Countering Vaccine Hesitancy

"With all the challenges acknowledged, the single most important factor in getting parents to accept vaccines remains the one-on-one contact with an informed, caring, and concerned pediatrician."

Vaccine-hesitant individuals are a heterogeneous group who hold varying degrees of indecision about specific vaccines or about vaccinations in general. The American Academy of Pediatrics (AAP) recommends that paediatricians continue to engage with vaccine-hesitant parents, provide other health care services to their children, and attempt to modify their opposition to vaccines. This report provides information about addressing parental concerns about vaccination.

A number of studies have attempted to define the reasons why parents are vaccine hesitant, and these factors are summarised in Table 2. "Pediatricians should keep in mind that many, if not most, vaccine-hesitant parents are not opposed to vaccinating their children; rather, they are seeking guidance about the issues involved, beginning with the complexity of the schedule and the number of vaccines proposed. Parents may be unsure of the need for vaccines, because most have never experienced the diseases vaccines are designed to prevent, and they have concerns about possible adverse effects of these vaccines."

Vaccine discussions continue to occupy the media and internet; data have shown that participation in social media reinforces one's beliefs about vaccination, no matter what those beliefs are. As suggested here, it is incumbent on the paediatrician to provide scientifically based and balanced information when these questions are asked. Table 5 provides a summary of some of the available resources to aid the paediatrician.

The report makes these key points:

• The current system for developing, testing, and regulating vaccines requires that the vaccines demonstrate both safety and efficacy before licensure and that long-term safety is monitored. Once vaccines are licensed, a number of processes are in place to ensure that the safety of vaccines is monitored.
• Children who are philosophically exempted from vaccination not only are at greater risk of developing vaccine-preventable disease (VPD) but also put vaccinated children and medically exempt children who live in the same area at risk.
• There is a delicate balance between perceived risk and benefit for each vaccine; this balance is linked integrally to vaccine acceptance.
• Parental concerns must be addressed, and concerns will vary among parents. Providers should address specific parental questions about the production and composition of the vaccines by directly providing the information requested.
• Providing vaccine information is time consuming. Physicians have several options to deal with this problem, ranging from scheduling longer well-care visits, with some loss of overall efficiency; to simply not having the discussion and acceding to a parent’s request to defer, delay, or skip a vaccination; or to dismissing such families from their practice. However, the time spent may well be worthwhile: "A well-informed pediatrician who effectively addresses parental concerns and strongly supports the benefits of vaccination has enormous influence on parental vaccine acceptance."
• "After acknowledging the varied concerns of vaccine-hesitant parents, the pediatrician needs to communicate with the parents about the development and safety testing of vaccines, the reasons for immunizing, and the risks of not doing so....It is important to present this safety information in a nonconfrontational dialogue with the parents while listening to and acknowledging their concerns."
• Parental education can be provided through Vaccine Information Statements (VISs) given to parents before vaccine administration, through an online review of the VIS before the routine immunisation visit, or through referral to authoritative websites, such as that of the Centers for Disease Control and Prevention (CDC).
• Educational efforts during residency training programmes should provide trainees with a comprehensive understanding of the effect of vaccines on disease burden and the knowledge to evaluate the safety of vaccines, as well as effective communication strategies (a brief single educational intervention may not be sufficient to provide physicians with the skills to counteract vaccine hesitancy).
• The paediatrician should remain up to date on the current recommended vaccine schedule and support it as the only evidence-based schedule that has been tested and approved by multiple authoritative experts for safety and efficacy.
• The presentation of basic medical information may not be sufficient to reassure parents about the safety and necessity of vaccines. Parents often are more likely to be persuaded by stories and anecdotes about the successes of vaccines, especially when offered in the context of a trusted relationship with a provider. Personal examples of children who were sick with VPDs can be much more effective than simply reading the numbers of children infected with a disease each year in the VIS.
• The decision to dismiss a family who continues to refuse immunisation is not one that should be made lightly, nor should it be made without considering and respecting the reasons for the parents' point of view. Nevertheless, the individual peadiatrician may consider dismissal of families who refuse vaccination as an acceptable option. In all practice settings, consistency, transparency, and openness regarding the practice's policy on vaccines is important.

In conclusion: "Countering vaccine hesitancy can best be accomplished in the course of clinical practice through open communication and discussion between the pediatrician and the parents. Because most parents agree to vaccinate their children, this dialogue, which can be started as early as the prenatal interview visit..., should be an ongoing process. Continued research is needed on the best methods to communicate the safety and effectiveness of vaccines....Most parents need and want education about the best way to provide care for their children, including vaccinations. Dealing with vaccine hesitancy is a wonderful opportunity to continue to provide this information and education to families."