Janice E Graham

Dalhousie University | Dal · Department of Pediatrics

Vaccines are not the only public health tool, but they are critical in routine and emergency settings. Achieving optimal vaccination rates requires timely access to vaccines. However, we have persistently failed to secure, distribute, and administer vaccines in a timely, effective, and equitable manner despite an enduring rhetoric of global health...

Objective Successful clinical conversations about vaccination in pregnancy (pertussis, COVID-19, and influenza) are key to improving low uptake rates of both vaccination in pregnancy and infancy. The purpose of this study was to understand Canadian perinatal care providers’ knowledge, attitudes, and practices around vaccination in pregnancy. Metho...

Background Negative information about vaccines that spreads online may contribute to parents’ vaccine hesitancy or refusal. Studies have shown that false claims about vaccines that use emotive personal narratives are more likely to be shared and engaged with on social media than factual evidence-based public health messages. The aim of this study w...

Canadians and Quebecers increasingly consult complementary and alternative medicine (CAM) practitioners in parallel with biomedical providers. The close relationship between vaccine hesitancy and CAM use remains under explored in Western countries. We present the results of a qualitative study conducted among one of Quebec's most used CAM approache...

In Canada, the first COVID-19 vaccine was approved for use in December 2020, marking the beginning of a large vaccination campaign. The campaign was not only unprecedented in terms of reach, but also with regards to the amount of information about vaccines that circulated in traditional and social media. This study's aim was to describe COVID-19 va...

Health care providers' recommendations can play an important role in individuals' vaccination decisions. Despite being one of the most popular complementary and alternative medicine (CAM), naturopathy is understudied in relation to vaccination decisions. We sought to address this gap through this study of vaccination perspectives of naturopathy pra...

Early in COVID-19 vaccine rollout, expert recommendations about vaccination while pregnant and breastfeeding changed rapidly. This paper addresses the (re)production of gendered power relations in these expert discourses and recommendations in Canada. We collected texts about COVID-19 vaccine use in pregnancy (N = 52) that Canadian health organizat...

Background: Analysing the Canadian government’s efforts to support the development of COVID-19 "medical countermeasures" (MCMs), this article seeks insights into political economy as a driver of pandemic response. We explore whether Canadian public funding policy during the pandemic involved departures from established practices of financialisation...

Background The COVID-19 pandemic exacerbated existing health disparities and disproportionately affected vulnerable individuals and communities (e.g., low-income, precariously housed or in institutional settings, racialized, migrant, refugee, 2SLBGTQ+). Despite their higher risk of infection and sub-optimal access to healthcare, Canada’s COVID-19 v...

Objectives Communication is central to the implementation and effectiveness of public health measures. Informed by theories of good governance, COVID-19 pandemic public health messaging in 3 Canadian provinces is assessed for its potential to encourage or undermine public trust and adherence. Methods This study employed a mixed-methods constant co...

Structural and systemic inequalities can contribute to susceptibility to COVID-19 disease and limited access to vaccines. Recognizing that Racialized and Indigenous Peoples may experience unique barriers to COVID-19 vaccination, this study explored early COVID-19 vaccine accessibility, including barriers and potential solutions to vaccine access, f...

Uptake of vaccination during pregnancy in Canada is lower than comparator countries. A recommendation from a trusted perinatal healthcare provider is a key opportunity to promote vaccine uptake and improve confidence. This study aims to identify barriers and opportunities to vaccination in midwifery care. Seventeen semi-structured telephone intervi...

Background In Canada, vaccination that protects against pertussis and influenza is recommended in every pregnancy, but uptake remains low. Communicating the risks and benefits of vaccination is key to clinical conversations about vaccination, which may influence the uptake of pregnancy and subsequent infant vaccines. Canadian midwives use an inform...

Objective To explore Nova Scotian experiences, barriers, and facilitators associated with pandemic public health measures (PHM), including COVID-19 vaccination. Methods We conducted semi-structured, individual interviews with Nova Scotians between May and August 2021, during the third wave of COVID-19 cases and provincial lockdown. Participants we...

UNSTRUCTURED The COVID-19 pandemic has spotlighted the intertwining of politics and public health. So too, a public health tool, surveillance, can also be used to expose the political context of an event and to guide better public health interventions. In its current form, infoveillance tends to neglect identity and interest-based users. Adopting a...

Background The COVID-19 pandemic has spotlighted the politicization of public health issues. A public health monitoring tool must be equipped to reveal a public health measure’s political context and guide better interventions. In its current form, infoveillance tends to neglect identity and interest-based users, hence being limited in exposing how...

UNSTRUCTURED The COVID-19 pandemic generated an explosion in the amount of information shared online, including false and misleading information on the virus, and recommended protective behaviours. Prior to the pandemic, online mis- and disinformation were already identified as having an impact on people’s decision to refuse or delay recommended va...

Background: The COVID-19 pandemic generated an explosion in the amount of information shared online, including false and misleading information on the virus, and recommended protective behaviours. Prior to the pandemic, online mis- and disinformation were already identified as having an impact on people's decision to refuse or delay recommended va...

Background Health care providers’ knowledge and attitudes about vaccines are important determinants of their own vaccine uptake, their intention to recommend vaccines, and their patients’ vaccine uptake. This qualitative study’ objective was to better understand health care providers’ vaccination decisions, their views on barriers to COVID-19 vacci...

Background: The gaps in clinical trial evidence about vaccination in pregnancy have serious implications for health care worker and public misunderstandings. Contradictions between National Immunization Technical Advisory Group (NITAG) recommendations and regulatory product labeling information contribute to misinformation about vaccine safety and...

Objectives Communication is central to the implementation and efficacy of public health measures. This paper explores public health messaging in Canada during the COVID-19 pandemic, assessing its potential to encourage or undermine public trust and adherence. Methods This study analyzed data from two primary sources. The first is government press...

Vaccination policies have shifted dramatically during COVID-19 with the rapid emergence of population-wide vaccine mandates, domestic vaccine passports and differential restrictions based on vaccination status. While these policies have prompted ethical, scientific, practical, legal and political debate, there has been limited evaluation of their p...

Background Vaccination coverage needs to reach more than 80% to resolve the COVID-19 pandemic, but vaccine hesitancy, fuelled by misinformation, may jeopardize this goal. Unvaccinated older adults are not only at risk of COVID-19 complications but may also be misled by false information. Prebunking, based on inoculation theory, involves ‘forewarnin...

The COVID-19 pandemic represents not only the spread of a highly contagious and potentially fatal virus, but also an outbreak of theories, rumors, discourses and representations trying to make sense of a crisis. In this article, we explore the issue of blame and stigma in the context of the COVID-19 pandemic in Canada. We do so by studying editoria...

Scholarship undertaken throughout the pandemic has identified a range of gaps in Canada’s immunization governance landscape, some of them persisting despite long-running calls for reform (e.g., absence of patient-centred health information systems, absence of unified vaccine injury compensation scheme, closed-loop nature of decision-making, etc.)....

Background: The influx of over 1.3 million refugees in Uganda, with over 10% settling in the capital city Kampala, challenges the ability of urban refugees to access Sexual and Reproductive Health services (SRH) and family planning (FP) amidst the multiple uncertainties of a precarious everyday life. Utilization of SRH services remains low among ur...

COVID-19 vaccine acceptance exists on a continuum from a minority who strongly oppose vaccination, to the “moveable middle” heterogeneous group with varying uncertainty levels about acceptance or hesitancy, to the majority who state willingness to be vaccinated. Intention for vaccine acceptance varies over time. COVID-19 vaccination decisions are i...

An amendment to this paper has been published and can be accessed via the original article.

L’Organisation mondiale de la Santé (OMS) reconnaît que la vaccination est l’une des interventions en matière de santé publique les plus efficaces pour sauver des vies. Lors de l’élaboration d’une feuille de route permettant d’établir un ordre de priorité relatif à l’utilisation des vaccins contre la maladie à coronavirus 2019 (COVID-19) dans un co...

The World Health Organization (WHO) recognizes immunization as one of the most successful and effective public health interventions for saving lives. In developing a roadmap for prioritizing use of the coronavirus disease 2019 (COVID-19) vaccines in the context of limited supply, WHO highlighted the importance of a values (ethical principles) frame...

Public health urgency for emerging COVID-19 treatments and vaccines challenges regulators worldwide to ensure safety and efficacy while expediting approval. In Canada, legislative amendments by 2019 Omnibus Bill C-97 created a new "agile" licensing framework known as the "Advanced Therapeutic Pathway" (ATPathway) and modernized the regulation of cl...

Through twelve ethnographic case studies, The Social Life of Standards reveals how standards – political and technical tools for organizing society – are developed, applied, subverted, contested, and reassembled by local communities interacting with norms often created by others. Contributors explore standards at work across different countries and...

Background Little is known about volunteers from Northern research settings who participate in vaccine trials of highly infectious diseases with no approved treatments. This article explores the motivations of HIV immunocompromised study participants in Canada who volunteered in a Phase II clinical trial that evaluated the safety and immunogenicity...

Background: The World Health Organization recommends immunization with inactivated influenza vac-cine (IIV) and tetanus-diphtheria-acellular pertussis (Tdap) vaccine during pregnancy. Yet, product label-ling information for IIV and Tdap sends a different message. In a previous study, we developed evidence-based statements about vaccination in pregn...

Medicine regulators rely on pivotal clinical trials to make decisions about approving a new drug, but little is known about how they judge whether pivotal trials justify the approval of new drugs. We explore this issue by looking at the positions of 3 major regulators: the European Medicines Agency, Food and Drug Administration, and Health Canada....

For control of COVID-19, community immunity is required, necessitating widespread immunization. COVID-19 vaccines are coming to Canada, with the government announcing in August 2020 agreements with four different companies for their COVID-19 vaccine if their trials are successful. Never before has public health had to rapidly develop a vaccine intr...

Canada has become a global leader in publicly releasing clinical data behind therapeutic products since 2019. Disclosure of clinical data is, however, limited to the point of product approval. The COVID-19 pandemic has underscored the limitations of such a point-in-time approach to transparency. As interventions are rapidly authorized for clinical...

International trends currently favour greater use of mandatory immunization. There has been little academic consideration or comparison of the existence and scope of mandatory immunization internationally. In this paper, we examine mandatory immunization in 28 Global NITAG (National Immunization Technical Advisory Group) Network (GNN) countries, in...

Background In the Global Vaccine Action Plan 2017 Assessment Report, WHO's SAGE noted need to understand ways in which legislation and regulation are used to advance or undermine immunization. The NITAG Environmental Scan Project sought to address this in a pilot study. Methods Data was collected via a secure online survey of GNN members (40 count...

Vaccine hesitancy–the reluctance to receive recommended vaccination because of concerns and doubts about vaccines–is recognized as a significant threat to the success of vaccination programs and has been associated with recent major outbreaks of vaccine-preventable diseases. Moreover, the association between complementary and alternative medicine (...

Background: In 2018, the Canadian National Advisory Committee on Immunization and the Society of Obstetricians and Gynaecologists of Canada recommended a single dose of tetanus toxoid, reduced diphtheria toxoid and reduced acellular pertussis (Tdap) vaccine in every pregnancy. To understand how perinatal health care providers in Canada are transla...

The discovery and development of the Ebola rVSV-ZEBOV vaccine challenge the common assumption that the research and development for innovative therapeutic products and vaccines is best carried out by the private sector. Using internal government documents obtained through an access to information request, we analyze the development of rVSV-ZEBOV by...

In 2017, the Strategic Advisory Group of Experts on Immunization's Assessment Report of the Global Vaccine Action Plan noted the need to "better document the ways in which legislation and regulations have been used to promote or undermine immunization at the national level". Despite National Immunization Technical Advisory Groups (NITAGs) now exist...

Background: National Regulatory Authorities approve the indications for vaccine use in the product information. Occasionally, National Immunization Technical Advisory Groups (NITAGs) make off-label recommendations for use in different age groups, populations, and dosing schedules from the product information. We sought to determine the rationale,...

Background: Product labelling information describing the use of vaccines in pregnancy continues to contain cautionary language even after clinical and epidemiological evidence of safety becomes available. This language raises safety concerns among healthcare providers who may hesitate to recommend vaccines during pregnancy. Purpose: To develop c...

Global vaccine development is driven by logics that can run counter to local understandings, needs, and contexts. In a global industrial complex, dependent on financial market logics that prioritize private enterprise, highly promising innovative health products developed in public laboratories may be shelved and revealed only when market opportuni...

How do postgenomic innovations emerge and become legitimate? Proteomics, a frequently utilized postgenomic technology, provides a valuable case study of the sociotechnical strategies used by an emergent scientific field to establish its legitimacy and assert political power. Chief among these strategies is standard making, an inherently political p...

Objective: To identify and describe features of relationship-based care that contribute to a successful collaborative model of primary care delivery. Design: Focused institutional ethnography using a critical medical anthropology approach. Setting: The North End Community Health Centre (NECHC) in downtown Halifax, NS. Participants: Twenty he...

Trust is an essential component of successful cooperative endeavours. The global health response to the 2014–2016 West Africa Ebola outbreak confronted historically tenuous regional relationships of trust. Challenging sociopolitical contexts and initially inappropriate communication strategies impeded trustworthy relationships between communities a...

Introduction/Hypothesis Recruitment of participants into phase 1 vaccine clinical trials can be challenging since these vaccines have not been used in humans and there is no perceived benefit to the participant. Occasionally, as was the case with a phase 1 clinical trial of an Ebola vaccine in Halifax, Canada, during the 2014–2016 West African Ebol...

Despite robust evidence that routine immunization is effective and safe, some parents refuse some or all vaccines for their children. In 2007, concern that Canadian paediatricians and family physicians might be considering dismissal of vaccine refusers from their practices prompted an ethical, legal, and public health analysis which concluded that...

Background: Influenza immunization is recommended in pregnancy to prevent severe infections in pregnant women and newborns, yet vaccine uptake remains low. Studies suggest that cautionary language in vaccine product monographs regarding safety and use in pregnancy affects health care providers' perceptions of vaccine safety and how they counsel pre...

Le projet Vaccins Méningite a permis à des millions d'Africains de disposer d'un vaccin peu coûteux, le MenAfriVac, grâce à un transfert de technologie. Les récits de la biomédecine en ont fait une histoire à succès, un mythe sociotechnique anonyme et collectif dans lequel le MenAfriVac revêt une efficacité magique. Les promoteurs du vaccin ont cho...

“Vaccine hesitancy” is a concept now frequently used in vaccination discourse. The increased popularity of this concept in both academic and public health circles is challenging previously held perspectives that individual vaccination attitudes and behaviours are a simple dichotomy of accept or reject. A consultation study was designed to assess th...

Author List. (PDF)

Questions asked during the First questionnaire and Second questionnaire. (PDF)

Proteomics is one of the pivotal next-generation biotechnologies in the current “postgenomics” era. Little is known about the ways in which innovative proteomics science is navigating the complex socio-political space between laboratory and society. It cannot be assumed that the trajectory between proteomics laboratory and society is linear and uni...

The primary healthcare approach advanced at Alma Ata to address social determinants of health was replaced by selective healthcare a year later at Bellagio. Subsequently, immunization was endorsed as a cost-effective technical intervention to combat targeted infectious diseases. Multilateral efforts to collaborate on immunization as a universal pub...

Richard Lewontin proposed that the ability of a scientific field to create a narrative for public understanding garners it social relevance. This article applies Lewontin's conceptual framework of the functions of science (manipulatory and explanatory) to compare and explain the current differences in perceived societal relevance of genetics/genomi...

Nutrigenomics and nutrigenetics (hereafter NGx) have stimulated expectations for beneficial applications in public health and individuals. Yet, the potential achievability of such promise is not without socioethical considerations that challenge NGx implementation. This paper focuses on the opinions of NGx researchers about potential risks raised b...

Background: In Canada and elsewhere, research policies require researchers to secure consent from a legally authorized representative (LAR) for prospective participants unable to consent. Few jurisdictions, however, offer a clear legislative basis for LAR identification. We investigated Canadian researchers' practices regarding the involvement of...

Homelessness is a critical social issue, both a product of, and contributing to, poor mental and physical health. Over 150,000 young Canadians live on the streets. Homeless youth experience a high incidence of infectious diseases, many of which are vaccine preventable. Early departure from school and limited access to public health services makes t...

The marketing of Gardasil® and Cervarix™ vaccines for the prevention of human papillomavirus (HPV) targeted pre-sexual girls and cervical cancer, representing young women as practicing ‘decision autonomy’ in acquiring the ‘facts‘ about HPV and cancer. We challenge this overly simple explanatory model of vaccine choice. Through interviews with vacci...

Older adults who are incapable of giving informed consent to participate in dementia research require special regulatory protection. We investigated the practices of Canadian research ethics boards (REBs) regarding research protocols that may involve these individuals. We also explored the opinions of REB chairs on related issues, including researc...

Gaining informed consent among marginalized groups that include decisionally incapacitated individuals and those outside of the researcher's own geo-social and ethnic background still challenges many researchers. We suggest that there is a need for consideration of a different approach to research ethics in international settings. Based on extensiv...

Appendix. The data file is a word file containing an explanatory appendix with a statement regarding the use of a proprietary term.

ABSTRACT: Human Papillomavirus vaccines are widely hailed as a sweeping pharmaceutical innovation for the universal benefit of all women. The implementation of the vaccines, however, is far from universal or equitable. Socio-economically marginalized women in emerging and developing, and many advanced economies alike, suffer a disproportionately la...

Advance planning for health care and research participation has been promoted as a mechanism to retain some control over one's life, and ease substitute decision making, in the event of decisional incapacity. Limited data are available on Canadians' current advance planning activities. We conducted a postal survey to estimate the frequency with whi...