Vaccine Hesitancy - Partnering to Change Mindsby Lydia Furman MD, Associate Editor, Pediatrics

Pediatricians are well aware that vaccine hesitancy is a major clinical challenge, not just in our offices andclinics, but worldwide. In order to assess and monitor vaccine hesitancy worldwide, the World HealthOrganization Strategic Advisory Group of Experts (WHO SAGE) published a Vaccine Hesitancy Joint ReportForm (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. Thetop reason for hesitancy globally, "risk/benefit (scientific evidence)," remained the same over the 3 years ofreporting data available thus far, yet this reason accounted for <25% of all categories. So, "it's complicated," andno 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 empathicallyto parent concerns, and has a treasure trove of resources for pediatricians to share with parents.2 "Respondingto Parental Refusals of Vaccination of Children" focuses on the reasons parents are hesitant or may refuse, andon actions pediatricians may take, including guidance to avoid either notifying Children's Services or dischargingthe 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 widelyused "Information Deficit Model" (which assumes that the only reason for hesitancy and refusal is lack ofknowledge) 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 thisavenue is underutilized. Recently, an Ohio teen "defied his mother's anti-vaccine beliefs and started getting hisshots when he turned 18, telling Congress [on Tuesday] that it's crucial to counter fraudulent claims on socialmedia that scare parents."6 He explained that his mother, whom he knows loves him deeply, had come tobelieve online conspiracy theories about vaccines.  Ethan came to attention when he posted on Reddit, "godknows how I'm still alive" and asked how to go about getting vaccinated on his own at age 18. On the other sideof 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 presentersshare information about themselves and their own lives in order to personalize the discussion and avoid anymisperception of paternalistic lecturing. The Boost Oregon website is subtitled "Informed Parents for HealthyKids" 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 vaccineadvocates. Rather, in our sense of responsibility and ownership of the problem, we may be overlooking our bestpotential partners: parents and recent graduates of our practices who truly "get it," and are willing to take the

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time to talk with others.

References

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

1.

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

2.

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

3.

McClure CC, Cataldi JR, O'Leary ST. Vaccine Hesitancy: Where We Are and Where We Are Going. Clin

Ther. 2017;39:1550-1562.

4.

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.

5.

Neergaard L Teen warns about anti-vaccine beliefs. The Plain Dealer 6 March 2019: A1,9. Print.6.

Parent-Provider Communication of HPV Vaccine Hesitancy●

Parental Vaccine Hesitancy and Declination of Influenza Vaccination Among Hospitalized Children●

How to Prepare for Expert Testimony on the Safety of Vaccination●

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