Hesitation blues: Are more parents refusing to vaccinate?

A recent study from the American Academy of Pediatrics (AAP) suggests that more doctors are encountering parents who are refusing vaccines for their children. What did the study show, and why is this trend happening? We sat down with Libby Page, Public Health’s Immunization Assessment and Promotion Program Manager to find out more.

Libby, what does the AAP study tell us about parents’ views about vaccinating their children?

The American Academy of Pediatrics conducted surveys in 2006 and 2013, and asked pediatricians about their experience with parents refusing recommended vaccines. The study did not actually measure the number of parents refusing.  What they found is that the proportion of pediatricians reporting parent vaccine refusals rose significantly, from 74.5% in 2006 to 87.0% in 2013. The perception among these pediatricians was that parents who refuse vaccines increasingly consider immunizations unnecessary. Respondents also reported that providing vaccine education persuaded about a third of vaccine refusers to change their minds. This observation is consistent with another study that found that when physicians continued to engage parents, roughly half went on to accept vaccines for their children.

nurse administering shot to young boy with mom in room.jpgHow does this affect your approach?

There were a couple of findings in the AAP study that stuck out to me. First, the authors observed that in 2013, most parents were hesitant because they believed that vaccination is unnecessary. This suggests to me that some parents may not have enough information about how severe vaccine preventable diseases can be. One reason for this is that we don’t see many of these diseases frequently or at all these days (paradoxically because of the widespread use of vaccines for many years in the US). It also indicates that some parents may need to be reminded that diseases that are largely controlled currently in the US are common in other parts of the world and are only a plane ride away. Even going to an international airport can put us at increased risk for vaccine-preventable diseases.

The researchers also found different motivations among parents who delay vaccines versus those who refuse vaccines altogether. Pediatricians reported that parents chose to delay vaccines for reasons related to worries about pain and discomfort of the shots and concerns about burdening young children’s immune systems. So, this suggests that health care providers will need to take time to listen to parents’ concerns and provide accurate information and education specific to those issues. It’s important for families to continuing to engage, ask questions and discuss their concerns because we know that with good information, most families do make the right decision to vaccinate.

Finally, it’s important to be sure parents understand that delaying or not vaccinating a child not only puts that child at risk, but also increases the risk of spreading vaccine-preventable infections to others in the community, such as children with medical conditions who can’t be vaccinated and people who have weakened immune systems.

Any suggestions for parents?

Find a healthcare provider you can trust and don’t be afraid to ask questions. There’s a lot of misleading information out there, and a trusted expert can help navigate that. For instance, we know that a lot of parents avoided vaccines in 2013 because of a perceived link between vaccines and autism, even though that theory has been thoroughly disproven.

It’s difficult to make big health decisions for your children, but childhood vaccines have undergone extensive testing before they are licensed, continue to be monitored closely for safety after they are licensed, and have been shown to be both safe and effective. Your provider can help explain all of these measures that help ensure your child’s safety.

Can anyone refuse to vaccinate their child?

In Washington State, families can choose to exempt children from one or more vaccines required for child care or school for medical, religious or philosophical reasons. However, if a parent or guardian requests an exemption for philosophical reasons, they must get information about the benefits and risks of vaccination from a licensed healthcare provider. The provider must sign a Certificate of Exemption or write and sign a letter that contains the child’s name and verification that they discussed immunization benefits and risks with the parent.

What do vaccination rates look like in King County? Are we seeing similar trends locally?

Overall, vaccination coverage levels have remained fairly steady in King County, with positive trends in the most recent (2015-16) school year. Among kindergarteners, coverage rates fluctuated between 80.5% complete during the 2014-15 school year to 85.0% complete during the 2015-16 school year, and exemption levels have ranged from 4.1% to 4.6% since 2012. Last school year, 80.4% of 6th graders in King County were complete for vaccines required for school, which is similar to previous school years. Interestingly, exemption levels among 6th graders declined last school year: 4.9% compared to 6.5% during the 2014-15 school year. A full report of annual school immunization assessment levels and interactive maps that show coverage rates reported by each school are available on our website.

Kindergarten immunization rates by school in King County for the 2015-16 school year.