Andy Becker’s research while affiliated with University of Minnesota, Duluth and other places

It is unclear how broadly aware parents are of the concept of herd immunity and whether parents consider community benefits of vaccination when making decisions about their child’s vaccinations. We aimed to determine whether educating parents about community-level benefits of measles, mumps, and rubella (MMR) vaccination and local vaccination rates would impact concern about their child’s risk of measles and risk of a measles outbreak. We conducted an electronic survey among Minnesota parents of children aged 6–18 years in August 2016. We assessed baseline knowledge of herd immunity, asked participants to estimate MMR vaccination coverage in their county, and asked participants to estimate the minimum coverage needed to prevent measles outbreaks. We then delivered a short, educational intervention via the survey to inform participants about the benefits of herd immunity, the actual MMR vaccination coverage in their county, and that at least 95% MMR vaccination coverage is needed to prevent measles outbreaks. Pre- and post-intervention, participants were asked to report how concerned they were that their child might get measles. We used logistic regression models to assess factors associated with awareness of herd immunity, change in concern about one’s child’s measles risk, and overall concern for a measles outbreak. Among 493 participants, 67.8% were aware of herd immunity at baseline. Post-intervention, 40.2% (n = 198) of parents learned that MMR vaccination rates in their county were higher than they expected. All participants found out that their county MMR rates were lower than the measles herd immunity threshold of 95%. Overall, 27.0% (n = 133) of participants reported an increase in concern that their child might get measles after learning about local vaccination coverage and the coverage needed to achieve herd immunity. We found that our short, educational intervention aimed to increase awareness about herd immunity and local vaccination led to an increase in concern about disease risk among less than a third of parents.

Background Declining vaccination coverage and increasing hesitancy is a worldwide concern. Many countries have implemented mandatory vaccination policies to promote vaccination. However, mandatory vaccination policies differ significantly by country. Beyond case studies, no comprehensive study has compared these policies or the penalties for non-compliance on a global scale. Methods We conducted extensive keyword, policy, and literature searches to identify mandatory national vaccination policies globally and develop a comprehensive database. A mandatory national vaccination policy was defined as a policy from a national authority that requires individuals to receive at least one vaccination based on age or to access a service. Two reviewers independently evaluated evidence for a mandate and whether non-compliance penalties were incorporated. We categorized penalties into four types, based on the nature of the penalty. These penalties impact an individual’s financial, parental rights, educational (i.e., child's school entry and access), and liberty status. We rated the severity within each category. Results Of 193 countries investigated, 54% (n = 105) had evidence of a nationwide mandate as of December 2018. The frequency, types, and severity of penalties varied widely across all regions. We found that 59% (n = 62) of countries with national mandates defined at least one penalty for non-compliance with a vaccine mandate. Among those, educational penalties (i.e., limiting a child's entry or ongoing access to school) were the most common (69%; n = 43), with most countries with educational penalties refusing school enrollment until vaccination requirements are met (81%; n = 35). Conclusion We undertook a comprehensive assessment of national mandatory vaccination policies and identified a diversity of penalties in place to promote compliance. Our results highlight the need to critically evaluate the implementation of non-compliance penalties in order to determine their effectiveness and to define best practices for sustaining high vaccination uptake worldwide.

Background Maintaining high coverage of measles, mumps, and rubella (MMR) vaccination is important for preventing outbreaks and maintaining herd immunity (HI), which benefits both individuals and communities. We aimed to determine whether information about the benefits of HI and local MMR vaccination rates could change a parent’s concern about their child’s risk of contracting measles. Methods We conducted a survey at the 2016 Minnesota State Fair among Minnesota residents ≥18 years who had at least one child aged 6–18 years. Participants were asked to choose the correct definition of HI, to estimate the MMR vaccination coverage in their county, and guess the minimum MMR vaccination coverage needed to prevent measles outbreaks. We delivered an educational intervention through the interactive survey informing participants about the benefits of herd immunity, the actual MMR coverage in their county, and that ≥95% coverage is needed to prevent outbreaks. Before and after the educational intervention, participants were asked to report their level of concern about their child contracting measles. We calculated adjusted predicted percentages from logistic regression models to evaluate changes in concern about risk pre- and post-intervention and to assess factors associated with concern about measles. Results Among the 493 participants, 92.7% reported vaccinating their child with MMR, though one third were not familiar with HI. Prior to receiving information, those knowledgeable about HI were significantly more likely to be concerned about their child getting measles (predicted percentage 80.2% [95% CI: 75.7–84.6]) than those who were unfamiliar with HI (predicted percentage 69.8% [95% CI: 62.1–77.5]), P-value for the difference = 0.027. Participants believed that MMR vaccination was, on average, 9.0% [95% CI: 6.9–11.0] lower than the actual coverage in their local area. Conclusion Information about HI and local vaccination coverage rates did not impact parental concern about their child being at risk for getting measles. Overall, parents learned that local MMR vaccination rates were higher than they had expected. Disclosures All authors: No reported disclosures.