Mosquito-borne diseases (MBDs), e.g., dengue, are an emerging public health threat in metropolitan France. While various preventive strategies exist, their real-world success depends on public uptake and adherence. However, research quantifying population preferences for these interventions remains scarce in non-endemic European settings. This study aimed to elicit preferences for key MBD preventive interventions to inform the design of acceptable health policies. We conducted a cross-sectional online survey in November 2023, recruiting a representative sample of adults aged 18–79 residing in metropolitan France (N = 2,087). We employed a discrete choice experiment (DCE) to elicit preferences. Participants completed ten unlabeled, forced-choice A vs. B tasks, selecting between two hypothetical intervention scenarios defined by four attributes: participation (e.g., government-led vs. individual), intervention frequency, environmental effects, and human health side effects. Average preferences and preference heterogeneity for each MBD attribute were retrieved from mixed multinomial logistic (MMNL) models with correlated random parameters. The drivers of preference heterogeneity were further assessed using interaction effects with respondents’ characteristics and simulations were performed to assess optimal interventions that achieved greatest gains in aggregated utility. All attributes influenced hypothetical decisions. Respondents exhibited the strongest aversion to interventions with systematic negative effects on animals and vegetation (β = -1.77), followed closely by those carrying risks of rare but serious human health side effects (β = -1.48). In terms of governance, government-led implementation was preferred over approaches relying on individual or community compliance. Notably, measures dependent on full community participation were disliked (β = -0.50). While interventions requiring greater time commitment reduced utility (β = -0.22), convenience was a secondary driver compared to health safety. Simulation analysis indicated that installing insect screens yielded the highest predicted utility, while chemical fumigation would generate highest welfare losses. Public acceptability of MBD prevention in France hinges critically on environmental and health safety rather than convenience. The findings reveal a preference for centralized, government-managed interventions over those requiring coordinated community effort and compliance. To maximize uptake, policymakers should prioritize environmentally safe interventions and adopt transparent communication strategies that directly address public concerns regarding ecological impact and health side effects.

Background:Swine farmers are at increased risk of zoonotic influenza virus transmission. In France, seasonal influenza vaccination is recommended for swine farmers, yet little is known about vaccine uptake in this at-risk group. Objectives:To assess seasonal influenza vaccination uptake, its determinants, and associated attitudinal factors among swine farm managers in Brittany during the 2023-2024 influenza season. Methods:A cross-sectional survey was conducted among a random sample of swine farm managers. Data were collected using a standardized questionnaire, including attitude items according to the French 7C-model of psychological antecedents of vaccination. Results:Among 735 respondents, 14.0% [11.8%-16.4%] declared they have been vaccinated for the 2023-2024 season, and 35.0% [32.1%-38.0%] were unaware of the national recommendation. Only 33.5% demonstrated a knowledge score above 2/4. Vaccine uptake was significantly associated with older age, prior severe influenza (OR: 3.29 [1.97-5.50]), and receiving a vaccination voucher from the agricultural social security system (OR: 2.76 [1.66-4.59]). However, only 31.8% [28.6%-34.8%] reported having received one. Five among the seven components of the 7C-model were associated with vaccine uptake.Unvaccinated unwilling to vaccinate were characterised by low collective responsibility (R2 = 16.98%) and unfavourable benefit-risk calculation (R2 = 16.84%), while unvaccinated willing to vaccinate were mainly influenced by vaccine accessibility (R2 = 17.32%) and negative social conformism (17.20%). Conclusion:Seasonal influenza vaccination uptake among swine farm managers is low. Targeting this population through tailored strategies is essential. These findings are relevant nationally and internationally and can inform One Health coordinated prevention efforts for professionals exposed to zoonotic influenza viruses.

Human papillomavirus (HPV) vaccine coverage (VC) remains suboptimal in many countries. The PrevHPV national research programme aimed to codevelop and evaluate a three-component intervention including: 'education and motivation' of adolescents, 'at-school vaccination', 'general practitioners (GPs)' training'. We assessed its impact on VC at one year through a cluster randomized trial (July 2021-April 2022) conducted in French municipalities (clusters) receiving 0, 1, 2, or 3 components. The outcomes (≥ 1-dose and full HPV VC at one year among 11-14-year-olds) were estimated using data from the national health reimbursement database and data collected during the trial. We performed intention-to-treat and post-hoc analysis adjusted for the dose of intervention using cluster-level linear models. Ninety-one municipalities were included. 'At-school vaccination' significantly increased ≥ 1-dose VC, in both intention-to-treat (+ 2.85 percentage points (pp), 95%CI = 0.62 to 5.09) and post-hoc analysis (+ 4.60 pp, 95%CI = 1.79 to 7.41). No significant effects were found for the other components. Results were similar for full VC. 'At-school vaccination' significantly increased VC only in municipalities with the lowest access to GPs. School-based vaccination was effective in increasing HPV VC in the medium term and may reduce VC healthcare access-driven territorial disparities. Challenges remain in parental engagement and consent for vaccination at school.Trial registration: Clinicaltrials.gov, NCT04945655. Registered 30 June 2021.

Background:Human papillomavirus (HPV) infections cause several cancers, including nearly all cervical cancer cases. While there are safe and effective vaccines, the adolescent HPV vaccine coverage in France is low (<50%). Thus, we studied the effect of municipality-wide interventions to increase HPV vaccine uptake and intention among middle school students. Methods:This cluster-randomised trial used an incomplete factorial design to arrange three components (in-school education, motivation, mobilisation (EMM); in-school vaccination; and local general practitioner (GP) trainings) into six intervention conditions, which were randomly assigned to 91 participating French municipalities. We assessed HPV vaccine status using online self-reported questionnaires that students (typically aged 13-14) and parents completed at baseline and 5-month follow-up. Using adjusted linear regression, we estimated differences in (1) vaccine uptake and (2) uptake and intention to vaccinate, both by randomisation arm and by intervention component. We explored subgroup effects by at-home multilingualism, gender, age and parental education. Results:2047 of 2664 (74%) students were unvaccinated against HPV at baseline. The 5-month probability of first-dose vaccine uptake in the control group was 0·09 (95% CI 0.06 to 0.11). Vaccine campaigns alone contributed a 24-percentage-point (0.18, 0.30) increase in uptake compared with the control group. EMM was only effective in increasing vaccine uptake among monolingual francophone students, and we detected no effect from GP training. Vaccine campaigns and EMM both increased the combined outcome of vaccine intention and first-dose uptake, but EMM had the same subgroup effect. Questionnaire data from parents (N=236) were sparser but demonstrated similar overall trends. Conclusions:Our results demonstrate that in-school HPV vaccine campaigns effectively increase HPV vaccine uptake among adolescents without exacerbating extant disparities in vaccine uptake. EMM can also be a useful tool to increase HPV vaccine intention but must be improved to bridge disparities in its effectiveness. GP training results were inconclusive. Trial registration number:NCT04945655.

INTRODUCTION:Human Papillomavirus (HPV) vaccine uptake in the French Caribbean has remained below 25% since introduction in 2007, which is well behind national and international targets. Using a discrete choice experiment (DCE), we explored parental preferences around HPV vaccination and optimized communication content in a sample of parents of middle-school pupils in Guadeloupe. METHODS:We conducted a cross-sectional survey in public and private middle age schools in Guadeloupe in June 2023 using an online questionnaire. Across a series of nine hypothetical scenarios, participants were asked to decide to vaccinate or not and how certain they were about this choice. Scenarios differed by five attributes (diseases characteristics, vaccine safety, health professionals or institutions promoting vaccination, social conformity and optimal vaccination age). We used random effect logit and linear regression models to estimate the effects of attribute levels on vaccine acceptance and vaccine eagerness. RESULTS:A total of 389 parents out of the 23,184 pupils' parents completed the DCE survey. The attributes with a significant effect size on theoretical vaccine acceptance were "social conformity" and "optimal vaccination age". Overall, the odds of scenarios stating high vaccine coverage in adolescents were at least 1.8 (95% CI: 1.2-2.6) times more likely to yield theoretical vaccine acceptance compared to a low vaccine uptake reference. The odds of providing scientific explanation along with age yielded theoretical vaccination acceptance respectively up to 3.2 times higher (95% CI: 1.7 to 6.1) in parents reporting an un vaccinated child and not intention to vaccinate. For vaccine eagerness, we observe significant positive effects of communication content overall when stating high vaccination uptake in adolescents or scientific evidence along with age or mentioning cancer prevention. Parents always refusing vaccination remained unsensitive to communication contents. DISCUSSION AND CONCLUSION:These original DCE results highlighted the need for tailoring specific HPV vaccination promotion communication in a French Caribbean setting. Contextual features such as sexuality concerns as regard to age and peers' adhesion to vaccination have to be thoroughly considered. The nationwide HPV vaccination campaign in middle schools should adapt communication in order to raise HPV vaccine uptake in the French Caribbean.

INTRODUCTION:Human papillomaviruses (HPVs) cause several vaccine-preventable cancers, including cervical cancer. In France, HPV vaccination coverage remains low. Decision aids (DAs) can help individuals make informed health choices. This study assessed the impact of an online DA (SOSHPV) on decisional conflict and vaccination intention, and explored user perceptions in real-life contexts. METHODS:A convergent mixed-methods design was used (November 2023-June 2024). The quantitative component included a pre-post questionnaire assessing knowledge, vaccination intention, and decisional conflict. The qualitative component involved semistructured interviews with a subsample of users, analyzed using grounded theory. RESULTS:Among 943 website visitors, 187 participants (54 males, 12 adolescents) completed the presurvey, and 44 (12 males, 6 adolescents) completed both assessments. Over half (54%) were young parents using the tool to support HPV vaccination decisions for their child. Post-intervention, knowledge improved (P < 0.001), and decisional conflict decreased (P < 0.001). Vaccination intention shifted: 55%-75% in favor and 32%-18% undecided (P < 0.001). Qualitative analysis (n = 12) revealed three themes: social ambivalence around vaccination, the DA as a support for informed choices, and its role in enhancing communication with healthcare providers. DISCUSSION:This study showed a reduction in decisional conflict and increased vaccination intention. These findings suggest that DAs may play an important role in addressing vaccine hesitancy and supporting value-aligned choices in real-world settings. CONCLUSION:This study highlights the potential of an online DA to improve vaccine acceptance by reducing decisional conflict and enhancing dialog. Further research is needed to assess its large-scale impact on vaccine uptake.

Aedes albopictus mosquitoes and the mosquito-borne diseases (MBDs) they transmit are spreading throughout France. Yet, research on the perceptions and behaviors of the French population regarding MBDs remains scarce and outdated. To quantify the knowledge, attitudes, and practices (KAP) regarding MBDs in the metropolitan French population and examine factors influencing MBD protective behavior. In November 2023, we conducted a cross-sectional KAP survey among a quasi-representative sample (n = 2,087) of adults aged 18 to 79 living in metropolitan France. We used mixed-effects models to examine factors influencing the frequency and variety of protective behavior separately. During summer, most participants were bitten by mosquitoes in their daily lives (73

BACKGROUND:Human papillomavirus (HPV) is responsible for the most common sexually transmitted infection in the world and persistent infection of oncogenic types is associated with an increased risk of cancers. This infection could be prevented by vaccination. However, in a time of vaccine hesitancy, the decision to get vaccinated or to have a child vaccinated is the result of a complex process and decision aids are tools that may be of help in this context. OBJECTIVE:The aim of this article is to present the development of a shared decision aid for HPV vaccination in France, destined to be used during general practice consultations. METHODS:In order to develop the shared decision aid, we followed the steps recommended by the International Patient Decision Aids Standard (IPDAS), i.e. scoping and defining the objectives, assembling the steering group, designing (carrying out two focus groups and a narrative review of the literature) and testing in a alpha test phase (carrying out three focus groups and 11 individual interviews). The tool was co-constructed with adolescents, parents and general practitioners. RESULTS:We created an online shared decision aid which included the definition of HPV, epidemiological data, the mode of contamination, the different locations of the disease, the development of cancer, the importance of Pap smears, the effectiveness of the vaccination as well as the possible side effects. The various focus groups as well as individual interviews made it possible to determine the values and expectations of patients and physicians thus improving the decision aid. This development also made it possible to confirm an existing need for this type of tool for both patients and physicians. CONCLUSIONS:We have developed a shared decision aid that could help general practitioners communicate about HPV vaccination and get more patients vaccinated. The impact of its use during the consultation will be evaluated on criteria such as the resolution of the decision-making conflict and ultimately on the vaccination coverage, as part of the PrevHPV study.

Vaccine hesitancy (VH) is a state of indecision regarding vaccination, marked by doubts despite vaccine availability. 1 Its relationship with vaccine uptake has been widely debated, though the cause-effect relationship remains unclear. Nevertheless, VH likely threatens the control of vaccine-preventable diseases, such as measles and hepatitis B, imposing unnecessary burdens on health systems.Inappropriate access to information, inadequate vaccine offers, and administration have been identified as primary contributors to reluctance and doubts surrounding vaccine uptake. However, social and individual factors related to knowledge and attitudes further prolong this psychological state of indecision, leading to delayed vaccinations and even refusal. Despite extensive efforts to promote vaccination across European countries, VH persists, affecting vaccine uptake across various demographic groups and settings. Hesitancy varies by country, type of vaccine (whether recently approved or longstanding), and target populations, including children, vulnerable groups, or the general population.Assessing the frequency, determinants, and impact of vaccine hesitancy presents a significant global and regional challenge. 2 Variations in definitions, data gaps regarding vaccine acceptance, and population coverage hinder precise evaluation. These discrepancies make it more difficult to develop targeted interventions and allocate resources to promote vaccination in a targeted manner and thus effectively improve vaccine acceptance on a large scale.VH has garnered global attention, particularly in Europe, the US, and Africa. As a result, multiple reports and studies have been published, including the determinants and consequences of vaccine hesitancy.While many studies and reports focus on VH determinants and consequences, emphasis is now shifting toward improved strategies and recommendations 3 , particularly through collaborations like EU-funded research consortia. 4,5 Healthcare workers play a crucial role in countering VH. Training in communication, managing misinformation, and enhancing self-assurance are key strategies for interacting with hesitant individuals, including parents seeking advice on children's vaccination 6 , and underserved communities, such as migrants 7 , ethnically diverse 8 , and prisoners. 9 A second focus is on the general population, aiming to combat misinformation and build trust in healthcare and science.Despite increasing research on VH, there's a limited understanding of how to address it effectively. Key questions remain: Is VH a symptom of systemic inequities, or is it an inherent phenomenon in global societies? Should interventions target public health systems or individual decision-making? Understanding the complexities of VH within local and global contexts is essential. Europe lacks a unified framework for addressing VH. While some efforts show promise, a cohesive strategy for interventions remains absent.It is also essential to address the ethical dimension, to be able to deal with traditional bioethical individual questions, but also focus on the dilemmas resulting from the unknowable statistical lives central in public health reasoning 10 The gaps in evidence on interventions to address vaccine hesitancy can be summarized as follows:• There is a need to map interventions to improve individual, communities and societal attitudes towards vaccination and to increase vaccine acceptance, intention, and uptake. Analyzing the performance of prior interventions will help to redefine future interventions and assess their efficacy in the EU and other countries. • It is essential to identify the problems currently faced by implementing interventions in the field by considering the specificities of target countries and regions, their unique attributes, determinants, and the challenges they encounter. • Interventions need to be designed based on research findings and previous activities, optimizing resources and actions, including current regular immunization procedures and follow-up vaccination intentions.• Pilot activities need to be evaluated and implemented. This includes initiatives with the expected highest likelihood of success, such as training courses for frontline health workers and public awareness campaigns to combat vaccine hesitancy. Access to real time data is crucial.In summary, there is an overall need to create a strong research-grounded sustainability strategy for ongoing implementations and interventions to tackle vaccine hesitancy, and toolkits and suggestions for scaling up in additional EU countries and beyond.Based on this needs assessment, we call on the scientific community and science funders to strengthen collaborative VAX-ACTION aims to make recommendations for action that support decision-makers to address vaccine hesitancy.Five EU countries -Portugal, France, Italy, Romania, and Czechiawill conduct the project, taking advantage of their unique features, including size, vaccination coverage, healthcare system, immunization programs (vaccination settings, involvement of family doctors, pharmacies, hospitals), and the population's trust in vaccines.Since there is currently a paucity of evidence regarding the success of previous and ongoing interventions, VAX-ACTION aims to fill the urgent need to support the identification and implementation of key public health findings resulting from the surge in initiatives in the field of vaccination and vaccine hesitancy in Europe, notably:• To ground in many of those initiatives that have already demonstrated encouraging results, whether for COVID-19 or routine vaccination, particularly catch-up vaccination that was neglected during the peak of the COVID-19 pandemic; • To contribute to improving vaccine uptake and immunization rates by evaluating best practices and implementing strategies and activities that go beyond European regions and COVID-19 cases; • To enhance vaccination intervention strategies and planning, advancing personnel planning and organization, and administering vaccinations as intended by countries and the current needs (e.g., new delivery models such as mobile units, preparing for future outbreaks); • To evaluate whether findings may be used for future public health emergencies requiring mass vaccination or extensive routine immunization programs.Vax-Action aims to implement a framework that can and should be used more broadly to address interventions in vaccine hesitancy, namely:1. Action plans to address vaccine hesitancy and improve the understanding of and approaches to:• health literacy, particularly gaps in knowledge and exposure to misinformation; • access, socioeconomic, practical problems, and concerns relating to prior experience; • developing a shared understanding of the importance and benefits of immunization; • positive experiences of immunization; • concerns about risks and over-medicalization; • trust towards the healthcare system, respecting cultural and personal beliefs.Training for health professionals and officials in communication behaviors helping them to anticipate and address potential vaccine hesitancy.3. Regular evaluation and revision of applied frameworks/models as new evidence emerges.4. Update experts in healthcare journalism and social media communications to minimize the risk of compromising the public's right to timely and accurate information from official sources and traditional and digital media.

BACKGROUND:Human papillomavirus (HPV) vaccine coverage (VC) remains lower than expected in France. The PrevHPV national research program aimed to codevelop and evaluate an intervention including three components: 'education and motivation' of adolescents in schools, 'at-school vaccination', 'general practitioners (GPs)' training'. This study aimed to evaluate the implementation outcomes of each component, whether they affected effectiveness, and identify factors influencing implementation in schools. METHODS:A mixed-method study embedded in a cluster randomized controlled trial in 91 French municipalities (July 2021-June 2022). Quantitative data were collected through activity reports and questionnaires, and qualitative data through focus groups with school staff. The implementation outcomes were fidelity, dose, reach, acceptability and sustainability, as defined in the Medical Research Council guidance for process evaluation of complex interventions and Proctor et al.'s Implementation Outcomes Framework; the effectiveness outcome was HPV VC (≥ 1 dose) two months after the end of the intervention. Qualitative data were analyzed using the Consolidated Framework for Implementation Research. RESULTS:The fidelity, acceptability, and sustainability of all three components among participants who completed the intervention were high. However, the withdrawal of one-third of schools before the trial started and difficulties in mobilizing GPs negatively impacted the dose and reach outcomes. Estimates for the on-treatment analyses of the effectiveness were greater than those for which the dose of intervention received was not considered; 'at-school vaccination' (11.25 percentage points, p < 0.001) and 'GPs' training' (3.56 percentage points, p = 0.049) increased VC, while 'education and motivation' remained nonsignificant. CONCLUSIONS:Increasing HPV VC among adolescents could be achieved by combining interventions in both schools and primary care settings. This study provides practical implications for implementing such interventions in real life. TRIAL REGISTRATION:Clinicaltrials.gov, NCT04945655. Registered 30 June 2021, https://clinicaltrials.gov/study/NCT04945655.

BACKGROUND:In France, HPV vaccine uptake among adolescents remains a public health concern. Therefore, we examined changes in French adolescents' knowledge, attitudes, and practices (KAP) following exposure to HPV-vaccination-related interventions. METHODS:Our cluster-randomized trial applied an incomplete factorial design to allocate three intervention components (in-school education, free in-school vaccination, and general practitioner [GP] trainings) into six arms, randomly assigned to 91 French municipalities. Adolescents' (N = 2758; typically aged 13-14) self-reported HPV-vaccine-related KAP was assessed via online questionnaires at baseline and follow-up. Using logistic regression, we estimated the decomposed effects of each intervention component on favorable responses to individual KAP items. Each model adjusted for the baseline level of the outcome. We conducted subgroup analyses of the effect of the education component. RESULTS:Adolescents who received in-school education, compared to those who did not, provided improved responses on all knowledge items at follow-up. They also reported more favorable attitudes, which included the perceived benefit-risk balance (OR = 1.6 [95 %-CI, 1.2-2.0]) and judging reduced onward transmission as important (1.5 [1.1-2.1]). In-school education increased the likelihood of having HPV-vaccine-related discussions with friends (1.8 [1.2-2.6]). In-school vaccination increased adolescents' likelihood of knowing that friends are vaccinated (3.1 [2.2-4.2]), and perceived accessibility (2.2 [1.5-3.2]). Perceived difficulties in accessing clear vaccine information increased specifically among multilingual adolescents (0.5 [0.2-0.9]). CONCLUSION:Free in-school HPV vaccination significantly increases perceived ease of access to HPV vaccination for students who are already motivated to get vaccinated, and in-school education and motivation improves students' HPV vaccine-related knowledge and attitudes and can encourage them to get vaccinated. Thus, when offered together over the course of multiple academic years, we would expect to see increased vaccine uptake as adolescents become both more amenable toward vaccination and perceive easier access. Educational material needs tailoring for families from different linguistic and cultural backgrounds.

This paper shows that prospect theory, extended to account for differences across individuals in their patience and their valuation of the vaccination as a common good can explain why more than 40% of the population has intent to reject the Covid-19 vaccination, as well as the differences in vaccination intentions across population subgroups. Indeed, prospect theory by over-weighting the side effect explains the reject of vaccination. This can be partially compensated by a high patience and/or a large valuation of the collective immunity. The calibrated version of our model, based on an original survey carried out on a representative sample of the adult population living in France allowing us to identify curvatures of their value function, their discount rates and their willingness to cooperate, can predict the evolution of the vaccination intentions between November 2020 an March 2021. We also show that the international differences in the vaccination intentions are closely related to the valuation of the vaccination as a common good.

BACKGROUND:Human papillomavirus vaccine coverage (HPV VC) remains suboptimal in many countries. French authorities launched the PrevHPV research program, which included a cluster randomized controlled trial (cRCT) to evaluate the effectiveness of an 'at-school vaccination' intervention. Within this trial, we conducted a process evaluation of this intervention, specifically analyzing (i) its implementation, (ii) its mechanisms of impact, and (iii) the contextual factors influencing implementation (facilitators/barriers). METHOD:We conducted a mixed-method study embedded in the PrevHPV cRCT (April 2021-April 2022). 'At-school vaccination' consisted of vaccination day(s) on school premises where mobile vaccination teams (MVTs) initiated HPV vaccination free of charge for eligible adolescents (i.e., non-vaccinated adolescents aged 11+). Quantitative data were collected through activity reports and self-administered questionnaires of adolescents and school staff. Qualitative data collected through six focus groups with school staff and MVTs were analyzed using thematic analysis. RESULTS:Of the 31 schools (14,772 adolescents) randomized to implement 'at-school vaccination', 12 (39 %) dropped out. Among the participating schools, analysis of implementation showed that 17 % of adolescents returned valid consent forms, of whom 89 % initiated vaccination. MVTs played a central role in implementing vaccination day(s), supported by several school staff (e.g., school nurses, education assistants). Regarding mechanisms of impacts, satisfaction with the vaccination days was high among adolescents and school staff. The intervention generated both positive and negative group effects among adolescents. Contextual factors that facilitated implementation included the preparation of a list of adolescents to be vaccinated and the availability and motivation of school staff. The main barriers related to the management of consent forms and missing health records. CONCLUSION:We formulated recommendations for implementing at-school vaccination, which may be particularly helpful for the French school HPV vaccination campaigns that were scaled up nationally in 2023. We also discussed potential macro-level improvement strategies, involving modifications to the legislative framework. TRIAL REGISTRATION:Clinicaltrials.gov, NCT04945655. Registered 30 June 2021, https://clinicaltrials.gov/study/NCT04945655.

BackgroundThe vaccine coverage against human papillomavirus (HPV) vaccination remains low in France. The objective of this study was to study adolescent perceptions by comparing boys and girls, in order to build effective school-based interventions.MethodsThis paper presents a cross-sectional study in French middle school pupils. They completed online questionnaires on their knowledge and attitudes toward the HPV vaccine, HPV vaccination status, their intention, reasons to vaccinate or not to vaccinate, and psychological antecedents of vaccination. A structural equation modeling (SEM) analysis was used to test the hypothesized model.ResultsThe participants are 818 pupils aged from 12 to 16 years (Mage = 13.78). Most pupils were in the pre-contemplative stage (62.7 % of boys and 40.8 % of girls). SEM analysis indicated that the relationship between the level of HPV knowledge, the representations of vaccines in general, and vaccine intention was mediated by attitudes towards the HPV vaccine among both boys and girls.ConclusionsThese findings reveal a high percentage of boys who do not feel concerned by the HPV vaccine and highlight the need to consider the psychological antecedents of vaccination in general in addition to the specific attitudes to the HPV vaccine.

BACKGROUND:We explored preferences around the benefit-risk ratio (BRR) of vaccination among the general adult population and health care sector workers (HCSWs). We estimated preference weights and expected vaccine uptake for different BRR levels for a vaccine recommended during an infectious disease emergence. In addition, we explored how far qualitative information about disease severity, epidemiological context, and indirect protection interacts with these preferences. METHODOLOGY:This was a cross-sectional study, using a self-administered online questionnaire containing a single-profile discrete choice experiment among HCSWs and the general population in France (quasi-representative sample). The questionnaire was available from January 12 to April 27, 2023, for HCSWs and from April 17 to May 3, 2023, for the general population. BRR is represented as the number of vaccine-prevented disease events for 1 event related to a vaccine side effect. Results are reported in 4 groups: general population sample, non-HCSWs, non-university-degree HCSWs, and university-degree HCSWs. RESULTS:Among the 1,869 participants, 1,038 (55.5%) varied their vaccine decision among the different vaccine scenarios. Hypothetical vaccine acceptance among university-degree HCSWs increased when the vaccination BRR was 100:1, while non-university-degree HCSWs and non-HCSWs were more sensitive to qualitative information about the vaccine BRR than quantitative indicators. Among participants in the general population sample with varied decisions, expected acceptance increased by 40% sample if disease risk was high. Among serial vaccine nondemanders, high disease risk decreased their certitude to refuse hypothetical vaccination. CONCLUSION:Our results suggest that only university-degree HCSWs are sensitive to the notion of BRR, but not the general public. Given that previous research found speaking about BRR might reduce vaccine acceptance, this notion should be avoided in vaccine promotion. HIGHLIGHTS:The notion of benefit-risk ratio (BRR) of vaccination appears to be taken into account in vaccine decisions by university-degree HCSWs, but not by the general public. Mentioning a favorable BRR could imply that the vaccine is not safe and reduce vaccine motivation.Mentioning qualitative attributes of BRR surrounding disease frequency and severity, and indirect protection effects, strongly affected theoretical vaccine decisions in all participants, irrespective of professional categories.Expected vaccine acceptance increased by 40% among the general population sample if disease risk was presented as high, and expected vaccine coverage exceeded 50% in scenarios with high disease risk.Among those refusing vaccination in all vaccine scenarios, only a high risk of developing the disease decreased their certitude to refuse vaccination. This further underlines the importance of disease risk perception on vaccine decision making, including among persons who a priori are unlikely to accept vaccination.

Background Across various stages of the COVID-19 pandemic and related vaccine recommendations in France, we assessed the association of the 7C-psychological antecedents with vaccine uptake/intention for booster vaccination among healthcare-sector workers (HCSWs). We also assessed whether 7C-antecedent profiles changed over time. Methodology The Research Group for the Prevention of Occupational Infections in Healthcare Workers (GERES) conducted three repeated web-surveys which were disseminated by email chain-referral among HCSWs throughout France. The questionnaires waves took place: July-November 2021, February-March 2022 and January-March 2023 (P2, P3 and P4). We also reanalysed data from a prior similar study conducted late 2020-early 2021 (Moirangthem et al. (2022)) (P1). To evaluate the association of 7C-items with vaccine uptake-intention for future vaccination, we estimated adjusted prevalence ratios (aPR) using robust variance Poisson regression. We report the 7C-item population attributable loss in vaccine intention. Results The four surveys (P1-P4) encompassed 5234, 339, 351 and 437 participants. At earlier stages of the vaccine campaign, the principal antecedents of vaccine intention were favorable perception of vaccination benefit-risk-balance (BRB) (vs. unfavorable, aPR: 2.32), reactance to employer encouragement for vaccination (motivates vs. dissuades-me, aPR:2.23), vaccine confidence (vs. not-being-confident, aPR: 1.71) and social conformism towards vaccination (favorable vs. skeptical opinion in private environment, aPR: 1.33). Under a vaccine mandate for HCSWs, only perceiving vaccination as a collective action was associated with current vaccine status (agree vs. disagree, aPR: 2.19). At later stages of the epidemic, hypothetical booster vaccine intentions were strongly associated with BRB perception (favorable vs. unfavorable, aPR: 2.07) and perceiving vaccination as a collective action (agree vs. disagree, aPR: 1.69). Fearing a severe side effect from vaccination decreased population vaccine intention by 26.2 %. Conclusion Our results suggest that both 7C-antecedents and their association with vaccine behaviour can change over time, and underscore the importance of assuring confidence in vaccine safety.

Vaccine hesitancy (VH) is an issue for healthcare students, influenced by safety concerns and misinformation. The need for better communication training and understanding sociocultural factors in VH was highlighted in a European University Alliance seminar. Practical exercises like simulation role-playing, interprofessional collaboration, and digital literacy may improve vaccine education.