Many people experience peace of mind from getting their children vaccinated, according to new research from the University of Bristol. However, this benefit is currently being ignored when health bodies weigh up vaccine benefits to make decisions about whether or not to introduce vaccines or expand their coverage.

The qualitative study, published in Vaccine, found that peace of mind should be considered in the health economic framework used by decision makers, but that more research is required to further define and quantify peace of mind.

Many different factors are considered by the Joint Committee on Vaccination and Immunisation (JCVI), who advise UK government on vaccines, but peace of mind is not currently one of them.

Researchers found that whether a person experienced peace of mind from vaccination depended on their knowledge of the benefits of having a jab. The reassurance they experienced was from knowing that when an individual was vaccinated it would offer some level of protection against a disease.

While peace of mind from vaccinating their children was important to some participants of the study, it wasn't for others. Parents who benefitted tended to think that vaccination was intrinsically beneficial, but people who simply considered vaccination as a routine health intervention said that they did not receive peace of mind benefits.

Even though these peace of mind benefits are only experienced by some parents, the added value to their health could still influence decisions on whether or not a government should fund a vaccine. The research suggests decision makers need to consider these benefits.

The researchers also found that peace of mind varies over time. Reassurance from the knowledge of benefits, or from healthcare providers, could be diminished by short-term unease about believing a child could be in pain or distress when receiving a jab. Certain vaccines brought less peace of mind if an individual either hadn't experienced the disease or if they had experienced of a mild form of the disease as a child but without complications.

Discussion from one focus group reported the longer a vaccine had been introduced, the more safe it felt to them. Participants were more cautious about vaccinations that they considered to be 'newer' or vaccinations that they had little personal experience with. There were exceptions to this for severe illnesses such as meningitis. The MenB vaccine, although considered relatively 'new' by some participants, provided increased reassurance because of the perceived severity of the disease.

Dr Gemma Lasseter, lead author, Research Fellow and Programme Manager at the National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions at the University of Bristol, said: "Our research, funded by the Meningitis Research Foundation, shows that vaccine associated peace of mind was important to some members of the UK general public when making vaccination decisions for themselves or their children. This peace of mind varied in magnitude, duration and over time. These findings are important because they indicate that the current economic approach used to make funding decisions about healthcare interventions in the UK may need to be refined to take peace of mind into consideration in the future."

Dr Hannah Christensen, co-author and Senior Lecturer at the University of Bristol, said: "When policy makers decide which health interventions are made available free at the point of use in the NHS they consider the benefits and costs, to assess whether the intervention provides value for money. This research shows us there is a benefit, in terms of peace of mind after vaccination, that could contribute to these policy decisions. Given the benefit appeared quite variable between people, and was influenced by a person's attitudes and beliefs about vaccinations, the challenge now is to work out how we can appropriately capture the 'value' of this peace of mind benefit so that it can contribute meaningfully to the vaccine decision-making process."

Vinny Smith, Chief Executive at Meningitis Research Foundation, the charity that funded the research, said: "This study now highlights that current government vaccine decisions miss some important benefits of immunisation. When considering the introduction of new vaccines, we want the government to take into account important health benefits, such as the reassurance that comes from knowing that your child is protected from death and disability."

"Parents know how dangerous and concerning meningitis is, and consistently rate it as a more serious illness than other preventable diseases. When the MenB vaccine was first introduced in September 2015 it was provided to young babies, but older children were not eligible for the vaccine on the analysis at the time of cost against benefits. Subsequently, the tragic death of a two year old from MenB in 2016, led to a surge in demand for the vaccine and an online petition calling for wider access. We have been calling for government to address the unfairness of the vaccine rules, which, if addressed, may have made the vaccine accessible to all children under the age of five."

"This study also gives us an insight into beliefs about vaccines can change. More time for conversations between healthcare professionals and parents could help address incorrect beliefs about vaccines and increase knowledge of the benefits."

###

For enquiries or interviews contact Sophie Beyer, Media Relations Manager for Meningitis Research Foundation Sophieb@meningitis.org 0333 4056251 / 07875 498047

For interviews with the Bristol academics please contact Joanne Fryer or Caroline Clancy-Cottle, Media Managers at Bristol University press-office@bristol.ac.uk and 0117 3940227 / 07747 768805

Copies of this paper are available to credentialed journalists upon request; please contact Elsevier's Newsroom at newsroom@elsevier.com or +31 20 485 2719

Notes to Editors

About Meningitis Research Foundation

Meningitis Research Foundation is a leading UK, Irish and international charity working to defeat meningitis wherever it exists. We fund and support vital scientific research. We campaign and provide information to the public, health professionals and researchers that promotes prevention, early diagnosis and treatment, and raises awareness of the diseases. We also provide direct support and ongoing personal help to individuals and families affected, whether they are living with impairment caused by the diseases or coping with the death of a loved one. See http://www. meningitis. org

About the MenB vaccine

The meningococcal B vaccine is recommended to be given at 2, 4, and 12 months as part of a child's routine immunisation schedule and uptake of the vaccine is high. In recent years the UK Government has been under pressure to address the cost-effectiveness approaches used by the JCVI for assessing the benefits of childhood vaccinations.

In April 2016 the largest health petition at the time, signed by 823,345 members of the public was submitted to Parliament calling for the Government to widen the provision of the MenB vaccine (more information available on request). https:/ / www. parliament. uk/ business/ committees/ committees-a-z/ commons-select/ health-committee/ inquiries/ parliament-2015/ meningitis-b-vaccine-inquiry/

About the NIHR HPRU in Evaluation of Interventions at the University of Bristol

The Health Protection Research Unit (HPRU) in Evaluation of Interventions, based in Population Health Sciences at the University of Bristol, is part of the National Institute for Health Research (NIHR) and a partnership between University of Bristol and Public Health England (PHE), in collaboration with University College London, Cambridge Medical Research Council (MRC) Biostatistics Unit and University of the West of England. We are a multidisciplinary team undertaking applied research on the development and evaluation of interventions to protect the public's health. Our aim is to support PHE in delivering its objectives and functions. Our focus is on the PHE priority area of infection. Follow us on Twitter: @HPRU_EI

The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:

funds, supports and delivers high quality research that benefits the NHS, public health and social care

engages and involves patients, carers and the public in order to improve the reach, quality and impact of research

attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future

invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services

partners with other public funders, charities and industry to maximise the value of research to patients and the economy.

The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR supports applied health research for the direct and primary benefit of people in low- and middle-income countries, using UK aid from the UK government.

About Vaccine

Vaccine is the pre-eminent journal for those interested in vaccines and vaccination. It is the official journal of The Edward Jenner Society and The Japanese Society for Vaccinology and is published by Elsevier http://www. elsevier. com/ locate/ vaccine