Committee addresses vaccine confidence

The National Vaccine Advisory Committee (NVAC) has recommended a strategy for improving parents’ confidence in vaccines, including a recommendation for development of pay-for-performance initiatives and incentives in physicians’ practices.

The pay-for-performance initiatives would be measured by whether a practice establishes an immunizing standard and whether it has continued improvement in immunization rates.

Recommended: Vaccine refusal

The multipoint plan, adopted at the committee’s June 2015 meeting after a 2-year study by a working group, now goes to the National Vaccine Program Office (NVPO) in the US Department of Health and Human Services (HHS) for implementation. The NVAC is an outside advisory body to HHS with 14 members including physicians, academic experts, state health officials and others.

The recommendations also call for a meeting of stakeholders to discuss the current coding infrastructure and “the possible need to develop and value a new code for vaccine counseling when vaccine is ultimately not given.”

The America’s Health Insurance Plans, the group representing insurers, had objected to a recommendation for a provisional billing code, saying there is no evidence that “increasing provider payments for counseling would improve the attitudes, beliefs, and overall confidence of parents.”

The document also called for “on-time vaccination” to be a quality measure for all health plans, public and private, “as a first-line indicator of vaccine confidence.”

The NVAC also recommended development of an index to measure vaccine confidence, with a number of individual and social dimensions that could, among other things, detect variations in vaccine confidence at the local level.

The working group said the current National Immunization Survey does not routinely “include measures related to vaccine confidence, nor is there a standardized, validated set of questions for measuring vaccine confidence.” It’s not currently possible, the group said, to gauge or understand community-level vaccine confidence, including potential vulnerability of communities or schools to outbreaks.

The committee also recommended that states and territories with personal belief exemption policies should be sure the exemption is available only after a parent is educated and acknowledges the risks of not vaccinating.

The report defined vaccination confidence as the trust parents or providers have in the immunizations, in the providers administering them, and in the process leading to vaccine licensure and the recommended schedule.

More: Changing attitudes towards vaccination

It also recommended that:

·      Providers and others reinforce the idea that vaccination according to the Advisory Committee on Immunization Practices schedule is the social norm and not the exception.

·      An infrastructure should be created to: assess vaccine sentiment and provide timely information on vaccine confidence to stakeholders; identify and validate communication resources and approaches; and create a repository of best practices for communicating with parents and others. At the meeting, Vish Viswanath, PhD, professor of health communication at the Harvard School of Public Health, said much work is being done on best practices, but it is in silos isolated from each other.

·      Educational institutions and childcare facilities should report vaccination rates publically, such as through a school health grade or report.

A Federal Register notice solicited comments on the draft report from April 6 to May 6 this year. The work group said that of the 1921 comments from individuals, 1916 were from members or followers of the Alliance for Natural Health. Groups including the American Academy of Family Physicians and the American Academy of Pediatrics also commented.

The NVPO is to report annually on the progress toward the goals.