Dynamics in public perceptions and media coverage during an ongoing outbreak of meningococcal W disease in the Netherlands

Abstract

Background: From 2015 to 2018, the Netherlands faced an outbreak of invasive meningococcal disease (IMD) caused by serogroup W. To counter the rise in infections, the government introduced a catch-up menACWY vaccination campaign for teenagers in 2018 and 2019. The outbreak situation induced substantial media attention and a run on menACWY vaccines outside the vaccination campaign. This study aimed to gain insights into the dynamics of public perceptions of and responses to the outbreak and the menACWY vaccination, and into the media coverage about the outbreak.

Methods: Three repeated surveys (N = 1110) between 2017 and 2019 were sent to parents of teenagers invited for a menACWY catch-up vaccination, other parents, and individuals with no under-age children. These surveys assessed IMD risk perceptions, attitudes towards the menACWY vaccination, trust in involved institutions, and willingness to vaccinate with the menACWY vaccine. Changes in the public perceptions and responses were studied with linear multilevel regression analyses. In addition, 103 national newspaper articles from the period 2017-2019 were thematically coded with themes about IMD and the menACWY vaccination.

Results: The survey results showed clear increases in perceived IMD severity, positive attitude towards the menACWY vaccination, and willingness to vaccinate over time. Perceived IMD vulnerability remained low across all three waves, and trust in involved institutions increased slightly. Differences between the survey groups were limited. The newspaper articles discussed the rise in infections extensively, the disease symptoms, and the possible fatal outcome of IMD. In addition, while many articles discussed the menACWY vaccine shortage, few discussed the safety or effectiveness of the vaccine.

Conclusion: The real-time insights into the interrelated dynamics of public perceptions, responses, and media coverage provide an integrated portrait of the social developments during this outbreak. The focus on IMD severity and the absence of doubt in the public discussion about vaccine safety may have played an important role in the societal response to this outbreak and the recommended vaccine.

Keywords: Disease outbreak; Media; Meningococcal disease; Risk perception; Vaccination; Vaccination behavior; menACWY.

Fig. 1

A timeline of the IMD outbreak situation between September 2017 and September 2019. *Foundation Pharmaceutical Key Figures. These figures are a proxy for the number of vaccines administered outside the National Immunization Program and catch-up campaign, for example by general practitioners at the request of their patients. These figures exclude the vaccines administered by the public health services (GGD), who were in charge of administering the vaccines in the National Immunization Program and the catch-up campaign. These figures have been published elsewhere [2, 3]. ** Due to limited menACWY vaccine availability, the government had to adapt its policy regarding the menACWY catch-up vaccination campaign over the course of 2017–2019. In September 2017 (1 in figure), the Dutch government announced plans to implement a catch-up menACWY vaccination campaign for junior-high-school children (usually aged 12–14 years old). In March 2018 (2), the government communicated that due to the limited vaccine availability only children born between May and December 2004 (aged ~ 14 years old) would be invited for catch-up vaccination in 2018 and that children born in 2005 would be invited for vaccination in 2019. In July 2018 (3), the target group for the catch-up vaccination in 2019 was extended to all children born between 2001 and 2005 (all aged 14–18 years old, excluding those who would receive the vaccination in 2018) as more vaccines had become available. In December 2018 (4), it was decided to offer the menACWY vaccine in subsequent years to all 14 year old teenagers via the National Immunization Program

Fig. 2

Mean values of risk perceptions, attitude towards the menACWY vaccination policy and trust in institutions at S1-S3, and the results from the multilevel analyses* in parents (of teenagers (T) and other children (O)) and individuals with no under age children (NC). * Tables with the descriptive analyses (means and standard deviations) and the results from the multilevel analyses are shown in Supplementary file 4. Multilevel results shown in this figure are the significante (p < 0.05) changes in the variables between the consequent waves. There were no significant differences between the groups observed, overall, or in slopes. ** Only assessed among parents

Fig. 3

Mean values of risk perceptions, attitude towards the menACWY vaccination policy and trust in institutions at S1-S3, and the results from the multilevel analyses* in parents of teenagers (T) and parents of other under-age children (O). * Tables with the descriptive analyses (means and standard deviations) and the results from the multilevel analyses are shown in Supplementary file 4. Multilevel results shown in this figure are the significant (p < 0.05) changes in the variables between the consecutive waves, the significant (p < 0.05) overall differences between groups, and the significant (p < 0.05) differences in slopes between groups

Fig. 4

Mean values of willingness to vaccinate (both with regard to one’s child as to oneself) and results from the multilevel analyses*, in parents (of teenagers (T) and other children (O)) and individuals with no under-age children (NC) on the one hand, and in parents (T) and parents (O) separately. * Tables with the descriptive analyses (means and standard deviations) and the results from the multilevel analyses are shown in Supplementary file 4. Multilevel results shown in this figure are the significant (p < 0.05) changes in willingness to vaccinate between the consecutive waves and the significant overall differences between groups. There were no significant (p < 0.05) differences in slopes between groups. ** Only assessed among parents. *** During wave 3, only 13 parents (T) answered the question of vaccination intention for their child because the majority of the respondents indicated that their child had already received the menACWY vaccination

Fig. 5

Percentages of newspaper articles with a theme and/or reference to an institution in S1-S2 and S2-S3*. * The results from period N = 6)