Background and aim: Childhood influenza vaccination coverage in Australia remains sub-optimal. Live attenuated influenza vaccine (LAIV), not previously available in Australia, has been proposed as a strategy to increase coverage. In 2026, LAIV will be offered to children aged 2 to <5 years in several jurisdictions including NSW. Little is known about parents’ attitudes and preferences regarding LAIV. The aim of this study was to explore parents’ perspectives on LAIV to inform strategies to encourage uptake.
Methods and Analysis: In November 2025 we interviewed and thematically analysed data from 16 parents of young children from urban and regional NSW. Interviews covered parents’ thoughts and feelings about vaccinating their child against influenza, perspectives on LAIV, and preferences for information and messages about LAIV. We analysed data thematically.
Outcomes: Most parents, even those who had not vaccinated previously, would consider LAIV for their child, viewing it as less invasive and more child-friendly, particularly for children afraid of needles. Parents emphasized that LAIV would need to be free, easily available and clearly recommended, and that they required additional information. This should be available in different languages and include official information comparing LAIV with needle-based vaccine. NSW and jurisdictional health departments have used these insights to inform strategies to encourage uptake, including communications campaigns.
Conclusion and future actions: These findings suggest potential for LAIV to improve childhood influenza uptake, but only if LAIV is easy for parents to access. Parents will also need information to increase awareness and inform decision-making. While most parents expressed positive views on LAIV, hesitant parents may need additional support overcoming common acceptance barriers that also limit uptake of the needle-based influenza vaccine. Future research should evaluate the LAIV rollout to understand parents’ experiences and inform future strategies to improve uptake.

Background and Aim:
Recent research on COVID-19 vaccination in China indicates that while most people perceive themselves to have vaccinated voluntarily, a significant percentage attribute their vaccination to “coercive mobilisation” efforts involving persuasion or pressure exerted through local communities. We sought to understand the extent to which parallels existed in the Australian context.

Methods and Analysis: We surveyed a representative sample (age/gender/state) of Australian adults (N=4,208) in late-2025 using a 15 minute online questionnaire, which included a range of measures of vaccine attitudes and behaviours, political preferences, personality, culture, and demographics. In addition to asking about the number of doses of a COVID vaccine received, and whether they were subject to vaccine mandate(s), we also asked participants about whether they perceived themselves to have vaccinated for COVID due to personal choice or external pressure, and the extent to which pressure from friends or family, the community, or an employer was a cause. We used GLM analyses to explore the nature and extent of perceived coercion to vaccinate, and associated demographic and political variables.

Outcomes: Findings paint a complex picture of vaccine coercion, stretching beyond direct governmental intervention. Notably, of those who had received a COVID-19 vaccine but were not subject to an employment mandate, 47% indicated pressure from friends or family was a contributing cause; 44% pressure from the community; and 22% pressure from an employer. 13% indicated that they did not view themselves as having vaccinated voluntarily.

Conclusion and Future Actions:
A significant proportion of Australians perceive that they were coerced into being vaccinated for COVID-19 via either indirect government pressure or non-government sources. Results highlight both the need to examine how coercive measures affect different subpopulations, and the potential benefits and risks of community pressure in motivating vaccine uptake.

Background and Aim
In Australia, vaccine mandates have been implemented through policies such as ‘No Jab, No Pay/Play’, and COVID-19 and occupational vaccination requirements to improve uptake and protect public health. Medical exemptions are integral, ensuring individuals with recognised contraindications are not disadvantaged. However, clinicians encounter complex cases that fall outside established criteria, including pre-existing medical conditions and adverse events following immunisation. In such instances, exemption decisions may be escalated to a state Chief Health Officer or the federal Chief Medical Officer. This study explored clinicians’ experiences assessing and granting special medical exemptions (SMEs) within Australian mandate settings.

Methods and Analysis
Twenty-seven semi-structured interviews were conducted with clinicians from all Australian states and territories who had assessed childhood, COVID-19, and/or occupational vaccine exemptions within the past five years. Interviews were audio-recorded, transcribed verbatim, coded in NVivo, and analysed using inductive content analysis.

Outcomes
Although SMEs are uncommon, clinicians regularly encountered complex presentations requiring nuanced clinical assessment. This involved detailed medical history review, appraisal of available evidence, collegial consultation, and consideration of contextual factors. Uncertainty regarding causality and recurrence risk was common. In the absence of explicit SME criteria, temporary exemptions were frequently used to allow time for further investigation; however, categories within the IM011 Services Australia medical exemption form (used to record exemptions on the Australian Immunisation Register) did not always align with clinical scenarios. Clinicians reported inconsistent understanding of escalation pathways, particularly among new or rotating staff, and suggested that discretionary judgement may have contributed to variability in exemption decisions. Clinicians also noted patients having limited understanding of the role and authority of specialist immunisation services, resulting in unrealistic expectations at consultation.

Conclusions
SME decision-making in Australia relies heavily on clinical experience and judgement. Refinement of IM011 documentation, clearer criteria, nationally consistent guidance, and targeted workforce education are needed to strengthen transparency, consistency, and equity within the exemption system.

Background and Aim: Moral Foundations Theory is linked to vaccine attitudes and hesitancy, but less is known about how distinct moral intuitions shape support for vaccine mandates and the trade-offs people make across mandate designs. We examine whether moral foundations predict (i) mandate support versus resistance and (ii) attribute-level preferences under mild (flu-like) versus severe (pandemic-like) outbreak contexts in Australia, France, and Italy.

Methods and Analysis: National adult samples in Australia (N=3,416), France (N=3,353), and Italy (N=3,380) completed a discrete choice experiment (DCE) under mild and severe framings. In each framing, respondents chose between two mandate policies and a no-mandate option. Policies varied by scope, exemption policy, lifting threshold, and expected lives saved per 100,000. Moral foundations were measured using the MFQ-20 domains: Care, Fairness, Loyalty, Authority, and Purity. Two-class latent class logit models were estimated, linking MFQ domains to class membership (mandate supporter vs resister).

Outcomes: In every country and framing, two classes emerged: a mandate supporter class that preferred mandate policies over no mandate, and a mandate resister class that strongly preferred no mandate. Supporters comprised 71.1% (France, mild) and 74.1% (France, severe), 74.5% (Australia, mild) and 77.8% (Australia, severe), and 69.3% (Italy, mild) and 74.3% (Italy, severe). Across countries, stronger Care and Authority orientations were consistently associated with supporter class membership, consistent with intuitions about protecting others and respecting legitimate public health guidance. Stronger Purity-related concerns were consistently associated with resistance, aligning with evidence linking purity-based intuitions to vaccine scepticism. Preference heterogeneity was substantial: supporters placed more weight on lives saved and were more accepting of stricter exemptions and, in some settings, higher lifting thresholds; resisters’ choices were dominated by the preference to retain the no-mandate option.

Conclusion and Future actions: Moral profiles help explain cross-country and within-country heterogeneity in mandate support and mandate-design preferences. Communication strategies may be strengthened by aligning messages with relevant moral intuitions and directly addressing purity-related safety/contamination concerns through transparent risk communication and reassurance about vaccine safety and monitoring.

Background and Aim: Public debates about vaccination mandates often pit collective welfare against individual autonomy, little is known about when or how personal values translate into mandate support. We investigated whether vaccine trust moderates the association between personal values and attitudes toward vaccination mandates in a hypothetical future pandemic scenario.

Methods and Analysis: We surveyed adults in Australia (N=4,208), France (N=3,858), and Italy (N=3,973) in late 2025/early 2026 using a 15 minute online questionnaire, which included a range of measures of personality, vaccine attitudes and behaviours, political preferences, culture, and demographics. Basic personal values were measured with the Best–Worst Refined Values (BWRr) scale; vaccine trust with the six-item Vaccine Trust Indicator (VTI); and attitudes toward mandatory vaccination with a newly-developed and validated 10 item scale, the Vaccination Mandate Attitudes Scale (VMAS). To examine the role of values and vaccine trust in attitudes towards vaccine mandates, we estimated a series of Pearson correlations and value x trust moderation models separately by value and country.

Outcomes: Vaccine trust moderated associations between values and mandate attitudes for 8/10 basic values in Australia, and 9/10 in France and Italy. Across countries, when vaccine trust was high, both growth oriented values and security values were associated with increased mandate support, however when trust was low, they were associated with reduced support. Self enhancement values and tradition values generally showed the opposite pattern of effects, while conformity values displayed a relatively stronger (positive) direct effect.

Conclusion and Future Actions:
Findings identify vaccine trust as a gating condition for the expression of value priorities in mandate attitudes. Policy and communication around vaccine mandates should be value congruent and trust enabling, or else value-expressive framing of mandates may be liable to backfire for those with lower vaccine trust.

Background
Australia is working toward elimination of cervical cancer as a public health problem, defined as fewer than four cases per 100,000 women per year, by 2035. Sustained high uptake of human papillomavirus (HPV) vaccination is central to achieving this target equitably across populations. Recent declines in coverage among adolescents and young adults pose a risk to progress, particularly in areas with historically lower uptake. As communication environments evolve and young people transition from school-based vaccination to independently navigating healthcare, it is critical to understand how they interpret HPV vaccination information. This project aimed to explore perceptions of HPV vaccination among young adults eligible for the catch-up program and identify approaches to strengthen engagement and equitable coverage.

Methods and Analysis
Five facilitated focus workshops were conducted with 70 young adults aged 18–25 years, including participants from South Australian council areas with low HPV vaccination uptake and members of the SA Youth Forum. Discussions explored awareness, perceived barriers and enablers, trusted messengers, and responses to proposed messaging concepts for the catch-up program. Qualitative data were analysed thematically.

Outcomes
Participants preferred messaging that framed vaccination as a collective act of shared responsibility, valuing protection of partners, peers, and the wider community alongside personal benefit. Uncertainty regarding relevance for all genders and confusion around eligibility outside the school program, cost, and booking pathways were common. Health professionals were viewed as highly credible, while relatable peer voices enhanced relevance, particularly within digital platforms where content is expected to engage almost immediately.

Conclusion and Future Actions
Aligning HPV vaccination communications with collective benefit narratives, clarifying access pathways, and supporting young adults transitioning from school-based vaccination to independent healthcare navigation may strengthen catch-up uptake. Embedding consumer-informed, adaptive capability within immunisation program planning may support equitable progress toward cervical cancer elimination in Australia.

Background and Aim: During pandemics, governments used vaccine mandates to boost uptake, but preferences for mandate design remain unclear. This study aims to quantify public preferences for future vaccine mandates in Australia, France, and Italy under mild versus severe outbreak contexts, and to identify the design features that drive support.

Methods and Analysis: Adult samples in Australia (N=3,416), France (N=3,353), and Italy (N=3,380) completed a discrete choice experiment under mild (flu-like) and severe framings. In each framing, respondents chose between two mandate policies and a no-mandate option. Policies varied by scope, exemption policy, lifting threshold, and expected lives saved per 100,000. Preference heterogeneity was analysed using latent class logit; results are reported as lives-saved equivalents and predicted mandate support for policy bundles.

Outcomes: Two classes emerged in each country and framing. “Mandate supporters” comprised 74.68%/77.78% (Australia mild/severe), 71.67%/75.03% (France), and 70.05%/74.77% (Italy). Predicted support increased with expected lives saved: for a targeted (high-risk occupations), medical-only exemptions, lifted at 50% coverage, support rose from 48.1% to 72.7% in Australia, from 48.9% to 69.8% in France, and from 49.0% to 66.2% in Italy as lives saved increased from 10 to 40 per 100,000. Holding lives saved at 25, expanding scope to population-wide in mild outbreaks reduced support (-2.8 pp Australia; -0.4 pp France; -1.9 Italy), whereas in severe outbreaks, population-wide scope with a higher lifting threshold increased support (+6.3 pp Australia; +5.7 pp France; +9.6 pp Italy). Personal-belief exemptions reduced support by 3.8 (Australia), 2.3 (France), and 4.5 (Italy) points in mild outbreaks, and by 4.1, 3.1, and 3.8 points in severe outbreaks. Lower institutional trust and vaccine-negative attitudes predicted “mandate resister” membership.

Conclusion and Future actions: Mandate support is design- and severity-sensitive; we translate results into an interactive decision aid tool (available at: https://drgenie.github.io/MANDEVAL-DecisionAid-V1/) enabling policy makers to test designs, compare acceptability, costs and benefits, and tailor strategies to severity.