Pediatricians are well aware that vaccine hesitancy is a major clinical challenge,
not just in our offices and clinics, but worldwide. In order to assess and monitor
vaccine hesitancy worldwide, the World Health Organization Strategic Advisory Group
of Experts (WHO SAGE) published a Vaccine Hesitancy Joint Report Form (JRF) in 2014.
With a good global response rate which ranges from 77-98% for the indicator questions,
only 10% of countries report no hesitancy.1 In other words, pediatricians in the United States are not alone. The top reason
for hesitancy globally, “risk/benefit (scientific evidence),” remained the same over
the 3 years of reporting data available thus far, yet this reason accounted for <25%
of all categories. So, “it’s complicated,” and no one strategy to counter vaccine
hesitancy will be optimal for all families.
The AAP has two relevant vaccine hesitancy and refusal policies. 2,3 “Countering Vaccine Hesitancy” emphasizes the safety and science of vaccines, as
well as the obligation to listen thoughtfully and empathically to parent concerns,
and has a treasure trove of resources for pediatricians to share with parents.2 “Responding
to Parental Refusals of Vaccination of Children” focuses on the reasons parents are
hesitant or may refuse, and on actions pediatricians may take, including guidance
to avoid either notifying Children’s Services or discharging the family from one’s
practice, when possible.3 Both documents are well written and contain practical guidance. However, there are
few evidence-based strategies to counter vaccine hesitancy and refusal, and the widely
used “Information Deficit Model” (which assumes that the only reason for hesitancy
and refusal is lack of knowledge) has very limited demonstrated effectiveness. 4,5
What about partnering with young adults and parents? Some recent media reports have
led me to wonder if this avenue is underutilized. Recently, an Ohio teen “defied his
mother’s anti-vaccine beliefs and started getting his shots when he turned 18, telling
Congress [on Tuesday] that it’s crucial to counter fraudulent claims on social media
that scare parents.”6 He explained that his mother, whom he knows loves him deeply, had come to believe
online conspiracy theories about vaccines. Ethan came to attention when he posted
on Reddit, “god knows how I’m still alive” and asked how to go about getting vaccinated
on his own at age 18. On the other side of the continent, a Portland Oregon mother
and lawyer, Nadine Gartner, started an independent nonprofit, “Boost Oregon”, that
sets up 2 hour workshops for parents to learn from medical professionals about vaccines,
and trains pediatricians to give these workshops. Before any discussion about vaccines
begins, the presenters share information about themselves and their own lives in order
to personalize the discussion and avoid any misperception of paternalistic lecturing.
The Boost Oregon website is subtitled “Informed Parents for Healthy Kids” and has a user-friendly format with
an FAQs button.
This is all not to say that parents and young adults can or should substitute for
pediatricians as vaccine advocates. Rather, in our sense of responsibility and ownership
of the problem, we may be overlooking our best potential partners: parents and recent
graduates of our practices who truly “get it,” and are willing to take the time to
talk with others.
Lane S, MacDonald NE, Marti M, Dumolard L. Vaccine hesitancy around the globe: Analysis
of three years of WHO/UNICEF Joint Reporting Form data-2015-2017. Vaccine. 2018;36(26):3861–3867. doi:10.1016/j.vaccine.2018.03.063
Edwards KM, Hackell JM. The Committee on Infectious Diseases, the Committee on Practice
and Ambulatory Medicine. Countering Vaccine Hesitancy. Pediatr 2016;138; DOI: 10.1542/peds.2016-2146
Diekema D and the Committee on Bioethics Responding to parental refusals of vaccination
of Children. Pediatr 2005;115:1428–1431 DOI: 10.1542/peds.2005-0316
McClure CC, Cataldi JR, O’Leary ST. Vaccine Hesitancy: Where We Are and Where We Are
Going. Clin Ther. 2017;39:1550–1562.
Nyhan B, Reifler J. Does correcting myths about the flu vaccine work? An experimental
evaluation of the effects of corrective information. Vaccine. 2015;33:459–464.
Neergaard L Teen warns about anti-vaccine beliefs. The Plain Dealer 6 March 2019: A1,9. Print.