caregiver and service provider vaccine confidence following the changchun changsheng CORD-Papers-2022-06-02 (Version 1)

Title: Caregiver and service provider vaccine confidence following the Changchun Changsheng vaccine incident in China: A cross-sectional mixed methods study
Abstract: INTRODUCTION: The Changchun Changsheng Vaccine Incident (CCVI) occurred mid-2018 and involved irregularities in the manufacture and quality control of diphtheria-tetanus-acellular-pertussis and rabies vaccines. This study investigates vaccine confidence amongst Chinese caregivers and vaccination-service providers (VSPs) six months after the CCVI. METHODS: Quantitative surveys were conducted in January 2019 with 2124 caregivers of children and 555 VSPs in three areas in China. The proportions of respondents who agreed to the four statements from the Vaccine Confidence Index were used to measure vaccine confidence. Descriptive and univariate analyses were performed to study the level of vaccine confidence. Semi-structured interviews were conducted with 48 caregivers 43 VSPs and 9 immunization program managers. Interviews were analyzed thematically using a combination of deductive and inductive coding. Media surveillance was conducted to monitor public responses to the CCVI. RESULTS: Media surveillance indicated that public attention to vaccine-related issues increased sharply immediately post-CCVI but declined rapidly thereafter. Six months post-CCVI 96.0% of caregivers and the same proportion of VSPs reported that vaccination was important and compatible with their religious beliefs. 82.7% and 88.2% of caregivers agreed that vaccines were safe and effective. 92.8% and 94.6% of VSPs agreed that vaccines were safe and effective. Both caregivers and VSPs reported an immediate decline in vaccine confidence post-CCVI. In most cases this trust was regained over time following government and public health responses however some people remained hesitant about vaccinating their children. Many VSPs were overwhelmed by consultations workload and psychological pressure after the CCVI. CONCLUSION: After an initial decline vaccine confidence recovered to pre-incident levels six months after the CCVI. However some caregivers moved from the higher to the lower end of the vaccine confidence spectrum pointing to the need to promote the acceptance of vaccination especially given the need for new vaccines to control the coronavirus epidemic.
Published: 2020-09-08
Journal: Vaccine
DOI: 10.1016/j.vaccine.2020.08.063
DOI_URL: http://doi.org/10.1016/j.vaccine.2020.08.063
Author Name: Tu Shiyi
Author link: https://covid19-data.nist.gov/pid/rest/local/author/tu_shiyi
Author Name: Sun Fiona Yueqian
Author link: https://covid19-data.nist.gov/pid/rest/local/author/sun_fiona_yueqian
Author Name: Chantler Tracey
Author link: https://covid19-data.nist.gov/pid/rest/local/author/chantler_tracey
Author Name: Zhang Xuan
Author link: https://covid19-data.nist.gov/pid/rest/local/author/zhang_xuan
Author Name: Jit Mark
Author link: https://covid19-data.nist.gov/pid/rest/local/author/jit_mark
Author Name: Han Kaiyi
Author link: https://covid19-data.nist.gov/pid/rest/local/author/han_kaiyi
Author Name: Rodewald Lance
Author link: https://covid19-data.nist.gov/pid/rest/local/author/rodewald_lance
Author Name: Du Fanxing
Author link: https://covid19-data.nist.gov/pid/rest/local/author/du_fanxing
Author Name: Yu Hongjie
Author link: https://covid19-data.nist.gov/pid/rest/local/author/yu_hongjie
Author Name: Hou Zhiyuan
Author link: https://covid19-data.nist.gov/pid/rest/local/author/hou_zhiyuan
Author Name: Larson Heidi
Author link: https://covid19-data.nist.gov/pid/rest/local/author/larson_heidi
sha: 998e3bc6975c11f104ad836bc89104499d159269
license: no-cc
license_url: [no creative commons license associated]
source_x: Elsevier; Medline; PMC
source_x_url: https://www.elsevier.com/https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/
pubmed_id: 32912643
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/32912643
pmcid: PMC7476908
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476908
url: https://api.elsevier.com/content/article/pii/S0264410X20311154 https://www.sciencedirect.com/science/article/pii/S0264410X20311154 https://doi.org/10.1016/j.vaccine.2020.08.063 https://www.ncbi.nlm.nih.gov/pubmed/32912643/
has_full_text: TRUE
Keywords Extracted from Text Content: rabies vaccines TM people children pre-incident Vaccine CCVI VSPs coronavirus vaccine DTaP vaccines 3-4 people children Anhui TC co-led West Europe Shandong vaccine Vaccine CCVI [6 CCVI coronavirus https://doi.org/10.1016/j.vaccine.2020.08.063 0264 FD CCVI [18 WeChat VSPs EPI Shenzhen megacity CDCs LR, HY rabies vaccines children <3 UNICEF rabies friends vaccine type (Fig. 2 left France participants TM VSP 37 Shenzhen residents COVID-19 non-EPI vaccines mothers East Asia VSP pre-incident FYS directors EPI vaccine HBV Anhui province twostage EPI vaccines VSP 24 Ziru
Extracted Text Content in Record: First 5000 Characters:Introduction: The Changchun Changsheng Vaccine Incident (CCVI) occurred mid-2018 and involved irregularities in the manufacture and quality control of diphtheria-tetanus-acellular-pertussis and rabies vaccines. This study investigates vaccine confidence amongst Chinese caregivers and vaccination-service providers (VSPs) six months after the CCVI. Methods: Quantitative surveys were conducted in January 2019 with 2124 caregivers of children and 555 VSPs in three areas in China. The proportions of respondents who agreed to the four statements from the Vaccine Confidence Index TM were used to measure vaccine confidence. Descriptive and univariate analyses were performed to study the level of vaccine confidence. Semi-structured interviews were conducted with 48 caregivers, 43 VSPs and 9 immunization program managers. Interviews were analyzed thematically using a combination of deductive and inductive coding. Media surveillance was conducted to monitor public responses to the CCVI. Results: Media surveillance indicated that public attention to vaccine-related issues increased sharply immediately post-CCVI but declined rapidly thereafter. Six months post-CCVI, 96.0% of caregivers and the same proportion of VSPs reported that vaccination was important and compatible with their religious beliefs. 82.7% and 88.2% of caregivers agreed that vaccines were safe and effective. 92.8% and 94.6% of VSPs agreed that vaccines were safe and effective. Both caregivers and VSPs reported an immediate decline in vaccine confidence post-CCVI. In most cases this trust was regained over time following government and public health responses, however some people remained hesitant about vaccinating their children. Many VSPs were overwhelmed by consultations, workload and psychological pressure after the CCVI. Conclusion: After an initial decline, vaccine confidence recovered to pre-incident levels six months after the CCVI. However, some caregivers moved from the higher to the lower end of the vaccine confidence spectrum, pointing to the need to promote the acceptance of vaccination especially given the need for new vaccines to control the coronavirus epidemic. In 2019 vaccine hesitancy was identified as a top ten threats to global health by the World Health Organization (WHO) [1] . The Strategic Advisory Group of Experts on Immunization identified lack of confidence as a key factor underlying hesitancy [2] . Public trust in vaccines is dynamic, context specific and driven by multiple factors, including emotions, culture and politics [3] . These factors can be exacerbated when concerns have some basis in vaccine safety or quality issues. Maintaining public trust in vaccination is increasingly important when it comes to resilience in the face of new and emerging disease outbreaks, such as COVID-19, to optimize the acceptance of a new COVID vaccine when it becomes available. https://doi.org/10.1016/j.vaccine.2020.08.063 0264-410X/Ó 2020 Elsevier Ltd. All rights reserved. In July 2018, Changchun Changsheng Biotechnology Co. Ltd was charged by China Food and Drug Administration (now renamed National Medical Products Administration) with two counts of malpractice: (i) manufacturing and selling 250,000 substandard diphtheria-tetanus-acellular-pertussis (DTaP) vaccines (Nov 2017) and (ii) illegal production of freeze dried rabies vaccines (July 2018) [4] . One of these contraventions resulted in substandard DTaP vaccines being administered to 215,184 Chinese children [5, 6] . Although no cases of long-term sequelae related to the substandard rabies and DTaP vaccines have been officially reported, claims that the substandard vaccines were poisonous were published on internet and social media sites [7] [8] [9] . The Changchun Changsheng vaccine incident (CCVI) and media reporting increased public anxiety about the safety of vaccines and the regulation of vaccine production in China [10] . This anxiety was evident in a survey conducted in August 2018 which found that self-scored confidence (scale ranging from 0 for no confidence to 9 for very confident) among the Chinese public declined from 6.7 to 3.2 [6] . In the months after the CCVI, substandard vaccines were recalled, and regulatory investigations conducted. Results from these investigations were published and the government adopted and implemented the first Vaccine Administration Act, which aimed to tighten vaccine regulation [4, 11] . Whether these institutional responses eased public concern is not clear. In this study we addressed this question and investigated vaccine confidence of Chinese caregivers (those with responsibility for children < 6 years) and vaccination service providers (VSPs, certificated health professionals who provide immunization related services in vaccination clinics or obstetrics departments) six months after the CCVI. We conducted a mixed-methods cross-sectional study in January 2019 in Anhui and Shaanxi provinces and Shenzhen megacity in Guangdong province. Anhui,
Keywords Extracted from PMC Text: East Asia hepatitis B virus Anhui " [12 people UNICEF left FYS friends EPI children's ... TC co-led 's " children rabies rabies vaccines ≈600 EPI vaccines HBV CDCs WeChat pre-incident vaccine type (Fig. 2 VSP 37 CCVI [6 mothers France TM Shenzhen residents CCVI [18 Anhui province coronavirus FD children <3 Vaccine Shandong vaccine VSP children ... EPI vaccine CCVI directors effectiveness."Our DTaP vaccines VSPs LR, HY Shenzhen megacity West Europe vaccine COVID-19 non-EPI vaccines participants
Extracted PMC Text Content in Record: First 5000 Characters:In 2019 vaccine hesitancy was identified as a top ten threats to global health by the World Health Organization (WHO) [1]. The Strategic Advisory Group of Experts on Immunization identified lack of confidence as a key factor underlying hesitancy [2]. Public trust in vaccines is dynamic, context specific and driven by multiple factors, including emotions, culture and politics [3]. These factors can be exacerbated when concerns have some basis in vaccine safety or quality issues. Maintaining public trust in vaccination is increasingly important when it comes to resilience in the face of new and emerging disease outbreaks, such as COVID-19, to optimize the acceptance of a new COVID vaccine when it becomes available. In July 2018, Changchun Changsheng Biotechnology Co. Ltd was charged by China Food and Drug Administration (now renamed National Medical Products Administration) with two counts of malpractice: (i) manufacturing and selling 250,000 substandard diphtheria-tetanus-acellular-pertussis (DTaP) vaccines (Nov 2017) and (ii) illegal production of freeze dried rabies vaccines (July 2018) [4]. One of these contraventions resulted in substandard DTaP vaccines being administered to 215,184 Chinese children [5], [6]. Although no cases of long-term sequelae related to the substandard rabies and DTaP vaccines have been officially reported, claims that the substandard vaccines were poisonous were published on internet and social media sites [7], [8], [9]. The Changchun Changsheng vaccine incident (CCVI) and media reporting increased public anxiety about the safety of vaccines and the regulation of vaccine production in China [10]. This anxiety was evident in a survey conducted in August 2018 which found that self-scored confidence (scale ranging from 0 for no confidence to 9 for very confident) among the Chinese public declined from 6.7 to 3.2 [6]. In the months after the CCVI, substandard vaccines were recalled, and regulatory investigations conducted. Results from these investigations were published and the government adopted and implemented the first Vaccine Administration Act, which aimed to tighten vaccine regulation [4], [11]. Whether these institutional responses eased public concern is not clear. In this study we addressed this question and investigated vaccine confidence of Chinese caregivers (those with responsibility for children < 6 years) and vaccination service providers (VSPs, certificated health professionals who provide immunization related services in vaccination clinics or obstetrics departments) six months after the CCVI. We conducted a mixed-methods cross-sectional study in January 2019 in Anhui and Shaanxi provinces and Shenzhen megacity in Guangdong province. Anhui, located in Middle China, was one of the provinces where vaccines associated with the CCVI were administered. To avoid causing emotional distress to participants we only recruited participants from areas where the CCVI-associated vaccines were not administered. Shaanxi, located in less-developed West China, was not involved in the CCVI. Shenzhen megacity, located in the most developed eastern coast area and not involved in the CCVI, was selected for its proximity to Hong Kong, where immunization services and available vaccines differ from those in mainland China. Shenzhen residents can access immunization services in Shenzhen and Hong Kong. We selected five districts/counties in total, which included one urban district from Shenzhen city, one urban district and one rural county separately from Anhui and Shaanxi provinces. Questionnaires were administered to caregivers of children aged 0–6 and VSPs. Caregivers were enrolled through a two-stage clustered sampling method. At district/county level, 3–4 communities were selected to represent lower, median and higher social-economic tiers within each district. At community level, caregivers were recruited from vaccination clinics (for children <3 years) and kindergartens (for children aged 3–6 years). Caregivers who visited the sampled clinics on a set day were invited to scan QR code to fill in questionnaires on their mobile phones or to fill in paper-based questionnaires delivered by field investigators. Caregivers of children from a class in the sampled kindergarten were invited to complete the mobile-phone-based questionnaires. We disseminated 2178 questionnaires to caregivers (298 paper-based, 1880 mobile-phone-based) and received 2124 valid questionnaires from caregivers with a response rate of 97.5%. We invited all (≈600) VSPs working in the sampled areas to complete a mobile-phone-based survey and obtained 555 valid questionnaires from VSPs with a response rate of 95.0%. Respondents received an electronic currency worth 5 CNY (0.7 USD) for completing the mobile-phone survey, or a small gift of equal value for the paper-based questionnaire. The questionnaires were developed by the research team and piloted in a non-study-site community with 30 caregivers and 10 VSPs. The contents
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