Vaccine hesitancy

Recent headlines from across North America make it clear that some vaccine-preventable illnesses are making a comeback. First there was an outbreak of mumps in professional hockey teams,¹ then over 100 cases of measles in 14 US states linked to the California Disneyland theme park,² and now unrelated cases in Toronto, southern Ontario and Quebec.³ The majority of those infected had not been vaccinated against the disease.^2,3 There was also a report of a vaccine-free day care⁴ as well as an Ottawa family of 7 (unvaccinated) children, all of whom contracted whooping cough!⁵

Parents make many decisions aimed at protecting and promoting their children’s health, including the decision to have them vaccinated. Vaccination is effective at preventing life-threatening communicable diseases,⁶ and most Canadian parents choose to have their children vaccinated, yet some refuse or delay vaccinations.^7,8

Why, despite the evidence, are parents hesitant to vaccinate their kids? Perhaps it’s that today’s parents have not seen the effects of many childhood diseases and question the necessity of vaccines to prevent illness.⁹ Or, they may be concerned about the safety of vaccines and their possible side effects.^8,9 Even parents who have had their children vaccinated may be vaccine-hesitant. Almost one quarter of Canadian parents report that their children have not received at least one of the recommended vaccinations.⁷ Reasons given for their decision include past experience with vaccination, the influence of family, beliefs about disease, or vaccine scares perpetuated in the media.⁹

It is worth noting that despite the influence of the Internet and media, Canadian parents still turn to health care providers for information and advice about vaccination.⁸ Physicians and nurses are seen as the most-trusted sources of information by parents, and play a significant role in influencing confidence in vaccines.^8,9 Parents, however, report that childhood vaccinations are not often discussed when they visit their health care provider.⁷ Vaccination status may be checked during well-child visits but it is not often checked during sick-care visits.⁹ This may be a missed opportunity to provide parents with credible information on vaccination.

An interesting dichotomy exists with regard to adolescents: while their parents may be most concerned about the long-term effects of vaccination, they themselves are often concerned about the needle and the pain resulting from the injection. The adolescents’ fears can end up swaying their parents away from vaccination.¹⁰ In addition, adolescents have little knowledge about vaccine-preventable diseases and their associated risks.^9,10 Further confounding the situation, adolescents are more often seen by their health care providers to treat injuries or illness, not for preventive care.^11,12 Health care providers should take advantage of every opportunity to discuss vaccination with their adolescent patients together with the parents. This includes when adolescents are seeking care for injury and illness, as this may be the only opportunity to discuss vaccination with them.¹²

Reaching out to adolescents about vaccines and providing clear information about the diseases they control is important. When coupled with a recommendation from a health care provider, these actions may be the deciding factor for parents and adolescents to accept vaccination.¹²