Vaccine hesitancy is now an issue of global concern. Parental concerns about the safety, efficacy and necessity of vaccines are increasing as exposure to vaccine preventable diseases decreases in Australia and other developed countries. These concerns are also driven by the increasing complexity of the vaccine schedule and increased access to information through the Internet and social media. Many parents who refuse vaccination rely on herd immunity to protect their child and whilst the proportion of unvaccinated children remains less than 95%, this circle of protection is threatened. Maintaining high vaccine coverage in Australia and confidence in vaccines is imperative to ensure that epidemics of vaccine-preventable diseases do not occur.
Recent research from general paediatric outpatients at the Royal Children's Hospital and from maternal and child health centres in the Bayside region of Victoria, confirm that the most common vaccine concerns that parents have include:
- the number of vaccines in the first two years of life and overwhelming the immune system
- the child’s immune system being more sensitive than most or weakened by vaccines.
- vaccine ingredients
- vaccines causing allergies such as asthma or eczema
- the potential link between MMR and autism.
There are also rising requests for selective or tailored schedules by parents where they only want one or some of the recommended vaccines. This seems to come from a desire for more control of exposure to vaccine ingredients, concerns about vaccine safety, the impact on the immune system and perceived disease risk. Whilst many healthcare providers do not believe that a selective schedule may be in the best interests of the child, they often relent because they believe that it will get the parent started or it may be necessary for maintaining the therapeutic relationship.
So how can we communicate with parents who have vaccine concerns?
Previous recommendations for healthcare providers have focused on the “What” is said not the “How”. However, we now know that knowledge alone is not enough to change behavior and that attempts to persuade or simply provide more information on the risks of the diseases or vaccines often fail or backfire. It is becoming clear that it is essential to introduce communication processes into the vaccine encounter that build rapport and trust and foster open discussion.
Research tells us that parents’ interactions with health care providers are critical to shaping their attitudes, beliefs and behaviours towards vaccination and are the most powerful influence on vaccination acceptance. We know that an effective interaction with a health care provider can motivate a hesitant or refusing parent towards vaccine acceptance. Ineffective communication can contribute to rejection of some or all vaccines and loss of trust and satisfaction with the health care provider.
Some suggestions on how to speak with vaccine hesitant parents:
- Spend adequate time with the parent, asking permission to discuss their concerns
- Without judgement, try to carefully elicit the vaccine concerns using a shared-decision making approach or guiding style where there is an open discussion of the parents’ questions and concerns
- Parents are more often focused on vaccine risk, but try to discuss vaccine benefit and disease risks as well
- Using clear resources to support the discussion can be very helpful (see below)
- Delayed or selective schedules are not recommended as they have not been tested for safety and often lead to delays in the getting the child up to date with their vaccines for their age. Sometimes it may be necessary to start a selective schedule to get the parent started and to gain their confidence in vaccination but a positive recommendation to vaccinate and to follow the NIP should always be made first.
With refusing parents, the aim is generally to keep the discussion brief but to leave the door open. Try not to dismiss their concerns, rather acknowledge them and don’t overstate vaccine safety- be honest: no vaccine is 100% safe or effective. It is usually not helpful to challenge firmly held philosophical, religious or scientific beliefs and try to avoid overt confrontation and “scientific ping pong”. Direct parents to resources that will help to address their concerns and invite more discussion later. These parents may be more able to consider accepting vaccination for their child down the track or may never accept vaccines.
What resources are available for parents?
There are many sources of information that parents can access to seek answers to their questions including their health care provider, which includes their GP, immunisation or maternal and child health nurse or paediatrician. The Immunise Australia website or the Department of Health and Better Health Channel in Victoria are very useful.
Other websites such as the National Centre for Immunisation Research and Surveillance (NCIRS) or specific vaccine education websites such as the Melbourne Vaccine Education Centre (MVEC) and the VEC at the Children’s Hospital of Philadelphia (CHOP) contain fact sheets and other resources such as short videos.
There are a suite of fact sheets called SKAI or Sharing Knowlede about Immunisation that have been developed to answer many of the common concerns above and are on the Immunise Australia website (see link below). TV documentaries such as the SBS Jabbed documentary or family, friends and other parents are also good resources for some parents.
The first step for parents is to try and work out their concerns about immunising their child, access resources that try to address these concerns and then discuss them with their Health Care Provider to make an informed decision about proceeding with immunisation.
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