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The internet is playing an increasingly important part in fueling vaccine related controversies and in generating vaccine hesitant behaviors. English language Antivaccination websites have been thoroughly analyzed, however, little is known of the arguments presented in other languages on the internet. This study presents three types of results: (1) Authors apply a time tested content analysis methodology to describe the information diffused by French language vaccine critical websites in comparison with English speaking websites. The contents of French language vaccine critical websites are very similar to those of English language websites except for the relative absence of moral and religious arguments. (2) Authors evaluate the likelihood that internet users will find those websites through vaccine-related queries on a variety of French-language versions of google. Queries on controversial vaccines generated many more vaccine critical websites than queries on vaccination in general. (3) Authors propose a typology of vaccine critical websites. Authors distinguish between (a) websites that criticize all vaccines (“antivaccine” websites) and websites that criticize only some vaccines (“vaccine-selective” websites), and between (b) websites that focus on vaccines (“vaccine-focused” websites) and those for which vaccines were only a secondary topic of interest (“generalist” websites). The differences in stances by groups and websites affect the likelihood that they will be believed and by whom. This study therefore helps understand the different information landscapes that may contribute to the variety of forms of vaccine hesitancy. Public authorities should have better awareness and understanding of these stances to bring appropriate answers to the different controversies about vaccination. [ABSTRACT FROM AUTHOR]

• Doctors' attitudes towards HPV vaccine depended on their trust in health authorities. • The lower their trust in health authorities, the higher their hesitancy. • The higher their hesitancy, the more importance they attached to patients' opinion. • Even when favorable to HPV vaccine, they were more or less proactive with patients. • This depended on their professional values regarding their public health role. The contemporary crisis of trust in vaccines has severely impaired acceptance of the HPV vaccine, especially in France, where its uptake culminated at 23.7% in 2018 (complete course at age 16). Physicians' recommendations strongly influence its acceptance/refusal. Our study sought to understand the decision processes leading physicians to recommend this vaccine (or not). Qualitative interviews of French physicians (general practitioners, gynecologists, and pediatricians). We first randomly selected doctors in a national register of medical professionals and then resorted to snowballing to build a convenience sample. We coded the interviews in a thematic analysis built both inductively and deductively from our research questions and data. Two thirds of the participants (19/28) were favorable to HPV vaccination, some (4) opposed it, while the others were hesitant about recommending it. In explaining their opinions, most participants mentioned that they trusted the stakeholders within the vaccination system: the less trust they had, the more critical they were of the vaccine and the more importance they attributed to patients' opinions. We identified three different ways they interacted with patients on this topic: informing and convincing; adapting to patients' opinions; refusing compromise about vaccination. Crossing these various themes, we found 5 types of physicians: dissidents (mistrustful of the healthcare system and HPV vaccine), hesitant (finding it difficult to make up their minds about this vaccination), laissez-faire (letting patients decide by themselves, but very favorable to HPV vaccination), educator (very favorable), and uncompromising vaccinators (refusing debate). Pediatricians were overrepresented among the latter two types. Physicians' judgment was influenced by their trust in the stakeholders involved in designing and implementing the HPV vaccination strategy. In this sense, doctors did not differ substantially from laypeople. They were, nonetheless, strongly influenced by their professional style and ethos. [ABSTRACT FROM AUTHOR]

Abstract Background The relations between vaccine hesitancy (VH) and individual socioeconomic status (SES) vary with context and remain poorly understood. We examined associations between parental SES and VH levels and their potential mediation by two attitudinal factors: commitment to making "good" health-related decisions and trust in mainstream medicine. Methods Data come from the 2016 Baromètre santé , a random cross-sectional telephone survey of the French general population. We analyzed a sample comprising 3927 parents of children aged 1–15 years, dividing them into 4 categories according to their VH level. We performed bivariate and then multiple multinomial logistic regression analyses to study associations between parental educational level, income, and VH. We then reassessed the logistic model with a causal steps approach, adding the commitment and trust scores. Results Vaccine refusers accounted for 26% of parents (95% CI = 25%, 28%), delayers 7% (95% CI = 6%, 8%), and acceptors with doubts 13% (95% CI = 12%, 14%). In bivariate analyses, educational level was associated with VH but income was not, while commitment and trust scores varied significantly with both VH and educational level (p < 0.001). In multivariate analyses, highly educated parents were more prone to be delayers (AOR ≥ Bac + 4 versus < Bac = 1.73, 95% CI = 1.12, 2.69) or refusers (AOR ≥ Bac + 4 versus < Bac = 1.56, 95% CI = 1.19, 2.04) than nonhesitant. These associations did not remain significant after inclusion of the commitment and trust scores in the model. Conclusions Vaccine refusal and delay are frequent among French parents, especially the more educated. Our results suggest that levels of commitment and trust play a key role in shaping VH. Suitable educational interventions are needed to restore trust in authorities and vaccines. Helping healthcare professionals to communicate better with vaccine-hesitant parents is also essential. [ABSTRACT FROM AUTHOR]

Objective General practitioners (GPs) play a crucial role in human papillomavirus (HPV) vaccine acceptance in France. We sought to study: (1) GPs’ perceptions of its risks and efficacy and their recommendation behavior; (2) the relative importance of factors associated with the frequency of their recommendations. Methods Cross-sectional observational study in 2014 nested in a national panel of 1712 randomly selected GPs in private practice in France (response rate: 92.4%). We used model averaging to analyze the associations of self-reported frequency of GPs’ HPV vaccine recommendations with their perception of its risk-benefit balance and their opinions about the utility of vaccines in general. Results Overall, 72% of participants reported frequently recommending HPV vaccination; 60% considered that not enough is known about its risks. The model averaging showed that the factors most associated with infrequent recommendation of this vaccine by GPs were: unfavorable perceptions of its risk-benefit balance (OR = 0.13; 95%CI = 0.09–0.21; partial R 2 = 0.10), a decision not to vaccinate one's own daughter(s) with this vaccine (OR = 0.13; 95%CI = 0.07–0.24; partial R 2 = 0.05), and doubts about vaccine utility in general (OR = 0.78; 95%CI = 0.71–0.86; partial R 2 = 0.03). Conclusion Although nearly three-quarters of French GPs frequently recommended the HPV vaccine, our findings indicate that a substantial percentage of them are hesitant about it. Doubts about its risks and efficacy strongly influence their recommendation behavior. More research is warranted to help design and evaluate tailored tools and multicomponent intervention strategies to address physician's hesitancy about this vaccine. [ABSTRACT FROM AUTHOR]