Communication about the safety of human papillomavirus vaccines

Crises can result from clusters of “adverse events following immunization”, reports of new studies or data on the safety of a vaccine, media reports and rumours about vaccine safety or regulatory action such as recall of a vaccine. These events can result in a negative perception of a vaccine’s safety and adversely affect its acceptance. Strategies for communication about vaccine safety are necessary throughout the life cycle of all vaccine products and not only as part of crisis management.

A GACVS subgroup on vaccine safety communication has studied selected vaccine communication crises, including that associated with Dengvaxia in the Philippines,12 measles, mumps and rubella (MMR) vaccine in Samoa and Sudan13 and HPV vaccine in 5 countries. A repository of case studies of vaccine safety communication in low-, middle- and high-income countries is expected to be helpful for preparing a common framework for crisis communication. The framework suggested in a WHO manual “Four immediate steps when responding to an event that may erode trust”14 was adopted for all the studies. The steps are establishing an “inner circle”, understanding the problem, liaising with key stakeholders and communicating effectively.

At this meeting, case studies of communication about HPV vaccine were examined. Misinformation, occasional coincidental deaths and stress-related reactions have led to controversy about the safety of HPV vaccines. Although these vaccines could control a major public health problem and despite robust evidence of their safety,15 their uptake has remained low, especially in many high-income countries.

Coordination and engagement among health departments, immunization programmes, stakeholders, influential public leaders and the media are essential for mitigating such crises. In Denmark and Ireland, the decrease in HPV vaccine coverage was relatively slow, and strategies to address the problem were developed in response to low coverage rather than to widespread negative media reports. An important initial step in addressing decreasing vaccine coverage is coordination and communication among key stakeholder groups. In the United Kingdom, a similar event was tackled promptly, and a crisis averted within 4 days.

The case studies reviewed demonstrate that crises can be mitigated when key stakeholders are involved and proactive communications are established immediately. In Samoa (MMR), there was prompt communication among the relevant authorities and appropriate investigations, but initial attempts to hide the vaccination error and blaming individuals rather than conducting systemic analyses were detrimental to the vaccine programme. The public was not informed of the reasons for the event.

Appropriate, timely communication with the public is of paramount importance. In Denmark and Ireland, after research, communication to the public was multifaceted, coordinated and widespread. In the United Kingdom, after the death of an adolescent shortly after HPV vaccination, the public was informed on the day of the event, and communication channels between the Department of Health and the media remained open for the duration of the crisis. In Brazil (Dengvaxia), the public were informed of the problem immediately, and the media were referred to the health authorities, WHO and the manufacturer.

The WHO European Regional Office document for managing vaccine safety communication was shared during the meeting. Lack of preparedness, insufficient crisis response and strategic communication capacity, limited financial and human resources and insufficient media relations negatively affect vaccine uptake, while a swift response and good coordination among stakeholders have positive effects.

Vaccine hesitancy may also be driven by social and political agendas. Many stakeholders other than the media can influence perceptions of vaccine safety, including teachers, religious leaders, lawyers and poli-tical activists. Delivering accurate messages at the right time is the basis of good communications. The intensity of the response should be proportionate to the context and the severity of the situation. During crises, the principles of being first, right, credible, empathetic, respectful, consistent and providing clear messages are essential.

Health workers must be educated about vaccine issues and given the appropriate skills and training. The characteristics of vaccines, their safety and possible questions from stakeholders can be foreseen and short answers prepared and included in training. The messages issued during a crisis must be consistent and the public educated about the benefits of immunization. More attention should be given to the education of young people about the value of vaccines.

Report of GACVS meeting of 5-6 June 2019, published in the WHO Weekly Epidemiological Record of 12 July 2019