Vaccines are among the most effective preventive measures against morbidity and mortality from infectious diseases. Smallpox, for example, was eradicated worldwide through concerted global vaccination alone. Likewise, deadly diseases such as poliomyelitis and measles are extremely rare in many parts of the world.
However, an increasing number of conspiratorial claims about vaccines has eroded confidence in immunization efforts, particularly during the current 2019 coronavirus disease (COVID-19) pandemic.
To learn: Vaccination hesitation in pediatrics. Photo credit: Drazen Zigic / Shutterstock.com
A new Advances in pediatrics The paper examines notable risk factors associated with this phenomenon, particularly with regard to influenza and human papillomavirus vaccines. Importantly, claims against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were excluded from the review.
Children are under the care of their parents, which is why parental permission is crucial for universal pediatric vaccination. However, parental confidence in vaccines is severely hampered by the proliferation of myths about harmful vaccine outcomes.
These conspiracy theories are often supported by the fact that vaccine-preventable diseases (VPDs) are extremely rare in many developed countries and therefore account for only a small proportion of overall childhood morbidity and mortality.
The unfortunate consequence of these conspiracies is a growing mistrust of the effectiveness and usefulness of these vaccines among parents. In fact, in the United States alone, up to one in seven young children does not receive the recommended immunizations simply because their parents refuse, while more than 25% of American parents choose to delay vaccinating their children.
Children who are not vaccinated because of parental refusal remain at increased risk of catching VPDs, which may later contribute to outbreaks, as has been noted in measles and whooping cough in recent years.”
The current paper describes the general reluctance to be vaccinated by parents of eligible children and some of the strategies that may be useful to counteract this trend.
Vaccination hesitation is defined by the World Health Organization (WHO), specifically by its Strategic Advisory Group of Experts (SAGE) on Immunizations, as “Delay in accepting or rejecting vaccines despite availability of vaccination services.”
Parents’ immunization attitudes depend on time, place, and vaccinations. The WHO names three Cs in this context: complacency, comfort and trust.
Both vaccination hesitancy and vaccination acceptance range from absolute refusal to take a vaccine to those who let their children take every recommended vaccine without asking questions.
In a previous report, researchers describe five categories of vaccination hesitancy, including the unconditional acceptor, the cautious acceptor, the hesitant, late or selective vaccinator, and the refuser. These classifications offer specific advice because the underlying reasons for a parent’s delay in vaccination may vary with the decision-making paradigm and between individuals themselves.
Additionally, some factors that contribute to parents vaccinating their children may include age, gender, education and income levels, religious and political beliefs, and the specific vaccine.
reasons for rejection
Vaccinations are rejected by parents for their children due to fear of side effects, perception that they are not really needed given the current low VPD prevalence, doubts about the effectiveness of vaccines, individualistic thinking, moral concerns, and opinions for or against vaccinations.
Many parents believe that vaccines cause disease instead of preventing it. Some even claim that a child’s immune system can be weakened by too many vaccines, that there are supposed toxins in vaccines, and that the entire vaccination movement is fueled by unscrupulous manufacturers who only care about their profit margins.
Over a third of parents think children get too many different vaccines in the first two years of life, while over 90% think no more than three vaccines should be given on any given occasion.
There is a clear correlation between belief in alternative medicine, natural living and reluctance to vaccinate with parents who refuse to vaccinate their children. These parents, who are up to four times more likely to use alternative medicine systems, often think that acquiring the VPD would serve the child better than vaccination. Other areas where such preferences manifest themselves in this subset of parents are organic food and alternative school approaches.
Similarly, despite a formal retraction of the influential 1998 article alleging a link between autism spectrum disorders and the measles, mumps, and rubella (MMR) vaccine, and the discrediting of author Andrew Wakefield, millions of parents continue to believe in such a club. These parents also claim that this association is not only due to the MMR vaccine but to vaccines in general.
Difficulty correcting wrong beliefs
An inherent error in assuming that the provision of information corrects erroneous beliefs is failure to recognize that people accept or reject information based on their ideologically motivated acceptance of the source of the information.
The pharmaceutical industry in particular, with its documented interest in profit rather than general benefit in drug development, has largely lost public credibility. His connections to research, medical and government communities are also seen as a liability.
When people lose faith in their government, the consequences are oppression. These, in turn, can lead to conspiracy theories that ultimately contribute to the reluctance of many parents to vaccinate.
The widespread use of school vaccinations has also led some concerned parents to view the recommendation that their children be vaccinated as a form of social coercion. As a result, these parents also increased the side effects of these vaccines instead of their benefits.
This is especially true for those who maintain busy parenting lifestyles, as well as those who hear information about vaccinations from family, friends, or books rather than their doctors.
Vaccination safety issues are predominantly highlighted in print, broadcast, social media and online.”
Of particular concern is that social media and the internet often provide information that is grossly misleading or inaccurate. Unfortunately, this information is often posted alongside more correct information without verifying the sources. Researchers have hypothesized that web-based interventions that offer factual vaccine information via social media could counteract the effects of misleading or inaccurate posts.
Web 2.0 capabilities allow any user to create and share content through social networks (e.g. Facebook, YouTube, Twitter), often without undergoing an audit to verify that their sources of information are reliable.”
The widespread needle phobia and painful local vaccination reactions also play a role in up to 10% of parental refusals to be vaccinated, especially if they themselves have experienced painful vaccinations in childhood. This must be counteracted by reassurance, pressure on the injection site, use of local anesthetics and distraction of the child during the vaccination process.
How to deal with vaccination delays
The best way to respond to vaccination hesitation and refusal involves a range of tailored approaches, including face-to-face meetings to offer educational information to those who accept vaccination but wish to practice, for example, a delayed vaccination schedule. This technique would not be effective if the rejection was based on religious beliefs, perceptions of vaccine-related dangers, or vaccine futility.
Historically, social motives for vaccination have not been a major factor in changing parental views on vaccines, particularly in societies that prioritize individual freedom over community responsibility.
A systematic review showed that while parents believed the concept of “vaccines that benefit others” was important, their decision was ultimately based on the perceived benefit to their own child.”
Healthcare providers continue to play an important role as trusted sources of information. When physicians take the time to discuss vaccination concerns and provide factual and authoritative rebuttals of false assumptions, at least a third of denials are reported to be reversed.
The success of this approach is based on a relationship that builds trust and encourages shared decision-making related to the health of the child. It also depends on the clinician being open-minded about the risks associated with vaccines while still presenting their benefits.
Up to 6% of paediatricians are reticent themselves. In fact, recent medical graduates are 15% less likely to believe in the benefits of vaccination. This requires better basic education in vaccinology during medical training.
Medical providers are more effective when they share the evidence in a nonjudgmental/nonconfrontational manner and acknowledge the parents’ concerns with empathy.”
Therefore, healthcare providers need to match the evidence-based framework of their thinking with more anecdotal and emotional information that their patients encounter every day.
A connection between these paradigms is offered by “motivational interviewing”, which is practiced among vaccination advocates. This technique identifies the parents’ concerns and motivations without confrontation, thus allowing the parents to change their behavior without coercion from the other side.
Providers should continue to work at the clinical practice and advocacy level to address vaccine delay from multiple angles.”