Vanina Laurent-Ledru Political Will, Public Confidence, and Immunization Impact: a few thoughts Political Will, Public Confidence, and Immunization Impact: Priorities, Policies, Perceptions panel Vanina LAURENT-LEDRU, Merck/ MSD Center for Vaccine Ethics and Policy Symposium 4 May 2011 Philadelphia 1

3 key messages 1. As perceptions of vaccination have been severely damaged, we need to rethink communication & move from Evidence to Story telling (I mmunization Impact angle) 2. Only through concerted efforts of all stakeholders that faith in vaccination can be restored, with new engagement strategies ( public confidence angle) 3. Public health communication campaigns to move from less education to more persuasion ( Political Will angle)

From Evidence to Story telling (Immunization Impact angle)

Vanina Laurent-Ledru From the « best value in medicine » to suspicion and fear (1) WHO website: WHO Vaccines eradicated smallpox (1980) which previously killed 5 million each year (1) Vaccines have virtually eliminated polio from Europe (2002) and have saved 5 million people from paralysis worldwide … yet a Measles outbreak is hitting Europe, with most cases in France « One of the problems is that people have fear of the vaccine more than the disease » R. Martin, WHO

Vanina Laurent-Ledru Boundaries between facts and beliefs have become increasingly porous Perceptions around vaccination have been irreversibly damaged by a series of scare stories, "to an extent that no amount of evidence can change the public’s mind." Margaret Chan, WHO, January 2011 Facts only are not enough to do the job and it thus appears high time to rethink the approach to communication to become more responsive to public concerns. Concept of Storytelling

Concerted efforts of all Stakeholders (Public Confidence angle)

Vanina Laurent-Ledru Suppliers End 1990’sEnd 2000’s1970’s Vaccine Industry DoctorsCustomers National Regulators Vaccine Industry InvestorsCustomers Politicians Financial analysts National authorities AcademiaEmployees DoctorsPatients’grMedia Health Insurances General Public EU regulators Regulator-driven Accountable to more & more stakeholders Driven by empowered stakeholders Health economists Source: adapted from Novo Nordisk Vaccinology is being radically transformed by the growth of health partners 7

Vanina Laurent-Ledru A new category of influencers in vaccinology : Patient groups are getting involved in vaccinology, via HPV vaccination Until now, patient groups were only active on treatment level or secondary prevention issues (screening) With HPV vaccination, it is also the 1st time that women associations are involved in vaccinology Vaccines are only given to healthy people... …but change of paradigm:

Vanina Laurent-Ledru Civil Society Organizations can provide a bridge from the science to the lay public Culture, language and politics drive public attitudes. Need to go through “ Trust networks ” for successful education/ communication campaigns CSOs often bring innovative and effective new approaches to communication on prevention benefits. Estonian Emakas association social media campaign "with impact on traditional media 9

From Education to Persuasion (Political Will angle)

Vanina Laurent-Ledru Communication should be an integral part of policy and planning "Success in public health relies on public trust” Wynia Adapted from Jo Yarwood We must dedicate as much effort to communicating on vaccines as we do on providing them Classical media will continue to provide much of the interface between immunisation programmes and the public Communication for vaccines, through classical and new channels, must be included in national immunization budgets

Vanina Laurent-Ledru How to move forward: Increase health literacy at all levels of education “Health literacy is the capacity to make sound health decisions in the context of every day life” …but in Europe & US, not enough Groups at the higher end of socio economic ladder tend to be the most sceptical of vaccines Sørensen et al. (2010): Health literacy and public health: A review and integration of definitions and models. BMC Public Health (in review)

Vanina Laurent-Ledru Sociobehavioral research Social norms predict both intention to be vaccinated and vaccination itself Go beyond education into persuasion in public health campaigns, through social sciences Call for more research to assess effectiveness and ethical impact of social sciences on vaccination social marketing peer education «nudging » and many others... See Sturm &al. J Dev Behav Pediatr 2005 Bonell "one nudge forward, 2 steps back“ BMJ, 2011 Opel, Arch pediatr Adolesc Med 2009

Vanina Laurent-Ledru In a nutshell Facts only are not enough to do the job Perceptions, Attitudes, Values and Beliefs key to vaccination sustainable success Paradigm shift needed for successful implementation : Concerted and active efforts of all stakeholders Move away from mere communication to behavioral change management…but at the same time becoming more transparent and responsive to public concerns