Efficient burdens decrease nonmedical exemption rates: A cross-county comparison of Michigan's vaccination waiver education efforts.

Michigan's introduction of mandatory counseling for nonmedical exemptions was associated with decreased nonmedical exemption rates. However, while each of Michigan's 45 local health departments made its own decisions about how to conduct immunization counseling, differences in the burdensomeness of counseling programs was not associated with greater or lesser changes in exemption rates. Data from a survey of Michigan local health departments (online, October 2015), epidemiological data from Michigan's Department of Health and Human Services (online, various dates), and social and economic data from the American Community Survey (online, various dates) were used in models explaining change in county-level nonmedical exemption rates. Counties that first required an education session after the December 2014 rule change had a 30% greater reduction in their nonmedical exemption rates for 2015 than did counties that already required education sessions. Michigan's experience with vaccination waiver education suggests that imposing burdens on nonmedical waiver applicants decreases nonmedical waiver rates. It also indicates there may be a burden threshold beyond which incremental increases in inconvenience do not further reduce exemption rates. Thus, in a context of hyper-politicization and austerity, health departments may be wise to avoid implementing additionally burdensome processes that are politically or economically expensive to administer.

A survey instrument for measuring vaccine acceptance.

Accurately measuring vaccine acceptance is important, especially under current conditions in which misinformation may increase public anxiety about vaccines and politicize vaccination policies. We integrated substantive knowledge, conceptualization and measurement expertise, and survey design principles to develop an instrument for measuring vaccine acceptance across the general public. Given this broad goal, we expect our novel instrument will complement, rather than replace, existing instruments designed specifically to measure parents' vaccine hesitancy. Our instrument measures five key facets of vaccine acceptance: (1) perceived safety of vaccines; (2) perceived effectiveness and necessity of vaccines; (3) acceptance of the selection and scheduling of vaccines; (4) positive values and affect toward vaccines; and (5) perceived legitimacy of authorities to require vaccinations. We report results of analyses demonstrating the reliability and validity of this instrument. High Cronbach's alpha values for five sub-scales and for the full scale indicate the instrument's reliability, and the consistent performance of expected predictors (i.e., trust in biologists, conspiratorial ideation, and political ideology) demonstrates the instrument's construct validity. Further, scientific reasoning increases vaccine acceptance among liberals but decreases vaccine acceptance among conservatives, which is consistent with motivated cognition. Also, trust in biologists has a stronger positive effect on vaccine acceptance among conservatives than among liberals, signaling a potentially promising means to reduce political polarization on vaccines and increase vaccine acceptance across the general public. We end by identifying key ways that public health researchers, science studies scholars, and health practitioners may employ the full (or short) version of our vaccine acceptance instrument.