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Hi, My name's Colin Darby and I'm in Advanced nearly a a nurse practitioner working incredible, very hospital with Southern Health of Super Car Trust. I'd like to thank Armstrong Medical for inviting me to come here today to talk about an area of my interest vaccine hesitancy. Today's talks going to look at what is faxing hesitancy? Why is it important for us to understand who's responsibility, is it? How can we combat it on Where can we find out the answers to the questions that parents and patients ask us when they have come? Some concerns around vaccine safety? In 2014, the World Health Organization Strategic Advisor Group of Experts developed a definition of vaccine hesitancy, which is the delay and acceptance or refusal off vaccines. Despite the availability of a vaccination service, vaccination hesitancy is complex on contact specific, burying across time, please on vaccines. It is influenced by factors such as complacency, convenience on confidence vaccine hasn't. C is listed on the World Health Organization is list off greatest threats to human health vaccine. Hesitancy is old is faxing themselves. Evidence is seen as far back as the 17 hundreds, where boxing's reviewed as diabolical operations to opposed God's parchment. The national anti vaccination leg was fine did in 18 66 in Britain, growing from earlier, smaller organizations in London, originally under the title of anti compulsory vaccination in 1973 we saw the Association of Parents of Faxing Times Children set up by Gordon Stewart on In 1982 100 Week Healed, a former British physician, an academic was struck off the medical register for his involvement in the paper published in the Mount said falsely linking the MMR vaccine daughter is, um, most of the people opposing were motivated on the fact of speakers, some of high repeat and medical circles. When we look at the vaccine acceptance as a continue, we can identify different views. There are some parents that will accept vaccines. I'll be happy for their Children be vaccinated. There are some questions, but get the vaccines anyway. On the poor end, there is a small minority who will reviews vaccines all together refuse to acknowledge the scientific evidence. I believe in a variety of conspiracy theories that support their choice to refuse. However, there is a larger group in the middle that delay or refuse because they're unsure on are not informed enough. We should focus our time and effort on these parents and patients as they will find reassurance and having conversations on getting the right information so they can make informed decisions. But their health under Charles help. Another determinant is confidence. Confidence is to find us trust in the effectiveness and safety of vaccines, the systems that deliver them, including the reliability incompetence off the health service on health professionals. On the motivations off the policy makers she decide on the new the vaccines was not anti vaccine. Many hesitant people still expressed concerns off the big pharma influence on the scheduling on creation of vaccines. Big pharma conspiracies have had a revival of lit due to the cold but 19 vaccine development on the closer look at the vaccine development process. There are many factors that affect the vaccine convenience such a physical availability, affordability, willingness to pay geographical accessibility, ability to understand what their language and health literacy on a peel off the immunization services that affect the uptick of vaccines. Let's not all of these are issues here in the UK There are factors to take into consideration with convenience with the National Health Service. Like the NHS evidence shoes, the larger families on families with a lower financial income shoveled here. 10 routine chatted, vaccination appointments with factors less than ours. No one to look after the other Children. The cost travel for the whole family to get to the appointment location that these parents rank. The importance of vaccines lower in their daily priority list alone that likes off with work on financial stability has a greater priority. Evidence also shows that parents with low income change mobile provider greater numbers of times and those with a greater financial income leaving to miss Texas reminders of appointments, thus resulting in a greater risk of non compliance with the vaccine schedule. When we look at the determinant, some vaccine hesitancy this could be classed across the three C's model. Faxing compliance exists. Were perceived risks of vaccine preventable diseases or low on vaccination is not deemed as a necessary preventive action. Complacency about a particular vaccine or about vaccinations in general is influenced by manufacturers, including our life and half responsibilities that maybe seem to be more important at that point in time. Immunization program success may result in complacency and ultimately hesitancy as individuals, where risks of vaccines against risks of diseases that are no longer common, which some might say is a fault of the vaccines themselves. We've been so good that eradicating diseases, which previously would have killed millions, no longer invoke fear or worry as many generations have not experienced any one with the legs of polio or smallpox or even diptheria. In order for us to have conversations, the vaccine has unprincipled to address the issues we need to understand the social complexities that go around the decision making process. Many of these are the surest IQ approaches. So when we look at a veil ability, bias confirmation, bias on a mission bias, the's influence heavily on vaccine has it in parents, on patients, we're looking availability bias. This can explain that causes off these risks perceptions when people have value it on events Likelihood, the often assess probabilities are easily specific icons come to mind. So other words, the more available I come is mentally, the more likely it is that I come will be assigned a higher probability of a curry taking sample. We're going on the floor in holiday. Many of us are afraid of flying, but actually, when we look at the data, there's greater risk off us travelling the 20 miles in the car to the ER report. Then there is actually a journey on the plan. But what we hear more often on what comes to your mind more when we think about for in trouble is by plane crashes. So we rank that probably slightly higher than what we would do if we were to frank about crashes and cars when we apply this to a vaccine situation. What comes to mind is the MMR vaccine, where people really concerns off the reported autism link rather than the risk of death or disability associated with diseases such as measles, mumps and rubella. This may be due to the success of the vaccines or generations of adults have not experienced these diseases. Therefore, they were these as low risk, thus generating on imbalance of concern. Confirmation bias is the tendency to look for evidence, which is in a line with our existing belief. So for people already skeptical of vaccine safety would look primarily for evidence and information, which is in line with that much like a person convinced that the safety of vaccines would rarely look for contradictory information. Confirmation bias start for also makes it difficult for new information to penetrate existing beliefs. Judah confirmation bias The way of gathering evidence further examine its disinformation on contributes to the rise and vaccine hesitancy. Many strong, hesitant people will have strong confirmation bias to a point where refusal off new information commit conversations between health care staff on parents and patients. Very difficult. So this is showing the disinformation. False reports. A negative vaccine Statements travel further on social media platforms. Travel broader on faster than factual evidence based information. This leads to imbalance of information available to people to make informed decisions on vaccine acceptance or refusal. The emission bias leads people to believe negative consequences from actions to be worse than negative consequences from in action. When I come Zarand clear, many people would prefer to remain passive rather than actively doing something. The emission bias is a fundamental obstacle to any vaccination process. As vaccination required action. I ever people already hesitant vaccinations might believe potential side effects to be worse than possibly contracted in the disease simply because side effect would not have occurred if they're not actively chosen to get vaccinated. In other words, people's preference towards in action in the face of potential add it comes confirmed. They're explain hesitancy towards vaccinations. This is often described and hesitant parents and patients as the naturalist biased. Rather, have the Children exposed naturally to disease and develop immunity that way without identifying correct with the risks associated with the disease. But they're in action, allies them to not feel guilt over their decision. We can focus on individual contributions to the vaccine program through our interactions with vaccine has an imprint, some patients, our own perceptions. You need to be clear about vaccines. As health professionals. We endorse them on his parents. We give them to our own Children. This is a very powerful message on We're in a powerful position to influence being champions for vaccines and upholding their benefit are key contributions too high we can influence vaccine has, um, parents to consider. Boxing's good communication is integral toe all aspects of care on three or in directions. We need to be respectful. You need to be empathetic on acknowledge parents concerns through listening, unknown, judgmental manner we're monitoring with threats of their child dying from a disease do not engage parents who already have far his concerns they could become defensive unknown. Receptive information is important, of course, but should not be considered as the most important in respect to our interactions with parent's through our nonverbal and terrible communication, we're not infectious disease experts on Do not need to know all the information available acknowledging are limitations of our knowledge base to parents can build a contrast on. This could be supported by providing parents with written information or sign post them two websites agencies. Unguided is for them to get the best information available. What we did in the Southern Trust is we developed a group called Prozac Movement of Champions that wanted to promote conversations with vaccine has been parents through this group on the support from the Arc A on the Southern Trust. We were able to develop on record scenarios of our lived experiences of Age of the Champions so that we can disseminate the information I other trusts on other departments so that learning could be used on me. It on improved confidence for healthcare professionals when they have interactions with vaccine hasn't parents or patients example, and I'll show you here. Today is a little experience that I had. Why don't need it. You know it with the vaccine has an important Prozac movement promoting conversations of faxing safety. The conversation takes place between a mother and column who is an advanced neonatal nurse practitioner in the New Natal unit where a premature baby is do our first eight week back. See? Hi, Sarah. I'm digging. Thanks. So it's great to see the word insulin isn't suggests, you know, if we think back to eight weeks when she was just born, how much interventions and support she needed back then you have the CPAP Machine IV antibiotics on the IV fluids. You just come such a long way ages in and up a carton. I just doing really well with establishing feeds. Do you see these changes? And it's such a difference. I'm really happy with how we're just in progressive. I wanted to come and have a chat with you today about Laura having a routine, chatted vaccinations and wanted to bring this leaflet for you to have to read on, then have a discussion about the vaccines to see if you have any questions about the vaccines and consent? Well, you know where Gp did send us a letter last week, and it got me thinking I'm just a little bit worried that she might still be too young for the vaccines. You know, she was born in the 28 weeks, and we'll just still preterm. Do you think that she would be able to cope with so many vaccines all together? You're right to ask these questions around prematurity cause she's still affected by a prematurity. But you know where it weeks older. Unless it weeks back. Whenever she was first born, she needed a lot more interventions because a lot of the systems and her body were premature on immature. So thinking about her lungs, they weren't really developed. And we had a support, her breathing with CPAP. You know, her liver was immature and she needed some support with John. Decide phototherapy be known either just 36 weeks, just one week off. Being classified as a term baby. I'm just doing so well. So a lot of those systems when I stronger, I'm better. Yeah, you know what? Like a different baby? All right, But you know, I was thinking, Is it no matter? Just to wait until her? J didn't. Well, you know, ultimately, in the next couple of weeks, we're gonna be supporting me and talking to you by discharge home. I'm getting all ready for home. One of the main goals if I can get home, is that your stays at home where she's going to flourish. We don't want her to have any admissions in the hospital on one of the best ways we can prevent that is by given childhood vaccinations at the weeks 12 weeks 16, you know, and so on because that's going to help build up her own active immunity to prevent her from being affected by the's preventable diseases. You know, if you think about your pregnancy, you know what 40 weeks is what you were, um, to get to, but unfortunately delivered a 28 weeks on in that last trimester of your pregnancy. There's a big surge of antibodies across the percent into the baby on that builds upon their active immunity. Lora never got to that stage, so it's even more important as a pre term baby that she gets this at the weeks night to prevent her from being affected whenever she's discharged home. You know you were talking there, a bite Being overwhelmed by the number of accidents, we come into contact with bugs of organisms every day on our bodies, able to cope A nor is able to cope. It's well, she's experiencing this exposure as well on just showing that she's capable of money to, not because she's staying well and healthy. So there's a lot of evidence that there that shows a preterm babies can manage and cope with the vaccine schedule on coping better as you get older. You know, I actually thought that my breast milk alone was providing protection for her. You know, that's one of the main reasons why I wanted to proceed in the first place. It does. You're right. That doesn't a lot of protection for the immunological benefits of breast thing, along with a lot more a swell. But what that does for the for it, or is it gives some passive community. So what's your immunity that's passing over? But it's not actually in Cajun with horrible Newman system on what process that vaccines does active. It's nor is active immunity so that if she comes into contact with one of the diseases that with vaccinated against her memory off that vaccine, will that engage the killer's house to stop the disease from affecting her or not affecting her as much on this, this active immunity that we want for Laura. But we would definitely recommend you to breastfeed for maybe, you know, has enough to get it totally recommend that for all mothers. But it's it by topping up the protection that the vaccine's giver I have with the questions on the answer to have discussed today. Yeah, well, I mean, like, a Do you feel less anxious? Nine. And I'm happy to have already have a relaxing this way. That's great relief, this information if it here for you. But any time you have any questions, or if that has any questions, just give me shaking. I'll come back in. Okay. Along with recording are scenarios we were able to develop these simple, graphically flips for parents and staff on each of our scenarios, or three are left experience. We were able to develop the common on the most frequent ask questions that parents have on vaccine safety are Infographic. Leaflets include those on huge PV Back. Sing the components Find in vaccines, which some parents raised concern about the MMR, the autism link on height. Uh, have a conversation with a parent when you discover that they have an unimmunized child. Thank you very much for listening to my talk today. I hope the key message is that you took away from today. Are the vaccines received? Vaccines are effective and it's never too late to vaccinate it. So every opportunity to be half with parents is a good opportunity to talk about the benefits of vaccinations on if we do come across. Vaccine has, um, parents that we use open, honest approach being respectful off their concerns, unsigned person to the areas where they get the information so they could have conformed consent or a few. So if the cheese thank you