Immunology Beliefs as a Factor in Vaccine Opposition among Complementary and Alternative Medical Providers

"If CAM providers influence parental beliefs,...it is conceivable that modifying CAM providers' immune beliefs would be an essential step in changing the views of parents who seek their advice, and, ultimately, will improve vaccine uptake..."

Research has shown that parental beliefs concerning the human immune system are robust correlates of modifying vaccine schedules or refusing paediatric vaccinations, including that too many vaccinations, or vaccinations in close temporal proximity, will "overwhelm" the child's immune system. These immune beliefs are not supported by current scientific evidence, but they provide parents with a science-like rationale with which to explain why vaccines pose health risks to young children. Complementary and alternative medical (CAM) providers may be key influences in the networks of those parents who do not vaccinate their children. Observing that little is known about CAM providers' own immunological beliefs, this study provides formative data on the nature of CAM belief systems and how they may affect CAM providers' self-reported recommendations to parents regarding paediatric vaccines.

From March to July 2013, the researchers conducted semi-structured interviews of CAM providers (n=36) in Oregon, United States (US) whose practitioners are known to express opinions about vaccines and vaccination. Interviewees included acupuncturists, acupuncturist-naturopaths, chiropractors, homeopaths, homeopath-naturopaths, midwives (2 of whom were nurse-midwives and 1 a midwife-naturopath), and naturopaths.

Three vaccine positional groups emerged: full acceptance (n=7), full opposition (n=10), and conditional acceptance of vaccines (n=19). The latter reflects acceptance of some, but not all, vaccines or vaccine protocols (e.g., scheduling and dosage). All participants admitted giving advice to parents, often in terms of "what I do for my children" rather than "what you should do", as none was qualified to provide medical advice.

Variations in immunological beliefs, categorised as science-based and alternative beliefs, were coded and examined across all 3 reported conditions. Science-based beliefs were defined as views consistent with Western biomedical concepts and research. For instance, research has determined that the immune system is (a) fully developed at birth, (b) constantly replenishing itself, and (c) robust. Thematic analysis identified 3 overlapping categories of immunological beliefs that were defined as alternative: (a) "natural is best", (b) "innate intelligence" (the body has an innate ability to heal), and (c) the "fragile infantile immune system". In terms of vaccine acceptance, the themes that emerged were (a) "vaccines prevent illness" and (b) "herd immunity".

All 10 of the opposers reported strong, alternative (unscientific) beliefs about the immune system. (As the researchers explain: "Although the internal logic of providers holding alternative immunological beliefs appears to be consistent, components of this belief system are based on misunderstandings and inaccuracies.") CAMs' sole focus was on health for the person, not the population. By contrast, CAM providers who accepted immunisation were more likely to have science-based beliefs as well as to understand and appreciate how vaccines protect at the individual and the population level (i.e., herd immunity).

Some implications and recommendations that emerge from the findings include:

• Perhaps vaccine-accepting CAM providers can be enlisted to play an instructional role with their science-averse peers in providing sound reasoning and support for science-based views of vaccines, vaccine-preventable diseases (VPDs), and the immune system.
• Immune belief systems among the general public may be modifiable through school-based educational efforts that reach young people long before they become parents and begin to form strong belief structures concerning immunity and vaccines. Such efforts should especially include an explanation of herd immunity, say the researchers.
• The study found that CAM providers come to their anti-vaccine positions largely through post-graduation continuing education (CE) courses and seminars. Thus, the researchers recommend that the state professional licensing agencies require incorporating the concept of herd immunity into all CAM CE courses. Because most CAM providers focus solely on personal health, introducing the idea of community protection in their formal and post-graduate training may help increase vaccine acceptance.

Conditional providers are, in the researchers' estimation, more likely than opposers to be amenable to training and continuing educational influences aimed at altering their advice to parents and, thus, improving vaccine uptake.