Ethical and policy implications of vaccinomics in the United States: community members’ perspectives

Figures & data

Figure 1. Data collection procedures

Table 1. Sociodemographic distribution of the sample

		Baltimore	Boulder	Total
		n = 34 (%)	n = 60 (%)	N = 94 (%)
Gender^a
	Female	24 (70.6)	43 (71.7)	67 (71.3)
Age Category (in years)^2
	18–29	6 (17.7)	26 (43.3)	32 (34.0)
	30–44	12 (35.3)	7 (11.7)	19 (20.2)
	≥45	15 (44.1)	25 (41.7)	40 (42.6)
Race/Ethnicity^3
	Non-Hispanic White	17 (50.0)	47 (78.3)	64 (68.1)
	Non-Hispanic Black	15 (44.1)	2 (3.3)	17 (18.1)
	Other	0 (0.0)	7 (11.7)	7 (7.5)
Education^4
	≤High school degree	9 (26.5)	21 (35.0)	30 (31.9)
	Associate’s/Bachelor’s degree	20 (58.8)	27 (45.0)	47 (50.0)
	Graduate degree	4 (11.8)	10 (16.7)	14 (14.9)
Household Income^5
	$0-$49,999	17 (50.0)	31 (51.7)	48 (51.1)
	$50,000-$99,999	6 (17.7)	14 (23.3)	20 (21.3)
	≥$100,000	5 (14.7)	10 (16.7)	15 (16.0)
	Unspecified	6 (17.7)	5 (8.3)	11 (1.7)
Age of Children (in years)^6
	<5	9 (26.5)	-	9 (26.5)
	5–18	15 (44.1)	-	15 (44.1)
	>18	11 (32.4)	-	11 (32.4)
	No children	7 (20.6)	-	7 (20.6)

^aGender: 1 (1.1%) missing; ²Age: 3 (3.2%) missing; ³ Race/ethnicity: 6 (6.4%) missing, other category includes 5 Asians, 1 Native Hawaiian/Other Pacific Islander, and 3 Hispanics; ⁴Education: 3 (3.2%) missing; ⁵Income: 11 (11.7%) missing; ⁶Age of children: only asked of Baltimore participants in the survey; multiple responses allowed to results sum to >100%. Boulder participants were polled during the meeting: 5 had children 0–10 years-old, 4 had children 11–18 years-old, and 7 had children >18 years-old.

Figure 2. Emergent themes

Figure 3. Vaccine-related funding priorities

Figure 4. Chronic disease-related funding priorities

Table 2. Vaccine confidence: two sample t-test for the equality of means

		Mean (SE)^a		P-value^b
Effectiveness:^b		Pre	Post
	Adults	8.80 (3.35)	9.10 (3.46)	0.67
	Babies	8.80 (3.35)	9.00 (4.05)	0.86
Safety:^c
	Adults	9.10 (4.01)	8.40 (3.24)	0.55
	Babies	9.10 (4.01)	8.10 (3.29)	0.42

^aSE: Standard Error; ²P-value represents the probability that the two means are not equal

^bEffectiveness: Pre-Babies: n = 84; Post Babies: n = 90; Pre Adults: n = 88; Post Adults: n = 91

^cSafety: Pre Babies: n = 92, Post Babies: n = 81; Pre Adults: n = 91, Post Adults: n = 84

Table 3. Participants’ written comments explaining pre vs. post-discussion vaccine safety ratings for adults

Theme	Comment
Pre-discussion
Personal experience	My cousin died of Guillain Barre syndrome – after swine flu shot From my personal experience, it is safe to adults
Allergic reactions	I think vaccines are safe for adults. The only issue is allergic reactions.
Safety and manufacturing process	They are not full live pathogens, so they do not cause harm
Disease prevention	They are safe because they help to eliminate the illness
	Vaccines help prevent illnesses that were once responsible for the death of a lot of people
Scientific rigor	They are very safe for most people. Extensive testing and years of use have shown little to no recourse or damage to mass people.
Post-discussion
Interest in vaccinomics’ potential	I became more concerned of the socio-political effects of vaccination that made me more concerned of the incidence of racism, insurance issues, status: immigration and deportations that can decrease safety among populations and thus effectiveness. But not the safety of effectiveness of the vaccine itself
Vaccines getting safer	Still very confident, vaccinomics seems to promote safety!
Adverse reactions rarely occur	It is safe. It is very rare to hear a about situation where people were harmed

Table 4. Participants’ written comments explaining pre vs. post-discussion vaccine safety ratings for babies

Theme	Comment
Pre-discussion
Benefits of vaccines outweigh the risks	I think the safety concerns of vaccines for children are overstated and the benefit (kid not getting sick & dying) outweighs the risk. Living baby>dead baby
Vaccines keep babies safe	Vaccines help to keep babies safe when they don’t quite yet have the immunity to fight certain illnesses
Generally safe: allergic reactions	Overall, I think vaccines are safe for babies to prevent diseases in the future. The only issue is unknown allergic reactions. But the benefit is better than risk
Generally safe: side effects AEFI are rare	In my experience, babies can have short-term discomfort but vaccines are overall safe
Generally safe: side effects AEFI are rare	I don’t like the chicken pox vaccine. I would have preferred my kids get their immunity by contracting it b/c its worse to get as an adult. I believe the motivating factor was to keep kids in school as opposed to for their health. Children that get chicken pox provide a natural booster for adults chicken pox is worse if your an adult & I worry that the vaccine will not protect them in adulthood. Many adults aren’t always good at going to Dr. & keeping up w/vaccines.
Disease prevention	It can keep babies healthy & avoid spreading illness
Personal experience	I received vaccines as a youngster and did not contract any childhood illnesses. They are safe
Scientific rigor	Vaccines are constantly tested and improved to avoid any negative consequences. They are made in a meticulous and precise way. There has been no significant scientific link to any negative effects.
Post-discussion
No change	My opinions regarding the safety and effectiveness have not changed. But! I now have hope that they are destined to become safer & more effective. [drew a peace sign] No change, still think very safe. More research = increase safety
Adverse reactions rarely occur	There will always be some with adverse reactions

Table 5. Participants’ written comments explaining pre vs. post-discussion vaccine effectiveness ratings for adults

Theme	Comment
Pre-discussion
VE greater for children than adults	Vaccines don’t work as well in adults than children bc of immune changes & being introduced to more
Somewhat effective – vaccine dependent	Depends on the vaccine but clearly the flu vaccine is limited in effectiveness year to year
	I think that they’re mostly very effective but it depends on the vaccine & the reaction of the person receiving the vaccine (allergies, etc) Vaccines are safe in the military. I had several and was in close contact with others. I didn’t get ill for the vaccines. I think vaccines are effective but the adult immune system may have been exposed previously
Effective in adults	Because adult has fully developed immune system, a 1 day old infant getting hep B vax won’t respond as well as adult getting hep B vaccine I think they’re less effective than for children but still more effective than nothing Some vaccines do not create long term resistance which may decrease net effectiveness But when the vaccine is effective in a group; diseases are eradicated Small pox
Post-discussion
Disease prevention	Vaccines are the absolute best way to prevent pathological damage to our community proven by science
Effective in adults	May not be customized but still work
	I think most vaccines are effective for adults the only ones that I don’t think are as effective are created yearly like flu vaccines
	Im not convinced that they’re more or less effective. but I’m hopeful but terrified for the future I think vaccines based on genes would be more effective. However, I feel more comfortable with vaccines that have been around for 20+ years For all questions after discussion – reinforced my beliefs in safety and experience of vaccines. No change in “dots” placement.
Change	No significant change because I already do vaccinations and believe in the science. However, I think this will better inform the science.

Table 6. Participants’ written comments explaining pre vs. post-discussion vaccine effectiveness ratings for babies

Theme	Comment
Pre-discussion
Adaptive immunity	Vaccines are an effective way for babies to be exposed to antigens in a safe way so they can build up their adaptive immune system in order to contact later exposure to pathogen
Vaccines improve immunity	I think vaccines are most effective in babies because their immune systems are still developing
Somewhat effective – timing	Varies depending on age of baby & if Breastfed on not. Maternal antibodies interfere with VE & vax more effective once immune system is fully developed (after 2 yrs old?)
Somewhat effective – vaccine dependent	Seem very effective for major diseases, not so much for flu, etc
Disease prevention	We have smallpox vaccine & smallpox is eradicated; we have polio vaccine & disease is almost eradicated. Seems pretty effective to me
Post-discussion
Disease prevention	Vaccines remain the best way to preventatively protect your children against the pathogen that will seek to harm them in their lives. (similar comment under Adults)
Effective for babies	It is effective, however, each person is going to respond differently
	Baby vaccines are effective. Polio and other diseases are being wiped out through vaccination. Keep all American kids safe.
No change	I still feel vaccines are best effective for babies No change, still think very effective. More research = increased effectiveness No significant change because I trust in the science and efficacy of vaccines and I did not get any new information. The science is maybe getting better
Change	As an epidemiologist, I have always had a positive view of vaccines and I think vaccinomics would make my opinion stronger I think vaccines based on genes would be more effective. However, the information must not be allowed to influence life & health insurance policies. The slides on/video said most vaccines (average) are only 80–90% effective & I didn’t know that before (same comment appeared under Adults)