title: Future pandemics and vaccination: Public opinion and attitudes across three European countries.
abstract: BACKGROUND
  Understanding public opinion and attitudes regarding vaccination is crucial for successful outbreak management and effective communication at the European level.
  
  
  METHODS
  We explored national differences by conducting focus group discussions in The Netherlands, Poland and Sweden. Discussions were structured using concepts from behavioural models.
  
  
  RESULTS
  Thematic analysis revealed that participants would base their vaccination decision on trade-offs between perceived benefits and barriers of the vaccine also taking into account the seriousness of the new outbreak. Except for those having chronic diseases, participants expected a low infection risk, resulting in a low willingness to get vaccinated. Information about the health status of cases was considered important since this might change perceived susceptibility. Participants displayed concerns about vaccine safety due to the limited available time to produce and test vaccines in the acute situation of a new pandemic. Swedish participants mentioned their tendency of doing the right thing and following the rules, as well as to get vaccinated because of solidarity with other citizens and social influences. This appeared much less prominent for the Dutch and Polish participants. However, Swedish participants indicated that their negative experiences during the Influenza A/H1N1 2009 pandemic decreases their acceptance of future vaccinations. Polish participants lacked trust in their national (public) health system and government, and were therefore sceptical about the availability and quality of vaccines in Poland.
  
  
  CONCLUSIONS
  Although participants overall expressed similar considerations, important differences between countries stand out, such as previous vaccination experiences, the degree of adherence to social norms, and the degree of trust in health authorities.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; National Institute for Public Health and The Environment, Centre for Nutrition, Prevention and Health Services, PO Box 1 (Internal Postal Code 101), 3720 BA Bilthoven, The Netherlands. Electronic address: d.determann@erasmusmc.nl.
authors.forename: Domino
authors.initials: D
authors.lastname: Determann
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Electronic address: e.debekker@erasmusmc.nl.
authors.forename: Esther W
authors.initials: EW
authors.lastname: de Bekker-Grob
authors.affiliation: Strategic Social Marketing Ltd, Conford, Liphook GU30 7QW, United Kingdom; Brighton University Business School, Mitras House, Lewes Road, Brighton BN2 4AT, United Kingdom. Electronic address: jeff.french@strategic-social-marketing.org.
authors.forename: Jeff
authors.initials: J
authors.lastname: French
authors.affiliation: Municipal Public Health Service Rotterdam-Rijnmond, PO Box 70032, 3000 LP Rotterdam, The Netherlands. Electronic address: h.voeten@Rotterdam.nl.
authors.forename: Helene A
authors.initials: HA
authors.lastname: Voeten
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Municipal Public Health Service Rotterdam-Rijnmond, PO Box 70032, 3000 LP Rotterdam, The Netherlands. Electronic address: j.richardus@erasmusmc.nl.
authors.forename: Jan Hendrik
authors.initials: JH
authors.lastname: Richardus
authors.affiliation: Centre for Language Studies, Radboud University, PO Box 9103, 6500 HD Nijmegen, The Netherlands. Electronic address: h.das@let.ru.nl.
authors.forename: Enny
authors.initials: E
authors.lastname: Das
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Electronic address: i.korfage@erasmusmc.nl.
authors.forename: Ida J
authors.initials: IJ
authors.lastname: Korfage
mesh_terms: D000328:Adult; D000368:Aged; D004196:Disease Outbreaks / Q000517:prevention & control*; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007252:Influenza Vaccines / Q000627:therapeutic use; D007251:Influenza, Human / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D009426:Netherlands; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011044:Poland; D011639:Public Opinion; D066262:Social Norms; D013548:Sweden; D035502:Trust; D014611:Vaccination / Q000523:psychology*; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines
keywords: Emerging infectious diseases; Europe; Focus group discussions; Pandemic preparedness; Qualitative research; Vaccination