Noni Macdonald

• Dalhousie University

This study was conducted to determine whether school-aged autistic youth received routine vaccines at a lower rate than their non-autistic peers. In Nova Scotia (NS), Canada, vaccines routinely delivered in early adolescence are administered to Grade 7 students through a school-based Public Health vaccination program. NS youth eligible to receive G...

Identifying effective interventions to promote children’s vaccination acceptance is crucial for the health and wellbeing of communities. Many interventions can be implemented to increase parental awareness of the benefits of vaccination and positively influence their confidence in vaccines and vaccination services. One potential approach is using n...

Despite a lack of clinical data demonstrating the effectiveness of alcohol swab cleansing prior to vaccinations as a prophylactic measure to prevent skin infections, it is recommended for vaccine administration by the Canadian Immunization Guide. The objective of this study was to evaluate the risk of adverse events after omitting alcohol skin clea...

The Covid pandemic has yielded new insights into psychological vaccine acceptance factors. This knowledge serves as a basis for behavioral and communication interventions that can increase vaccination readiness for other diseases.

School-based immunizations are fear-inducing events for many students and contribute to vaccine hesitancy. We developed an immunization delivery framework called the CARD (Comfort Ask Relax Distract) system that incorporates evidence-based interventions to improve the experience (eg, reduce fear, pain, dizziness). We evaluated CARD in grades 6 and...

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...

Introduction Community pharmacists report that providing vaccinations can be challenging, particularly if the vaccine recipient is a child, because of heightened levels of fear. The objective of this study was to determine acceptability and feasibility of the CARD (Comfort Ask Relax Distract) system as a vaccination delivery framework for children...

Vaccines have contributed to substantial improvements in health and social development outcomes for millions in recent decades. However, equitable access to immunization remains a critical challenge that has stalled progress toward improving several health indicators around the world. The COVID-19 pandemic has also negatively impacted routine immun...

Introduction CARD (Comfort Ask Relax Distract) is a vaccine delivery program demonstrated to reduce pain, fear and associated immunization stress-related responses (ISRR) in children undergoing vaccinations at school. This study evaluated CARD’s clinical impact when integrated into community pharmacy–based pediatric vaccinations. Methods This was...

This study examined perceptions of children and parents about a new web-based CARD (Comfort, Ask, Relax, Distract) game that teaches children how to cope with needle-related pain and fear. A convenience sample of 15 child-parent dyads (children, 6–12 years) participated. Children played the game on a handheld device while being virtually monitored....

National Immunization Technical Advisory Committees (NITAGs) are tasked with the responsibility of guiding ministries of health and national immunization programmes in their policy development processes. Many NITAGs rely on evidence reviewed by the World Health Organization’s (WHO) Strategic Group of Experts (SAGE) on immunization and aim to adapt...

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...

At a workshop on 22–24 March 2022, leaders of 33 advanced vaccinology courses were invited to meet with partners to further the aims of the International Collaboration on Advanced Vaccinology Training (ICAVT) initiated in 2018 to assist courses in addressing challenges in priority areas and facilitate interactions and exchange of information. This...

Background Injection-related pain and fear are common adverse reactions in children undergoing vaccination and influence vaccine acceptance. Despite the large body of literature on sources of vaccine non-compliance, there is no estimate of the prevalence of pain and fear as contributing factors. The objective was to estimate the prevalence of injec...

Under-vaccination is a complex problem that is not simple to address whether this is for routine childhood immunization or for COVID-19 vaccination. Vaccination mandates has been one policy instrument used to try to increase vaccine uptake. While the concept may appear straight forward there is no standard approach. The decision to shift to a more...

Background Predatory journals charge authors for publication without quality peer review or editorial services. They target researchers not only in high-(HIC) but also in lower income countries (LIC). The purpose of this study was to investigate characteristics of predatory journals and their recruitment techniques aimed at researchers in LIC and H...

Background Additional doses of COVID-19 vaccine have been proposed as solutions to waning immunity and decreased effectiveness of primary doses against infection with new SARS-CoV-2 variants. However, the effectiveness of additional vaccine doses relies on widespread population acceptance. We aimed to assess the acceptance of additional COVID-19 va...

Background: Emergency obstetric referrals develop adverse maternal-fetal outcomes partly due to delays in offering appropriate care at referral hospitals especially in resource limited settings. Referral hospitals do not get prior communication of incoming referrals leading to inadequate preparedness and delays of care. Phone based innovations may...

Objectives : CARD (Comfort-Ask-Relax-Distract) is a vaccine delivery framework that includes interventions to improve the patient’s experience. CARD has not been previously implemented in long-term-care (LTC) settings. This study evaluated drivers to implementation for COVID-19 vaccinations in a LTC facility. Methods : Post-implementation interpre...

Academics and multinational pharmaceutical companies from high-income countries (HIC) are major drivers of health research in many low- and low-middle-income countries (LMIC) but have neglected investing in and growing local research capacity. Community-focused health research in LMICs needs to be more locally driven and benefiting. The MicroResear...

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 Additional doses of COVID-19 vaccine have been proposed as solutions to waning immunity and decreased effectiveness of primary doses against infection with new SARS-CoV-2 variants. However, the effectiveness of additional vaccine doses relies on widespread population acceptance. We aimed to assess the acceptance of additional COVID-19 va...

Objective To investigate COVID-19 vaccine uptake and intent among pregnant people in Canada, and determine associated factors. Methods We conducted a national cross-sectional survey among pregnant people from May 28 through June 7, 2021 ( n = 193). Respondents completed a questionnaire to determine COVID-19 vaccine acceptance (defined as either re...

The COVID-19 pandemic has highlighted the vital role of vaccination in preventing life-threatening diseases and improving global health. Understanding and addressing the concerns of vaccine-hesitant individuals, including those with chronic diseases, is key to increasing vaccine acceptance and uptake.

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...

Background The CARD (Comfort Ask Relax Distract) system is a vaccine delivery framework that integrates evidence-based interventions to reduce stress-related responses and improve the vaccination experience for children undergoing vaccinations at school. In preliminary studies, CARD was acceptable and effective. The objective was to evaluate CARD i...

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...

(Abstracted from JAMA 2021;325:2285–2293) Vaccination for seasonal influenza is an important health intervention, even for pregnant women. Influenza vaccination helps to reduce the risk of severe influenza illness for the mother and child.

Background Vaccinating children (≤17 years old) is important for controlling the COVID-19 pandemic. As parents are primary decision makers for their children, we aimed to assess parents’ perceptions and intentions regarding COVID-19 vaccination for their children, including for some underserved populations (e.g., newcomers, Indigenous peoples, and...

Aims: To evaluate an educational pamphlet that incorporates evidence-based pain mitigation strategies during adult vaccine injections and determine its effect on the knowledge, attitudes and behaviours toward use of such strategies among adults in the community receiving immunizations. Methods: An evidence-based pamphlet about how to reduce pain du...

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...

Despite ample evidence of the safety and efficacy of the influenza vaccine and the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine during pregnancy, two-thirds of pregnant women do not receive these vaccines. Providers have a significant role in increasing prenatal vaccine uptake. It is important to understand how different sources of v...

Importance Seasonal influenza vaccination in pregnancy can reduce influenza illness among pregnant women and newborns. Evidence is limited on whether seasonal influenza vaccination in pregnancy is associated with adverse childhood health outcomes. Objective To assess the association between maternal influenza vaccination during pregnancy and early...

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...

Background Vaccination is a common painful procedure for children. Parents’ concern regarding vaccination pain is a significant driver of vaccine hesitancy. Despite the wealth of evidence-based practices available for managing vaccination pain, parents lack knowledge of, and access to, these strategies. Knowledge translation (KT) tools can communic...

An often-stated public health comment is that “vaccination is a victim of its own success.” While the scientific and medical consensus on the benefits of vaccination is clear and unambiguous, an increasing number of people are perceiving vaccines as unsafe and unnecessary. The World Health Organization identified “the reluctance or refusal to vacci...

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...

En dépit des efforts visant à promouvoir la vaccination et à rendre les services de vaccination facilement accessibles, les taux de couverture vaccinale demeurent inférieurs aux taux cibles de nombreux vaccins dans plusieurs administrations. Le Bureau régional de l’Organisation mondiale de la santé (OMS) pour l’Europe a élaboré l’approche des Progr...

Despite efforts to promote vaccination and make vaccination services easily accessible, vaccination coverage rates remain below the target rate for many vaccines in various jurisdictions. The Tailoring Immunization Programmes (TIP) approach was developed by the World Health Organization Regional Office for Europe to support efforts of countries to...

Introduction: Although several evidence-based strategies for managing children's vaccination pain exist, many parents report being unaware of them. Knowledge translation (KT) tools present evidence-based information in plain language. Objectives: This two-phase study assessed parents/caregivers' uptake of evidence-based pain management strategie...

The individual and community health benefits of vaccination have received significant attention and are now well understood. However, much less is known about immunization as a regulated space, its principles and standards and its institutions and instruments. In 2011, the World Health Organization (WHO) recommended that National Immunization Techn...

Background Negative experiences with school-based immunizations can contribute to vaccine hesitancy in youth and adulthood. We developed an evidence-based, multifaceted and customizable intervention to improve the immunization experience at school called the CARD™ (C-Comfort, A-Ask, R-Relax, D-Distract) system. We evaluated the feasibility of CARD™...

Most vaccinations are administered with a needle, which can cause pain and pain-related symptoms such as fear and fainting. At present, interventions aimed at preventing pain and associated symptoms are not systematically integrated in the vaccination delivery process even though they contribute to negative experiences with vaccination and vaccinat...

La plupart des vaccins sont administrés avec une aiguille, ce qui peut provoquer des douleurs et des réactions liées à la douleur, tels que la peur et l’évanouissement. À l’heure actuelle, les interventions visant à prévenir la douleur et les réactions connexes ne sont pas systématiquement intégrées dans le processus d’administration de vaccins, bi...

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...

Background: Pain and fear during immunizations can affect children and their future behaviour toward immunization. These negative experiences can be amplified when children receive vaccines as part of school-based immunization programs, where parental or tutor supports are missing. In 2015, HELPinKIDS&ADULTS, a Canadian network of experts, publish...

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...

Concerns about the quality and use of immunization and vaccine-preventable disease (VPD) surveillance data have been highlighted on the global agenda for over two decades. In August 2017, the Strategic Advisory Group of Experts (SAGE) established a Working Group (WG) on the Quality and Use of Global Immunization and Surveillance Data to review the...

Increasing the comfort of vaccine delivery at school is needed to improve the immunization experience for students. We created the CARD™ (C-Comfort, A-Ask, R-Relax and D-Distract) system to address this clinical care gap. Originally designed for grade 7 students, this study examined the perceptions of grade 9 students of CARD™. Grade 9 students who...

Vaccines are among the safest therapeutic agents, and serious adverse events rarely occur. When they do occur, an individual may have to bear some or all of the costs associated with their injuries, seek compensation through litigation or, if available, seek compensation from a publicly-supported Vaccine Injury Compensation Program (VIC Programs)....

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 (...

COVID-19 has led to disruption in routine immunization programs around the globe and here in Canada. The National Advisory Committee on Immunization (NACI) in Canada has indicated that this sets the stage for serious outbreaks of vaccine-preventable diseases. The World Health Organization has evidence-based guidance on how to address missed opportu...

Governments around the world have implemented measures to manage the transmission of coronavirus disease 2019 (COVID-19). While the majority of these measures are proving effective, they have a high social and economic cost, and response strategies are being adjusted. The World Health Organization (WHO) recommends that communities should have a voi...

Introduction The Global Vaccine Action Plan (GVAP), unanimously endorsed by the World Health Assembly in 2012, defined an ambitious strategy to improve immunization. At the end of the decade, significant progress has been made but four of the five GVAP goals are likely to be missed. This report describes a set of surveys and interviews relating to...

In Canada, over 80% of parents choose to vaccinate their children. Although this may appear positive, it is one of the lowest vaccination rates in the western world, and does not meet the 95% coverage rate needed to prevent outbreaks of vaccine-preventable diseases such as measles. A recent national immunization survey showed approximately 50% of p...

Au Canada, plus de 80 % des parents choisissent de faire vacciner leurs enfants. Bien que cela puisse sembler positif, ce taux de vaccination figure parmi les plus faibles du monde occidental, et reste inférieur au taux de couverture vaccinale nécessaire (95 %) pour prévenir les éclosions de maladies évitables par la vaccination comme la rougeole....

The Global Vaccine Action Plan 2011–2020 (GVAP) was developed to realize the ambitions of the Decade of Vaccines – that all individuals and communities enjoy lives free from vaccine-preventable diseases. It included a comprehensive monitoring and evaluation/accountability framework to assess progress towards global targets with recommendations for...

Introduction The Monitoring & Evaluation/Accountability (M&E/A) framework of the Global Vaccine Action Plan (GVAP) was used to report progress annually to the World Health Assembly (WHA). Methods Stakeholder feedback was obtained through five reviews consisting of surveys and semi-structured interviews conducted from 2017 to 2019. Participants con...

In preparation for the first Global Vaccinology Training workshop in 2018, a survey of 27 advanced vaccinology courses was conducted to provide a landscape of the vaccinology education around the world. Advanced vaccinology courses have expanded dramatically over the last 20 years, with courses located in almost all regions, but with underrepresent...

The Council for the International Organizations of Medical Sciences (CIOMS) and WHO working group on pharmacovigilance defines five cause specific AEFI which includes an immunization anxiety-related reaction. Historically this term has been used to describe a range of symptoms and signs that may arise after immunization that are related to “anxiety...

We appreciate the thoughtful comment from Dr Liao. While framed around religion he has honed in on a very important area not just related to religion, i.e., the importance of trust. Health care workers may be seen as ‘powerful’ by some who are hesitant. Thus, extra care must be taken not to intimidate, demean, or in any way downplay concerns, value...

L’avalanche d’informations sur la vaccination en ligne a une énorme incidence sur le pourcentage de la population qui choisit de se faire vacciner. La désinformation sur les vaccins peut se répandre largement dans le Web 2.0 interactif et les médias sociaux, ce qui peut noyer les informations scientifiques fondés sur les données probantes. La multi...

Les progrès scientifiques réalisés autour de la mise au point, de l’utilisation et de l’amélioration des pratiques visant à communiquer les avantages des vaccins sont rapides, et se tenir au courant du vaste ensemble de données à cet égard représente un défi. L’augmentation du nombre de vaccins et le déclin des maladies évitables par la vaccination...

Background: Exclusive breastfeeding (EBF) is one of the key strategies to ensure infants and young children survive and grow. However, a 2010 study showed that it was only practiced by 50% of Tanzanian women. That study also found that men were rarely supportive; either at home or in the health facilities, due to their personal beliefs or to tradi...

Abstract A high quality systematic review search has three core attributes; it is systematic, comprehensive, and transparent. The current over-emphasis on the primacy of systematic reviews over other forms of literature review in health research, however, runs the risk of encouraging publication of reviews whose searches do not meet these three cri...

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...

Background: Surveillance of AEFI is fundamental for improving safety and maintaining public support for vaccination. In SEAR, billions of doses of vaccine are given annually. The objective of the 2019 SEAR AEFI training workshop was to further strengthen in-country vaccine safety, assess capacity compared to 2014 and to better integrate communicat...