When Evidence is Not Enough: Pro-Vaccination Strategies

By Katharine Sedivy-Haley, PhD Candidate, Hancock Lab, CBR

Along with antibiotics and sanitation, vaccines are among the cornerstones of modern medicine, preventing or even eradicating diseases and saving countless lives.1 Despite overwhelming evidence in favour of vaccination, immunization rates have fallen, in some areas below the thresholds necessary to protect against outbreaks of diseases, such as measles.2 Why do people reject vaccination, and what can be done?

Concerns about vaccine safety are commonly cited in the media. While these concerns can be based on misunderstanding or lack of education,3 parents with strong anti-vaccination convictions are often well educated,4 but may mistrust the government or the medical industry and want to make their own decisions about healthcare.5 Practical concerns and socioeconomic barriers, such as lack of access to clinics, have also been implicated in non-vaccination within Canada2,3 and lower-income and rural groups in the United States.4

The first step in improving vaccination rates is to adjust practical factors so that it is easier to vaccinate than it is to not vaccinate. Barriers should be removed – for example, extending clinic hours or offering home visits – and opting out of vaccination should be made more difficult. Mandating vaccination is an imperfect solution, as it is difficult to find incentives that will sway parents concerned for their children’s safety but that will not unduly burden those parents already struggling to get their children vaccinated. Strong legal pressure also risks backlash among anti-vaccination movements. Some experts argue for “compulsory informed choice,”2  rather than compulsory vaccination, requiring parents to actively decide against vaccinating their children.

Requiring individual counseling prior to refusal would offer an opportunity to communicate the benefits of vaccination and address concerns about safety. Advice of health care providers – doctors, nurses, and midwives – can have a great deal of influence over parents, and specific strategies can increase vaccination acceptance.6 Healthcare workers should elicit individual concerns about vaccination and specifically address those concerns, debunking myths and providing a balanced assessment of the risks and benefits in terms that parents can understand. Anecdotes illustrating the consequences of diseases may be useful if they can be framed positively in terms of protection; inducing fear in vaccine-skeptical parents can backfire.7

Parents who are strongly against vaccination are likely to dismiss evidence contradicting their views.7 To break through their opposition, it is necessary to target these parents’ world views, for example, by emphasizing how vaccines stimulate the body’s natural defenses, or using the term “community immunity” instead of “herd immunity.” Staunch anti-vaxxers comprise a small proportion of the population,2 and yet their tendency to cluster can create risks of local outbreaks. Still, even communities with a vocal anti-vaccination faction likely include many quietly pro-vaccination parents; pointing out the number of dissenters may dilute anti-vaccination social pressure.5

Finally, creating a national registry of vaccination status would make it easier to identify areas at risk for disease outbreak, target interventions, and communicate with parents early and often about gaps in their child’s vaccination status.2  In combination, these strategies would promote vaccination and keep our communities safe from preventable diseases.

  1. Orenstein, W. A. & Ahmed, R. Simply put: Vaccination saves lives. Proc. Natl. Acad. Sci. U. S. A. 114, 4031–4033 (2017).
  2. Busby, C. & Chesterley, N. A Shot in the Arm: How to Improve Vaccination Policy in Canada. (2015).
  3. Gilbert, N. L., Gilmour, H., Wilson, S. E. & Cantin, L. Determinants of non-vaccination and incomplete vaccination in Canadian toddlers. Hum. Vaccin. Immunother. 13, 1447–1453 (2017).
  4. Smith, P. J., Chu, S. Y. & Barker, L. E. Children Who Have Received No Vaccines: Who Are They and Where Do They Live? Pediatrics 114, 187–195 (2004).
  5. Sobo, E. J. Social Cultivation of Vaccine Refusal and Delay among Waldorf (Steiner) School Parents. Med. Anthropol. Q. 29, 381–399 (2015).
  6. MacDonald, N. E. & Finlay, J. C. Working with vaccine-hesitant parents. Paediatr Child Heal. 18, (2013).
  7. Nyhan, B., Reifler, J., Richey, S. & Freed, G. L. Effective Messages in Vaccine Promotion: A Randomized Trial. Pediatrics 133, 1–8 (2014).

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