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Motives differ between parents who refuse, delay vaccination for children
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Parents who refused to vaccinate their children were more likely to believe vaccination was unnecessary, and parents who delayed vaccines were more concerned with their child’s discomfort and immune system burden, according to recent study data.
“Decreasing parental acceptance of the benefits and safety of vaccines has resulted in increasing rates of nonmedical vaccine exemptions and of children who are underimmunized and unimmunized,” Catherine Hough-Telford, MD, a specialist in pediatric infectious disease medicine at University of Alabama Hospital, and colleagues wrote. “Historical data suggest that the reasons for these refusals and delays (also called alternative vaccine schedules) may be changing over time.”
Hough-Telford and colleagues pooled data from the national AAP Periodic Surveys from 2006 and 2013 to compare pediatrician perceptions of prevalence in vaccine refusals and delays, parental reasons for refusals or delays, and physician dismissals of parents who refuse or delay vaccines for their children. Of the AAP members who were mailed surveys in both years, responses from 629 were included in 2006 and 627 in 2013. In both surveys, pediatricians were asked whether they encountered vaccine refusals in the past 12 months and asked to estimate the number of parents in their practice who refused one, more than one or all vaccines. Vaccine delay questions were asked only on the 2013 survey.
Comparison analysis showed that pediatricians encountered an increase in vaccine refusals from 2006 (74.5%) to 2013 (87%) (P < .001). Further, physicians reported that the reason most parents decide not to vaccinate their children is because they think vaccines are unnecessary (63.4% in 2006 vs. 73.1% in 2013; P = .002). For parents who delay vaccines, pediatricians responded that parents were concerned about discomfort (75%; 95% CI, 71.3-78.7) or immune system burden (72.5%; 95% CI, 68.6-76.3) in their children.
The percentage of pediatricians who “always” dismissed parents for refusing vaccines for their children nearly doubled between surveys. It increased from 6.1% in the 2006 survey to 11.7% in 2013 (P = .004), due to largely to pediatricians’ frustrations in the lack of trust between physicians and patients’ parents.
The investigators wrote that during both survey years, educating parents resulted in pediatricians convincing only about 33% of vaccine-refusing parents to change their minds.
“More research is needed to identify effective techniques to address the concerns of vaccine-hesitant parents as identified in this report,” the researchers wrote. – by Kate Sherrer
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Henry Bernstein, DO, MHCM, FAAP
We know vaccines work, but many parents apparently don’t agree. According to this study, a growing proportion of pediatricians (up to 87% in 2013) report facing vaccine-refusing parents who do not think vaccines are necessary. Approximately three-quarters of pediatricians believe parents delay vaccines due to the anticipated discomfort their child would experience or concerns that so many vaccines will overwhelm their infant’s immune system.
Therefore, we explain, extol, and emphasize the real value of vaccines every day in clinical practice. But here’s the conundrum: Hough-Telford and colleagues also documented that the proportion of pediatricians who always dismiss vaccine-refusing families nearly doubled from 6.1% in 2006 to 11.7% in 2013. Parental concerns can range from being hesitant about certain vaccines to outright refusal of all vaccines. With the internet making information ubiquitous for everyone, more research is needed to clarify the evolving reasons families are hesitant about or even refuse all vaccines in order to develop effective, targeted educational strategies to promote vaccination.
What if our efforts to educate, encourage, and cajole parents to accept vaccines for their children fail? Do we accept the family’s decision and keep providing care to that family whose child remains unimmunized or do we ask the family to seek medical care with another provider who is more in line with their personal philosophies? Each pediatric practice can decide what feels right and fits best for its local community, but in my opinion, there first must always be open communication and ongoing conversations with families before making a decision in either direction.
More research needs to be done to develop and test different methods of communication and relationship-building that may help pediatricians convince parents of the safety and efficacy of vaccines, as well as their role and responsibility in the health of not only their own child, but also of other children in the practice, community and throughout the nation. As pediatricians, we owe it to children whose lives are at stake.
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Paul A. Offit, MD
Hough-Telford and colleagues, in their study of parental attitudes about vaccination, offer some good news and some bad news. The good news is that a smaller percentage of parents are concerned about vaccine safety issues, such as autism and vaccine ingredients. The bad news is that more parents are choosing to delay vaccines, fearing that children get too many vaccines too soon. This finding shouldn’t be surprising.
During the first few years of life, infants and young children can receive as many as 26 inoculations to prevent diseases that most people don’t see using biological fluids that most people don’t understand. Of further concern, these researchers noted that education about the importance of vaccines doesn’t appear to be particularly convincing.
So what’s the answer? As we learned from the response to the 2015 measles outbreak that began in southern California, it appears that the viruses and bacteria themselves might have to be the best educators.
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