Introduction: Australia’s adult vaccination coverage against respiratory infection is suboptimal. Heightened vaccine hesitancy and misinformation following the COVID-19 pandemic have exacerbated existing strategic, policy, access, and knowledge barriers to adult uptake. To better understand knowledge challenges, open-ended survey responses were examined to identify vaccination information needs and the nature of misinformation. These insights will inform improved health messaging.
Method: Survey data were collected in mid-2024, with participants (n=3,352) recruited from Lung Foundation Australia’s client cohort and the general public. Forty percent of participants reported living with a lung disease. A qualitative content analysis is being conducted on responses to two open-ended questions: one on vaccination information needs and another allowing participants to raise any vaccination concerns (n=~2000 valid responses). Rigour will be sought through iterative analysis, with illustrative quotes provided to support credibility. Chi square tests of association will compare demographic and health characteristics of respondents who described information needs or who expressed views contrary to scientific evidence with those who discussed other topics or did not respond to the open-ended questions.
Results: A pilot analysis of a subset of responses revealed knowledge gaps on recommendations for adult vaccinations and vaccine frequency and timing, as well as misunderstandings around vaccine safety and efficacy. Categories of responses will be presented along with contextual information on Australia’s adult vaccination schedule and policy.
Conclusion: Even among a health-engaged participant group (reflecting a large client cohort and evidenced by high self-reported respiratory vaccination rates) there is confusion, misunderstanding and distrust about adult vaccination. With new Australian immunisation strategies now including targets for adult vaccination coverage, effective community education initiatives are needed to drive improvement in uptake. Findings from this project will help shape consumer-informed communication strategies that enhance confidence in the benefit of adult vaccination.

Context:

Boorloo (Perth) Public Health Unit regularly provides written information to consumers to assist with public health management of communicable disease. We recently undertook a project to improve the readability and comprehension of our consumer resources to ensure our consumers were making informed decisions about their health care and to improve health literacy. We used plain language, visual aids and bright colours, and simplified information where possible, incorporating feedback from consumers and key stakeholders including the Aboriginal Health Council WA, Derbarl Yerrigan Health Service, and staff from our Aboriginal Health Team.

Aim:
We aimed to assess old and new consumer resources using word count, number of words per sentence, Flesch Reading Score, Flesh-Kincaid Grade Level, and an adapted Patient Education Materials Assessment Tool for Printable Material (PEMAT-P). We are also seeking qualitative feedback from key stakeholders, including the North Metropolitan Health Service Aboriginal Cultural Advisory Group.

Analysis and Outcome:
Objective measures of readability were higher in the new resources as compared to the previous resources, with a mean reduction in number of words of 97.9, an increase in Flesch Reading Ease Score from a mean of 53.7 to 70.1 (a higher score indicates content is easier to read and understand), a decrease in mean Flesch-Kincaid Grade Level from 9.8 to 6.3 (Grade level of 7 or below is advised for consumer health resources). The PEMAT-P scores also demonstrated an improvement in readability and comprehensibility with the new resources. We will also aim to present qualitative findings at the conference if accepted.

Conclusion:
Written public health resources should be readable, engaging, and easily understood by consumers, in order to facilitate informed health decision-making. This evaluation demonstrates that our new resources are more readable and more understandable for consumers.

Aboriginal Community Engagement
If any of the feedback sought from the North Metropolitan Health Service Aboriginal Cultural Advisory Group is included in the presentation, we will consult with them and seek endorsement prior to the presentation. Additionally, the Boorloo PHU Aboriginal Health Team supports presenting the findings.

Background:
A school-based immunisation program for adolescents has been in place in Australia since the 1970s. Adolescent vaccine uptake has been steadily declining with the COVID-19 pandemic further exacerbating this decline. This trend mirrors national adolescent vaccine uptake. The study aims to co-design potential nudge interventions to inform community-led communication strategies and optimise school immunisation uptake in adolescents.
Methods:
The nudgeathon actively involved all stakeholders including young people from schools in areas with low vaccine uptake in the co-design process. This nudgeathon incorporated expertise in behavioural science, nudging and health policy, and developed the evidence-based "nudge" interventions.
Results:
On 16 and 17 December 2024, a Nudgeathon was conducted in Adelaide. There were 58 participants from various organisations, including SA Health, the Department for Education, private vaccination and health service providers, local councils, schools, academia, and representatives of target populations such as Year 7–10 students and their parents, representing a range of ethnicities and culturally and linguistically diverse backgrounds. The following nudge interventions were co-designed by participants:
• Toolkits with tailored communication materials for school principals, administrative staff, and teachers.
• Communication campaigns for delivering vaccination-related information to students and parents through videos, school assemblies, and text messages.
• Integration of immunisation materials within school enrolment packs and implementation of a one-time consent process.
• Education sessions with incentives to promote the timely return of consent forms.
• A default opt-out consent model to streamline the consent process.
• A multi-faceted approach combining informational, educational, and vaccination-focused interventions delivered through multiple engagement points.
• Including immunisation into the school curriculum.
Conclusions:
This nudgeathon engaged diverse stakeholders to co-design nudge-based interventions aimed at improving school-based immunisation uptake by enhancing communication, streamlining consent processes, and increasing engagement. Future evaluation of these strategies will be essential to assess their effectiveness and inform broader implementation.

Vaccine hesitancy is adversely influencing people’s health. An infodemic is threatening trust in science and has contributed to peaks in vaccine hesitancy among New Zealanders, particularly teenagers (Hodson, 2023). The problem is exacerbated by social media informational cascades that entice youth toward belief in mis- and disinformation (Alemu et al., 2023). Health and vaccine literacy can lead to higher levels of vaccine acceptance, especially among young people (Singh & Chase, 2022). Hence, education is not only required for teenagers exposed to various information sources but also for science teachers to educate these learners. Using a Delphi approach, this study sought the opinions of 16 experts to determine the content of an immunology curriculum for teenagers. Immunologists, virologists, physicians, medical writers, advisors and educators were surveyed as expert informants. In a 3-phase iterative survey, the informants recommended the inclusion of four main areas for teaching an immunology curriculum: the immune system, vaccination, mis- and disinformation, and pedagogical advice/strategies. Findings suggest that secondary teachers should aspire not only to teach basic immunology and vaccination but also explicitly teach myths about vaccines and the fallacies that underpin them. Experts reason that delving into complex immunology and vaccination ideas can deter students from the topic. However, engaging in classroom discussions about myths may offer unique opportunities for teachers to debunk mis- and disinformation, especially as classrooms can be a uniquely safe space for learners. Using a variety of pedagogical tools and strategies to engage learners in immunology, along with verified resources for a complicated topic, was also recommended.

References:
Alemu, D., Diribsa, T., & Debelew, G. T. (2023). COVID-19 Vaccine Hesitancy and Its Associated Factors Among Adolescents. Patient Preference and Adherence, 17, 1271–1280. https://doi.org/10.2147/PPA.S400972
Hodgson, B. (2023). Vaccine confidence index map. Vaccine confidence project. https://www.vaccineconfidence.org/vci/map/
Singh, H., & Chase, A. J. (2022). Measuring vaccine acceptance and knowledge within health professions education br. Vaccine, 40(37), 5452–5458. https://doi.org/10.1016/j.vaccine.2022.07.039

During the COVID-19 pandemic, the Western Australian Government employed public space vaccine mandates to promote vaccine uptake. Individuals had to show proof of vaccination to enter service and hospitality venues, including coffee shops, bars, and cinemas. Checking proof of vaccination became the duty of venue employees, many of whom were young workers. The impact of this operational responsibility for vaccination governance upon young hospitality workers has not been explored.

This paper presents findings from a qualitative interview study conducted in WA exploring how being functional public health governance officials impacted young workers and overall mandate efficacy. Employing the theoretical lens of Kasperson et al.’s 1988 ‘risk amplification framework’, it analyses how experiences with mandate enforcement shaped young workers’ perceptions of public health and other risks; their compliance with their enforcement role; and the strategies they used to cope with competing risk signals and burden.

We found that young workers were subject to several secondary risks by virtue of their enforcement role, including negative interaction with customers; an increased time pressure and responsibility at work; and burden fatigue. They exercised significant discretionary power in their enforcement roles, and often prioritised the immediate alleviation of these frontline secondary risks over a strong commitment to enforcing mandates and promoting public health.

This paper contributes insight into the challenges of appointing young, untrained workers to act as informal public health officers, and its ultimate impact on communication, implementation, and effectiveness of public space mandates. The study further contributes knowledge by making recommendations to policymakers to improve future mandate design, emphasising a stronger focus on supporting young workers in their enforcement role.

Our recommendations are important not only to improving the efficacy of public space vaccine mandates, but also to socially constructing a positive citizen-government relationship as a foundation for future public health policy compliance.

Background: Governments worldwide implemented vaccine mandates during the SARS-CoV-2 pandemic, impacting public health and societal norms. In Australia, these mandates affected a large workforce segment, yet public preferences for their design remain unclear. This study explores public preferences to inform evidence-based policy decisions for future health emergencies.

Aim: To quantify public preferences for vaccine mandates in Australia, France, and Italy to guide future policy-making.

Methods: A multi-country Discrete Choice Experiment (DCE) will survey individuals aged 18+ in the three countries. The study examines five key attributes: 1) Mandate scope, 2) Infection threshold for activation, 3) Coverage requirement for lifting, 4) Incentives/benefits, and 5) Exemptions. Online surveys will assess demographic, political, and moral influences on preferences. Statistical analysis will predict acceptance rates and assess socio-demographic effects. An online Decision Aid Tool (DAT) will allow users to explore cost-benefit analyses of vaccine mandates (https://drgenie.github.io/VaxMandateDecisionAid/).

Results: Preliminary interviews with a community advisory group reveal diverse rankings of mandate attributes, reflecting societal values and past experiences. Detailed findings on trade-offs related to scope, exemptions, and enforcement strategies will be presented.

Conclusions: Understanding public preferences is key to designing effective, equitable, and socially acceptable mandates. Insights from this study will aid policymakers in improving public trust and compliance, strengthening societal resilience against future pandemics.

Policy Implications: Findings will help develop policies that balance public health benefits with individual freedoms, strengthening more sustainable and publicly accepted health strategies.

Background: Medical exemptions to mandated vaccines are permitted for particular health risks, such as anaphylaxis and immunosuppression. However, clinicians encounter requests for ‘special medical exemptions’ when the medical reason for requiring an exemption falls outside strict criteria. The specific processes for seeking, assessing, and granting these exemptions are often unclear and vary across jurisdictions.

Aim: To map and synthesise published literature on the experiences of parents, caregivers or individuals seeking special medical exemptions for mandated childhood vaccines, occupational vaccines for healthcare workers, and COVID-19 vaccines, as well as the experiences of clinicians assessing and granting such exemptions.

Methods: A scoping review guided by PRISMA-ScR and JBI methodology was conducted. Databases searched included Embase, Medline, CINAHL, PsycInfo, PubMed, Web of Science, and Google Scholar. Qualitative, quantitative, review articles, and grey literature were included. Citations were managed in Endnote and Covidence for screening and data extraction by two independent reviewers.

Results: The search yielded 3637 unique citations, with 33 articles undergoing full-text review. Preliminary findings reveal very few published articles that specifically address special medical exemptions. Most literature primarily focuses on parental experiences in seeking exemptions for their children. There is a significant gap in the literature regarding individuals’ experiences in obtaining COVID-19 vaccine medical exemptions and clinicians’ perspectives on managing these requests. Furthermore, the process and ethical considerations surrounding special medical exemptions remain largely unexplored.

Discussion/Conclusion: The lack of research in this area highlights the need for future research to understand the experiences of clinicians and exemption seekers and to clarify the exemption process. Such evidence will be vital in developing equitable evidence-based approaches to vaccine exemptions that consider both individual circumstances and public health imperatives. As vaccine mandates continue, understanding stakeholder experiences is crucial for building trust and effective public health policies amidst this complex issue.