Promoting Vaccine Confidence

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Key points

  • Although vaccines are one of the most successful public interventions of all time, some parents remain concerned about vaccine safety.

  • Vaccine hesitancy includes a broad spectrum of parental attitudes, beliefs, and behaviors that includes vaccine refusal and intentional vaccine delay.

  • Providing parents with reliable evidence-based information about vaccines is an important component of vaccine risk communication.

  • Taking a presumptive approach is an effective strategy when discussing vaccines with

What is vaccine hesitancy anyway?

Vaccine hesitancy is a heterogeneous term that encompasses the entire spectrum of parental vaccine concerns. One definition proposed by a working group from the World Health Organization (WHO) is as follows:

Vaccine hesitancy refers to delay in the acceptance or refusal of vaccination despite availability of vaccination services. Vaccine hesitancy is complex and content specific, varying across time, place and vaccines. It is influenced by factors such as complacency, convenience and confidence.2

How common is vaccine hesitancy?

With such a heterogeneous definition, vaccine hesitancy can be difficult to measure. Data from the 2013 National Immunization Survey (NIS) demonstrate that most children in the United States received all recommended vaccines.3 NIS data do not include reasons for vaccine nonreceipt, so they cannot distinguish intentional parental behavior from missed opportunities or poor access to care. However, it is generally accepted that receipt of no vaccines at all indicates intentional vaccine refusal.4

Complacency and vaccine risk perceptions

Vaccines are one of the greatest public health accomplishments of all time. As a result, they have become a victim of their own success. Because parents do not have personal experience with the devastating effects of vaccine-preventable diseases, they may not view them as important. Furthermore, because vaccines are administered to healthy children to prevent, and not treat, disease, parental threshold for risk is even lower. Any theoretic concern about the safety of childhood vaccines may

Confidence in vaccine safety

Like any other pharmaceutical agent, vaccines may have unintended side effects. Fortunately, most vaccine adverse events are transient and mild. These include fever and injection site reactions such as erythema, warmth, and tenderness. Although they need to be explained to parents, serious vaccine adverse events are extremely uncommon. For instance, a review of 7.5 million vaccine doses from 1991 to 1997 identified only 5 cases of anaphylaxis for an estimated 0.65 cases/million doses

Confidence in the health care system

Because vaccine clinical trials are sponsored by the pharmaceutical industry, parents may question their validity. In addition, the fact that many childhood vaccines are mandated as a condition of school entry may raise questions about civil liberties and freedom of choice, a discussion that dates back to the first mandatory smallpox vaccination laws in the United States in 1855. Both of these raise issues of trust with vaccines and the bodies that recommend and enforce them. Fortunately, there

Addressing vaccine hesitancy

Although primary care physicians are well positioned to convince parents about the safety and necessity of childhood vaccines, the optimal strategies for addressing vaccine hesitancy remain to be elucidated. A recent systematic review identified 30 peer-reviewed studies published between 1990 and 2012 that assessed the impact of various interventions on objective measures of vaccine hesitancy including parental attitudes toward vaccines, intent to vaccinate, and actual vaccine refusal.19 Of

Delivering the message

Although providing parents with information is important, the most critical element in effective vaccine risk communication may be how the message is delivered. Several studies have attempted to address this important question.

Opel and colleagues20 videotaped interactions between pediatricians and parents during routine office visits, oversampling vaccine-hesitant parents. They were particularly interested in how physicians initiated discussions about vaccines. They focused on the use of

Strategies for communicating with vaccine-hesitant parents

Although evidence-based guidelines are lacking, recommendations for discussing vaccine safety with concerned parents have been published (Box 1).22 Most experts agree that interventions need to be targeted to each individual family. Strategies for responding to some of the more common vaccine safety concerns are suggested in the following discussion.

Some parents may be concerned about the number of injections given at a single visit. In a study including 32 pediatric offices, Meyerhoff and

Prologue: back to Disney

The balance between vaccination and infectious diseases is depicted graphically by the so-called life cycle of an immunization program (Fig. 1) Disease incidence begins to decline when a new vaccine is introduced (2). As incidence continues to decrease, adverse vaccine events, both perceived and real, become more prevalent than the disease itself (4). At that point, loss of confidence may develop in a critical proportion of the population (5), and outbreaks may occur (6). Continued decrease in

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  • Cited by (20)

    • Rapid behavioral assessment of barriers and opportunities to improve vaccination coverage among displaced Rohingyas in Bangladesh, January 2018

      2019, Vaccine
      Citation Excerpt :

      Prior studies have described vaccine hesitancy across diverse settings and populations [17–29]. While interventions addressing vaccine hesitancy [30–43] usually require careful design to fit the local context, there is increasing evidence suggesting that interventions must address barriers at the individual, interpersonal, community, and policy levels in order to be effective [11–15]. Findings from the rapid assessment were used to revise subsequent vaccination campaign messages and improve demand promotion strategies.

    • Development of a US trust measure to assess and monitor parental confidence in the vaccine system

      2019, Vaccine
      Citation Excerpt :

      Recent findings indicate that even among parents of children who are up-to-date on immunizations, broad concerns still exist about pediatric immunizations [6]. Thus, having trust in those who produce vaccines, provide vaccine oversight, and offer vaccine recommendations is important for engendering and sustaining public confidence [36]. Our index provides an early set of options towards an efficient, yet comprehensive, set of items that assess trust in the processes that lead to vaccine licensure, advisory committee recommendations and trust in oversight entities, and in those who recommend vaccines and schedules [18].

    • Increasing Immunization Adherence Among Infants of Low-income Parents: The Effects of Visually Enhanced Education

      2016, Journal for Nurse Practitioners
      Citation Excerpt :

      This type of approach may be more effective than focusing on myths surrounding immunizations.12 Further, Smith19 indicated that immunization risk communication should involve educating parents that refusing immunizations presents the greatest risk for their child. Timely immunizations are of upmost importance to the health of children and herd immunity.

    View all citing articles on Scopus

    Disclosure: The author has received research funding as site principal investigator for phase 3 vaccine clinical trials from Novartis and Sanofi. No specific products or off-label indications are discussed in this article.

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