Vaccines: Too many, too soon, too risky. What do we know about parental hesitancy?

Vaccines: Too many, too soon, too risky. What do we know about parental hesitancy?

Recently, the debate about vaccines has been reverberating in the media due to the ongoing measles outbreak, which began in California last December and has now spread to 14 states. Failure to vaccinate a child against measles and other highly contagious diseases puts the child at an increased risk for contracting serious and vaccine-preventable illnesses; and puts communities at an increased risk for an infectious disease outbreak.

Given the clear public health benefits of routine child vaccination, it is increasingly important that we understand the factors that contribute to parental hesitancy about vaccines in the United States.

Vaccine-hesitant parents’ concerns

In her review article “What are factors that contribute to parental vaccine-hesitancy and what can we do about it?,” published in the journal Human Vaccines & Immunotherapeutics, Sarah E. Williams examined communication barriers to vaccination as reported by vaccine-hesitant parents. Williams argued that most barriers to vaccine-use stem from concerns about vaccine safety. Vaccine-hesitant parents are more likely to believe that contemporary children receive too many vaccines, that a child could have a serious side effect from a vaccine, and that a child’s immune system is negatively impacted by vaccines. In addition, some parents prefer their children develop immunity to childhood diseases through acquiring the disease. They also believe that some vaccine-preventable diseases are rare in the United States and easily treatable.

An educational intervention for vaccine-hesitant parents

Williams reviewed articles with quantifiable results describing interventions for either parents or providers who give care to vaccine-hesitant parents. She found that very few studies have actually targeted and enrolled parents who self-identified as vaccine-hesitant prior to the intervention.

To address this lack, Williams and colleagues designed a pilot study to increase acceptance of childhood vaccines among vaccine-hesitant parents. The study examined the change in attitudes towards childhood vaccines among vaccine-hesitant parents of two-week old infants after participating in an educational intervention. The intervention, which included a short video, a handout on common myths regarding vaccines, and a handout detailing places to find accurate vaccine information, resulted in significant improvement in parental attitudes in the intervention group compared to the control group at the two month well visit. While there was no difference in the on-time receipt of vaccines between the two groups measured at 12 weeks of age, the authors cite the small study size as a major limitation at being able to detect these differences at this early age.

Tailoring interventions to increase vaccination rates

Although the educational intervention in the pilot study did not yield increased vaccination rates among infants, Williams noted that the intervention significantly improved parental attitudes about childhood vaccines. She stated that ultimately, a multifaceted approach to provide accurate information to parents is needed, and that the intervention tested in the pilot study can constitute one part of such an approach.

Williams also concluded that, although there is evidence that interventions can be productive in increasing rates of childhood vaccination, current data demonstrates that interventions need to be tailored to a particular community. For example, some research has suggested that in providing parents with accurate information to counter the myths of vaccine safety, first-person parental accounts of vaccine experiences can be valuable educational tools. These messages, as recounted by parents instead of experts, can counter some of the emotionally charged narratives that are so powerfully utilized in “anti-vaccine” messaging.

While research has examined the barriers that prevent vaccine-hesitant parents from immunizing their children, there is very little evidence for effective strategies and successful interventions to increase childhood immunizations. Developing and testing health communication messages and community public health interventions that can address the hesitancies of parents to vaccinate their children could help reverse the decrease in vaccination rates for measles and other highly contagious and serious diseases observed over the past decade.

Read the articles

What are factors that contribute to parental vaccine-hesitancy and what can we do about it?

A Randomized Trial to Increase Acceptance of Childhood Vaccines by Vaccine-Hesitant Parents: A Pilot Study

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U.S. Multi-state Measles Outbreak, December 2014-January 2015

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Photo credit: Oksana Kuzmina via

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