Julie Bettinger is an associate professor of Pediatrics, at the Vaccine Evaluation Center, University of British Columbia. Devon Greyson is an assistant professor of Health Communication, the University of Massachusetts, Amherst
Ridiculing and ostracizing non-vaccinating parents is tempting to do: It’s easy to roll our eyes at those who opt their children out of life-saving vaccination, and those who believe in erroneous theories about vaccine harms. But this is counterproductive. Instead, Canadian vaccine advocates should swallow their righteous pride and do the work it takes to build confidence.
With the Vancouver area experiencing a measles outbreak this year, vaccinations – and those who don’t vaccinate – have been receiving much more attention. While dismissing non-vaccinating parents as anti-science, uneducated, conspiracy theorists might be tempting, we find these stereotypes represent only a small minority of this population.
As vaccine confidence researchers, we have surveyed, interviewed, and observed more than 2,000 parents to understand what causes vaccine hesitancy and how to address it. The answer defies quick fixes, but will benefit community health including, but not limited to, vaccines.
Parents who vaccinate without hesitation and parents who are afraid to vaccinate both have their children’s best interests at heart. However, hesitant parents have some reason to doubt or fear the safety of vaccines. Sometimes this reason is misinformation from a source they trust, or a lack of knowledge about the extensive testing and safety monitoring that ensures the safety of Canada’s vaccine supply. Sometimes they’ve felt betrayed by the medical system and aren’t likely to trust health-care providers and medical researchers about anything. And sometimes, it’s a misinterpretation or misapplication of actual scientific principles.
But whatever the reasons, one thing is certain: name-calling and ostracizing backfire and cause people to dig further into anti-vaccine stands rather than be persuaded to reconsider.
Contrary to stereotypes, vaccine-hesitant parents come from diverse ethnic, educational, and socioeconomic backgrounds. These hesitant parents often support vaccination in general, but aren’t sure for their children. There is a lot of pressure on parents, particularly mothers, to make educated decisions about everything from medical care to child care to extracurricular activities.
Additionally, we must acknowledge that some people have real reasons to mistrust the medical system: reasons that range from negative personal health experiences to systemic issues such the legacies of Canadian colonization. So how do we reassure these concerned parents that vaccines are safe and effective for their children? Research points to a few solutions.
Parents often trust their health-care providers, particularly those they have continuing relationships with such as their family doctor, nurse practitioner, obstetrician or midwife. These health-care providers can be a consistent source of quality information on vaccine safety and effectiveness, sharing the reasons they recommend vaccination and establishing vaccination as the default while allowing for questions as normal expressions of parental due diligence. Other trusted individuals, such as community elders, religious leaders and community group leaders, while not scientific experts, can also promote vaccination and assure parents that their concerns are understandable, and reinforce that vaccines are very safe and effective ways to prevent disease, death and disability for their child and the community.
As Canadians, we have a very pro-social society: We shovel each other’s sidewalks and bring food to new parents – vaccination is another element of our commitment to our communities. Some parents we’ve spoken with only began vaccinating their own children after learning how their actions could affect others who are more vulnerable. A parent who is willing to take the risk of their own child contracting influenza or varicella may decide to vaccinate nonetheless, if he or she knows that such diseases can easily be deadly to others such as the elderly, infants, the immuno-compromised and people in parts of the globe with poorer health and health systems.
We should note that not all non-vaccination is due to hesitancy. Although Canada has removed many barriers to vaccination, people in rural areas, those who must move home frequently, families who don’t qualify for parental leave or who have inflexible employment and members of populations historically marginalized may experience undervaccination because of circumstance, not choice. Stigma and punishment is particularly unhelpful in these situations. Improving access to immunization clinics in convenient locations with extended hours and keeping vaccine records in a centralized, national registry rather than relying on parental record-keeping, would go much further in terms of providing access and increasing vaccination coverage.
As vaccine researchers, we will never forget the agonized voice of the mother of a 14-year-old Canadian girl who died from a vaccine preventable disease, or the difficult decision by a mother with cancer to risk her own life by keeping non-vaccinating friends and family close in order to provide community for her child.
But we’ve also been deeply moved by talking with parents who felt immobilized by the anxiety that vaccination could injure their children, and those too terrified of being labelled “one of those parents” to speak to their health-care providers about their concerns.
Based on the science of vaccine decision-making, we know that ridicule and name-calling are ineffective ways to build faith in vaccines. To encourage vaccination among the hesitant, we should instead develop trusting and trustworthy relationships, provide more verifiable information on the value of vaccination, and reassure all parents we understand they, and we, want the best for their children as well as our communities. It’s not a quick fix, but it works.