cultural change might be extended to help make sense of recent post-liberal challenges in other domains.

Complexity and controversy in media coverage of Human papillomavirus (HPV) vaccination: A qualitative content analysis of news coverage in Denmark 2008–2018

IntroductionTraditional news media play an important, yet notoriously complex role in vaccination communication. News media remain a common source of information about vaccines and potentially influence individual decisions to choose vaccination or not. In Denmark, Human papillomavirus (HPV) vaccination rates remained relatively high until suspected adverse reactions began to receive extensive coverage in the news. Existing research studies associate the decline in HPV vaccination rates with misleading or negative news stories.MethodsWe probed Danish media coverage beyond dichotomies such as misleading vs. informative, or negative vs. positive. We combined quantitative and qualitative approaches to media coverage of the Danish HPV vaccination crisis and recovery. Our research design focused on six national newspapers and allowed us to identify 865 articles published in periods of peak media coverage from 2008 to 2018 (extracted from a total sample of 1,437 articles published between 1991 and 2019). We used qualitative content analysis to discern the main topics covered, and we analyzed contextual factors that affected the meanings of our main topics.ResultsOur results confirm the rise of suspected adverse reactions as the dominant main topic in 2015. However, we find that news stories about adverse reactions were diverse and closely related to other main topics such as conflicts of interests and debate among experts and other stakeholders. In 2017, the media began downplaying suspected adverse reactions when concerns about declining vaccination rates and misinformation by the media were voiced.DiscussionOur findings suggest that controversial media messages about vaccination are hard to classify as either negative or positive but must be interpreted carefully in context of what is known about the controversy. Learning from past media controversies remains important to understanding the media's role in the social construction of risks and benefits associated with vaccination.

COVID’s collateral damage: likelihood of measles resurgence in the United States

BackgroundLockdowns imposed throughout the US to control the COVID-19 pandemic led to a decline in all routine immunizations rates, including the MMR (measles, mumps, rubella) vaccine. It is feared that post-lockdown, these reduced MMR rates will lead to a resurgence of measles.MethodsTo measure the potential impact of reduced MMR vaccination rates on measles outbreak, this research examines several counterfactual scenarios in pre-COVID-19 and post-COVID-19 era. An agent-based modeling framework is used to simulate the spread of measles on a synthetic yet realistic social network of Virginia. The change in vulnerability of various communities to measles due to reduced MMR rate is analyzed.ResultsResults show that a decrease in vaccination rate (mathrm{alpha }) has a highly non-linear effect on the number of measles cases and this effect grows exponentially beyond a threshold (mathrm{alpha }). At low vaccination rates, faster isolation of cases and higher compliance to home-isolation are not enough to control the outbreak. The overall impact on urban and rural counties is proportional to their population size but the younger children, African Americans and American Indians are disproportionately infected and hence are more vulnerable to the reduction in the vaccination rate.ConclusionsAt low vaccination rates, broader interventions are needed to control the outbreak. Identifying the cause of the decline in vaccination rates (e.g., low income) can help design targeted interventions which can dampen the disproportional impact on more vulnerable populations and reduce disparities in health. Per capita burden of the potential measles resurgence is equivalent in the rural and the urban communities and hence proportionally equitable public health resources should be allocated to rural regions.

The impact of COVID-19 and catch-up strategies on routine childhood vaccine coverage trends in Latin America: A systematic literature review and database analysis

ABSTRACT Globally, an estimated 23 million children missed vaccination in 2020 due to the coronavirus disease 2019 (COVID-19) pandemic. We analyzed vaccination coverage trends and catch-up strategies/recommendations implemented in Latin America during the pandemic. We performed a national administrative database analysis and a systematic literature review to evaluate vaccination coverage data and identify catch-up strategies for missed vaccinations in selected countries in Latin America (Argentina, Brazil, Chile, Colombia, Mexico and Peru). Data were extracted from national health ministry vaccination coverage and supranational databases to identify coverage of rotavirus (RV), pentavalent/hexavalent, measles, Bacillus Calmette-Guérin (BCG) and pneumococcal conjugate vaccines (PCV) at country level before and during the COVID-19 pandemic. A systematic literature review of published papers was conducted to identify vaccination catch-up strategies published in January 2020–June 2021. National administrative database-reported data showed that vaccination coverage trends were declining prior to 2020. The change in vaccination coverage before and during the COVID-19 pandemic ranged from 2.5% to −11.5% (RV), −3.0% to −11.0% (measles), 1.5% to −7.5% (PCV), 9.0% to −14.0% (pentavalent/hexavalent), and 3.0% to −18.5% (BCG). Among 696 identified studies, 14 studies were included in this review. Catch-up vaccination strategies included prioritizing routine vaccinations as per the national immunization schedule. Overall vaccination coverage declined by varying degrees among the countries investigated. This trend was observed prior to 2020, suggesting multifactorial reasons for declining vaccination rates in Latin America.

Enhancing vaccination of key populations

Vaccination is effective in preventing the increase of disease, especially emerging infectious diseases (EIDs), and it is particularly important for people in close contact with infected sources and susceptible populations who are at increased risk of getting infectious diseases due to behavior, occupation or health. Despite targeted vaccination guidelines, inadequate vaccination of the key populations fails to receive widespread attention, resulting in a high-risk transition of disease from key populations to general populations. Strengthening the vaccination of the susceptible groups can effectively block the spread of pathogens to general populations, and reduce the consumption of medical resources in universal vaccination, which has significant economic value. In this review, we describe the prevalence of EIDs, analyze the experience and lessons of infectious disease vaccination in key populations through several cases, and further explore the causes for the decline in vaccination rates of key populations. According to the trends of EIDs, a plan to strengthen the vaccination of key populations is proposed to effectively prevent the transition of EIDs from key populations to general populations.

The looming health hazard: A wave of HPV-related cancers in Japan is becoming a reality due to the continued suspension of the governmental recommendation of HPV vaccine

The looming health hazard: A wave of HPV-related cancers in Japan is becoming a reality due to the continued suspension of the governmental recommendation of HPV vaccine

Enlarging Access to Vaccination in Italy According to the Citizens and the Pharmacists’ Perspective

In recent years, Europe has been struggling with declining vaccination rates

Common childhood exanthemata

Childhood exanthemata are a group of conditions that are characterised by an eruptive rash, typically caused by an infection. Six classic childhood exanthemata were defined in the early 20th century causing high rates of morbidity and mortality. With improvements in hygiene and living standards, and the development of vaccines, they are now a rare occurrence. However, in recent years with declining vaccination rates, there is a reported increase in incidence of such infections. As such, it is important for GPs to be able to identify such conditions and manage them appropriately.

1076. Gaps in Measles and Mumps Seroprevalence Among Cancer Patients

BackgroundImmunosuppressed cancer patients are at risk for morbidity and mortality from vaccine preventable diseases. Recent outbreaks and declining vaccination rates put cancer patients at increased risk for measles and mumps exposures. To assess the current status within our center, we measured measles and mumps seroprevalence among cancer patients.MethodsResidual clinical plasma samples from patients seen at Seattle Cancer Care Alliance were collected between 8/11/2019 and 8/15/2019 and tested for measles and mumps IgG using ELISA (Genway Biotech); patients receiving intravenous immunoglobulin ≤16 weeks prior to collection date were excluded. Seroprevalence was calculated based on positive results; equivocal results were not considered protective. Demographic and clinical data were abstracted from medical records. Overall and subgroup seroprevalence were estimated with Wilson 95% confidence intervals (CI); Poisson regression with robust standard errors was used to compare subgroups and estimate prevalence ratios (PR).ResultsOf 1000 unique patients, 987 were eligible, with a median age of 61 years (range 2-97). More than half had a solid tumor (574 [58%]) while 376 (38%) had a hematologic malignancy (HM); 155 (16%) were hematopoietic cell transplant (HCT) recipients. The percentage of seropositive patients was 75% (95% confidence interval [CI]: 72%, 78%) for measles and 62% (95% CI: 59%, 65%) for mumps. Seropositivity was highest among older age groups, particularly those older than 63, who most likely have naturally acquired immunity (Figure 1-2). In multivariable analysis, patients aged 30-59 years were significantly less likely to be seropositive compared to patients ≥80 years of age. Patients with HM and those undergoing HCT were also less likely to be seropositive (Figure 3).Figure 1. Distribution of age at sample collection and measles antibody test results Figure 2. Measles and mumps seroprevalence by age Figure 3. Multivariable model estimates for measles and mumps seroprevalence ConclusionOne-quarter of cancer patients tested did not have evidence of seroprotection for measles and mumps. Seronegative and equivocal responses were observed primarily among younger patients and those with hematologic malignancies. Deficits in protective antibody seen in this study are common among cancer patients and underscore the need for population/community-based efforts to increase herd immunity and protect vulnerable populations.Disclosures Helen Y. Chu, MD MPH, Cepheid (Grant/Research Support)Ellume (Grant/Research Support)Glaxo Smith Kline (Consultant)Merck (Consultant)Sanofi-Pasteur (Grant/Research Support) Steven A. Pergam, MD, MPH, Chimerix, Inc (Scientific Research Study Investigator)Global Life Technologies, Inc. (Research Grant or Support)Merck & Co. (Scientific Research Study Investigator)Sanofi-Aventis (Other Financial or Material Support, Participate in clinical trial sponsored by NIAID (U01-AI132004); vaccines for this trial are provided by Sanofi-Aventis)

Global Measles Epidemic Risk: Current Perspectives on the Growing Need for Implementing Digital Communication Strategies.

A safe vaccine against measles has been available and globally recommended since 1974. The World Health Organization established measles elimination as a goal for 2020 but, unfortunately, this objective has not been achieved yet and outbreaks still occur. Herd immunity, ie, a population immunity higher than 95%, is required to stop the measles virus transmission. Communication plays a crucial role in immunization strategy to obtain high coverage levels, as it helps to fight barriers against vaccination. Delay and refusal of measles vaccination have become widespread due to misinformation, fake news and barriers to effective communication. This phenomenon has been defined as “vaccine hesitancy” and is considered as one of the top ten risks for global health. The alleged association between measles vaccination and autism has caused a sharp decline in vaccination rates. In this current situation, mass communication integrated into public health policies is fundamental to sway people’s positive attitudes toward vaccination. Digital communication strategies based on social media and other internet platforms may represent useful tools to promote immunization and discourage skepticism and complement information provided by health-care professionals who have been considered as the most credible source on risk/benefits on vaccines for families. Digital communication strategies that may help supporting the measles elimination strategy include monitoring information needs online, integrating digital communication into immunization programs, involving a multidisciplinary group in communication, developing content that balances facts with positive messaging, using multiple communication channels. Further research activities should be promoted in the field of effective communication for immunization.

A model for the incremental burden of invasive Haemophilus influenzae type b due to a decline of childhood vaccination during the COVID-19 outbreak: A dynamic transmission model in Japan

BackgroundThe current coronavirus disease 2019 (COVID-19) outbreak has caused a persistent decline in childhood vaccination coverage, including Haemophilus influenzae type b (Hib) vaccine, in some countries. Our objective was to evaluate the impact of decreased Hib vaccination due to COVID-19 on invasive Hib disease burden in Japan. MethodsUsing a deterministic dynamic transmission model (susceptible-carriage-infection-recovery model), the incidence rates of invasive Hib disease in under 5 year olds in rapid vaccination recovery and persistent vaccination declined scenarios were compared for the next 10 years after 2020. The national Hib vaccination rate after the impact of COVID-19 reduced to 87% and 73% in 2020 from approximately 97% each in 2013–2019 for primary and booster doses. ResultsWhile the persistent decline scenarios revealed an increase in invasive Hib disease incidence to 0.50/100,000 children under 5 years old, the incidence of the rapid recovery scenario slightly increased with a consistent decline of incidence after 2021. The shorter the duration of the decline in vaccination rate was, the smaller the incremental disease burden observed in the model. Compared to the rapid recovery scenario, the permanent decline scenario showed a 296.87 cumulative incremental quality-adjusted life years (QALY) loss for the next 10 years. ConclusionsThe persistent decline of Hib vaccination rate due to COVID-19 causes an incremental disease burden irrespective of the possible decline of Hib transmission rate by COVID-19 mitigation measures. A rapid recovery of vaccination coverage rate can prevent this possible incremental disease burden.

“Transfer, Contestation and Conflict”: How Italian regional and national governments claim and challenge authority in mandatory vaccination policies

Abstract Background This paper explores conflictual policy transfer in Italian vaccination policy 2007-2018. The region of Veneto formally suspended mandatory vaccination in 2007. Soon after, declining vaccination rates across the country sparked a public health crisis. Emilia Romagna adopted a new vaccine mandate for early education, which the national government adopted in 2017. Each policy decision invoked collaboration and contestation between governments. In showing the conflictual aspects of intra-state policy transfer, we offer lessons for multi-level health governance of contested issues. Methods We used qualitative documentary analysis of parliamentary transcripts, legislation and government reports, supplemented with semi-structured key informant interviews, using the coding software NVivo 12. We applied theoretical and conceptual scholarship to develop an analytical framework drawing out the key mechanisms through which contestation and conflict take place. Results Italian regional and national governments employed three key mechanisms to forcibly transfer or resist vaccination policy: ideas, evidence, and law. Ideas included “the nation”, “herd immunity” and “science.” Evidence included coverage rates and explanations of changes over time. Protagonists of Italy's coercive policy transfers used the law to claim and challenge authority. Contestations occurred in political and bureaucratic spheres. Discrepant historical and evidentiary narratives emerged between levels of government that had injected significant resources into acquiring or defending governance of vaccination policy. Conclusions Scholarship has predominantly considered coercive policy transfer at a supra-national or inter-state level. We demonstrate the political blood-spilling within a country when divergent regional policies become contested in a situation of national crisis. 'Evidence' and 'law' can be open to differing interpretations, with 'ideas' shaping the context in which policies prevail.