Risk, hope and trust: vaccine confidence and pregnant women

Infectious disease outbreaks can cause severe social disruption and excess mortality while commonly exposing long-standing health inequities and deepening vulnerabilities in populations at risk. For pregnant women, outbreaks, epidemics and pandemics have severe consequences for maternal health, with harrowing effects for infants and mothers-to-be. While optimal immunization is one of the most successful and cost-effective measures to prevent and control infectious disease, vaccination deployment efforts have been hindered by doubtful or refusing publics. In turn, while many diseases can be controlled via immunization, for some diseases there are no vaccines available. In these circumstances, outbreaks can put even more pressure on healthcare systems, leaving populations with incapacitating health consequences. Building confidence in both vaccines and healthcare delivery post-outbreak is an important part of efforts to mitigate the negative health impacts caused by infectious diseases. In this thesis, I present four qualitative studies and one quantitative study investigating how risk perceptions, hope and trust modulate willingness to accept vaccines and healthcare interventions. First, I investigated how hope and trust influenced the uptake of health interventions in the aftermath of a debilitating Zika outbreak in Brazil. The ability of caregivers to trust healthcare professionals and co-create hope appears to have improved acceptance of recommended treatments for children affected by Zika, despite uncertain outcomes. Second, in a pre-pandemic benchmark study, we mapped trends of vaccine confidence globally, measuring trust in effectiveness and safety of vaccines. This study found important trends in vaccine confidence globally and presented views of safety, effectiveness, and importance of vaccines in 149 countries. In addition, other determinants of vaccine uptake were investigated such as religious compatibility, trust, sociodemographic and information seeking behaviours. Lastly, Brazil, Mexico and Panama were selected for three separate in-depth investigations of views and attitudes towards maternal vaccines. These studies, the first of their kind in the respective countries, explored how attitudes were informed by risk perceptions and multiple dimensions of trust. Results identified important confidence builders among pregnant women, as well as barriers to maternal vaccine uptake which should be accounted for in future policy. My findings contribute to inform strategies and health policy that is sensitive to maternal health and populations affected by outbreaks