Navigating vaccine hesitancy

Navigating vaccine hesitancy: What can the physician do?

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Navigating vaccine hesitancy

Monday morning: a routine visit by a young mother with her small child. A discussion about vaccine safety ensues. After an average visit of between 10 and 19 minutes, and equipped with the latest statistics and several leaflets, the mother leaves to consider her options. Sound familiar? Will she return the following week to get her child started on the recommended vaccine schedule? Will she ask for a delayed schedule? Will she opt out entirely?

Navigating vaccine hesitancy: What can the physician do?

A recent paper analyzing the American Academy of Pediatrics (AAP) Surveys highlighted that the number of pediatricians who report parental vaccine refusal rose from 74.5 percent in 2006 to 87 percent in 2013.

The perception that parents thought the vaccinations were unnecessary increased from 63.4 percent to 73.1 percent.

The study also noted that although pediatricians educate parents about vaccinations, they are also dismissing patients more often.

When faced with this situation, what can and should primary care physicians do to support the individual patient, their patient population, and the wider community?

What are parents’ concerns about vaccinations?

“Parents have three major reasons, one is that they think that vaccines are no longer needed and the diseases are gone, the second is that they fear that the vaccines are associated with adverse reactions, and third [is that] they think that they should be able to decide what their children should receive and not have to be mandated to receive vaccines for school or other requirements,” Dr. Kathryn M. Edwards, the Sarah H. Sell and Cornelius Vanderbilt Chair in Pediatrics at the Department of Pediatrics and Infectious Diseases at Vanderbilt University School of Medicine in Nashville, TN, told medical News Today.

In an attempt to depolarize the “anti-vaxxers” versus “pro-vaxxers” movements, the acceptable term to use is now “vaccine hesitancy.” Within the spectrum of opinion, parental attitudes toward childhood vaccinations can be divided into five categories. These are:

  • Unquestioning acceptors (30 to 40 percent): These are advocates for immunizations who feel that vaccines are safe and necessary.
  • Cautious acceptors (25 to 35 percent): These are parents who do not necessarily question vaccination but who may not have a full understanding. The cautious acceptors continue to vaccinate their children despite some minor concerns.
  • The hesitant (20 to 30 percent): These parents vaccinate their children but have significant concerns, mainly about vaccination risk.
  • Late or selective vaccinators (2 to 27 percent): These parents have knowledge about vaccination but still have concerns, sometimes leading to delay or refusal of some vaccines.
  • Refusers (less than 2 percent): These parents may have concerns about safety, religious beliefs, or mistrust of the medical system and may ultimately refuse all vaccinations for their children.

This sophisticated stratification of parents into categories improves our understanding of the motivations and reasons that underlie vaccine hesitancy.

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