Distorted Human Decision-Making as a Critical Aspect of Pandemic Planning and Preparedness.

The United States continues to experience lower than expected vaccination rates against COVID-19 due to a variety of barriers such as lack of trust, lack of planning, cultural perspectives and issues, suboptimal communication, and political/economic conflicts of interest. In this paper issues of human behavior and decision-making are highlighted as integral to understanding the generally poor US response to the SARS-CoV-2 pandemic. In particular, the US pandemic response was significantly distorted through a combination of cultural and human behavior issues related to conflicting leadership, cultural individualism, the prevalent idea of the democratization of expertise, and a false epistemological lens for decision-making. Including experts from multiple disciplines reveals how to address the human behavioral side of pandemic planning and operations to increase vaccine coverage rates. Including content experts from psychology and the social sciences allows the explicit recognition and preparation for distorted human behavior in planning for future pandemic response.

Vaccine hesitancy and health care providers: Using the preferred cognitive styles and decision- making model and empathy tool to make progress.

Low vaccination rates among health care providers (HCPs) pose a risk to themselves, their colleagues, their patients, and the general public. This paper seeks to frame the issues surrounding health care provider vaccine hesitancy and vaccination rates, as well as explore factors influencing respective decision-making, including health care occupation and demographic characteristics. This paper will then propose the use of the Preferred Cognitive Style and Decision-Making (PCSDM) Model and the Empathy Tool to increase health care provider vaccination rates, and will end by discussing several recommendations. It is important while discussing HCP vaccination rates to not view them as a monolithic group or apply "one-size-fits-all" approaches, and thus it is essential to present information and engage in conversations in ways that align with how the HCP takes in and processes information and decisions. Furthermore, it is vital to increase health literacy across the spectrum of HCP programs and professions. To this end, it is important to teach and incorporate the PCSDM Model and Empathy Tool, along with information about how individuals think and make decisions, into vaccine education programs and training sessions.

Immunization education for internal medicine residents: A cluster-randomized controlled trial.

PURPOSE: The aims of this study are to evaluate the impact of a novel immunization curriculum based on the Preferred Cognitive Styles and Decision Making Model (PCSDM) on internal medicine (IM) resident continuity clinic patient panel immunization rates, as well as resident immunization knowledge, attitudes, and practices (KAP). METHODS: A cluster-randomized controlled trial was performed among 143 IM residents at Mayo Clinic to evaluate the PCSDM curriculum plus fact-based immunization curriculum (intervention) compared to fact-based immunization curriculum alone (control) on the outcomes of resident continuity clinic patient panel immunization rates for influenza, pneumococcal, tetanus, pertussis, and zoster vaccines. Pre-study and post-study immunization KAP surveys were administered to IM residents. RESULTS: Ninety-nine residents participated in the study. Eighty-two residents completed pre-study and post-study surveys. Influenza and pertussis immunization rates improved for both intervention and control groups. There was no significant difference in immunization rate improvement between the groups. Influenza immunization rates improved significantly by 33.4% and 32.3% in the intervention and control groups, respectively. The odds of receiving influenza immunization at the end of the study relative to pre-study for the entire study cohort was 4.6 (p < 0.0001). The odds of having received pertussis immunization at the end of the study relative to pre-study for the entire study cohort was 1.2 (p = 0.0002). Both groups had significant improvements in immunization knowledge. The intervention group had significant improvements in multiple domains that assessed confidence in counseling patients on immunizations. CONCLUSIONS: Fact-based immunization education was useful in improving IM resident immunization rates for influenza and pertussis. The PCSDM immunization curriculum did not lead to increases in immunization rates compared with the fact-based curriculum, but it did significantly increase resident confidence in communicating with patients about vaccines.

Vaccinology in the third millennium: scientific and social challenges.

The epidemiology of deaths due to vaccine-preventable diseases has been significantly and positively altered through the use of vaccines. Despite this, significant challenges remain in vaccine development and use in the third millennium. Both new (Ebola, Chikungunya, Zika, and West Nile) and re-emerging diseases (measles, mumps, and influenza) require the development of new or next-generation vaccines. The global aging of the population, and accumulating numbers of immunocompromised persons, will require new vaccine and adjuvant development to protect large segments of the population. After vaccine development, significant challenges remain globally in the cost and efficient use and acceptance of vaccines by the public. This article raises issues in these two areas and suggests a way forward that will benefit current and future generations.

New Wisdom to Defy an Old Enemy: Summary from a scientific symposium at the 4th Influenza Vaccines for the World (IVW) 2012 Congress, 11 October, Valencia, Spain.

Both seasonal and pandemic influenza cause considerable morbidity and mortality globally. In addition, the ongoing threat of new, unpredictable influenza pandemics from emerging variant strains cannot be underestimated. Recently bioCSL (previously known as CSL Biotherapies) sponsored a symposium 'New Wisdom to Defy an Old Enemy' at the 4th Influenza Vaccines for the World Congress in Valencia, Spain. This symposium brought together a renowned faculty of experts to discuss lessons from past experience, novel influenza vaccine developments, and new methods to increase vaccine acceptance and coverage. Specific topics reviewed and discussed included new vaccine development efforts focused on improving efficacy via alternative administration routes, dose modifications, improved adjuvants, and the use of master donor viruses. Improved safety was also discussed, particularly the new finding of an excess of febrile reactions isolated to children who received the 2010 Southern Hemisphere (SH) trivalent inactivated influenza vaccine (TIV). Significant work has been done to both identify the cause and minimize the risk of febrile reactions in children. Other novel prophylactic and therapeutic advances were discussed including immunotherapy. Standard IVIg and hIVIg have been used in ferret studies and human case reports with promising results. New adjuvants, such as ISCOMATRIX™ adjuvant, were noted to provide single-dose, prolonged protection with seasonal vaccine after lethal H5N1 virus challenge in a ferret model of human influenza disease. The data suggest that adjuvanted seasonal influenza vaccines may provide broader protection than unadjuvanted vaccines. The use of an antigen-formulated vaccine to induce broad protection between pandemics that could bridge the gap between pandemic declaration and the production of a homologous vaccine was also discussed. Finally, despite the availability of effective vaccines, most current efforts to increase influenza vaccine coverage rates to higher levels (i.e., above 70-80%) have been ineffective in highly developed countries where the vaccine is used, hindered by the public's skepticism towards vaccines in general. New educational and social media methods to increase vaccine acceptance and coverage were discussed. While the first priority should be the development of improved influenza vaccines, a particular focus on the aging global population is critical. It is also important to draw lessons from other academic disciplines that can help to inform vaccine education programs, policy, and communication. By tailoring communications and patient education using an understanding of cognitive bias and the model of preferred cognitive styles, the likelihood of effecting desirable health decisions can be maximized, leading to improved vaccine coverage and control of influenza and other vaccine-preventable diseases.