The Impact of a Vaccine Scare on Parental Views, Trust and Information Needs: A Qualitative Study in Sydney, Australia

"There is a need for public health authorities to be proactive during an adverse events incident and engage with both parents and providers....[A]gencies cannot rely on the message getting through via other sources or parents actively seeking out information."

This qualitative study provides detailed, contextualised information about how parents of young children responded to a particular vaccine scare in their own words at key time points as it evolved. In Australia in April 2010, there was a temporary suspension of influenza vaccine for children under 5 years of age after reports of an increase in the rate of adverse events (febrile reactions, including convulsions) following vaccination. The study aimed to explore the impact of the vaccine suspension on parental knowledge, attitudes, trust, information needs, and intent related to influenza vaccination and broader immunisation programmes.

Details about this and other vaccination safety scares, such as those related to the measles-mumps-rubella vaccine (MMR) and diphtheria-tetanus-pertussis (DTP) vaccines, are offered. The problem in the case of the influenza vaccine in Australia was real (vs. in the case of MMR, when associations with autism were debunked). However, regardless of the causal relationships involved, such scares, which may be amplified by mass media, have the potential to undermine public confidence in vaccines and lower immunisation rates, resulting in disease outbreaks and deaths.

As part of the study, semi-structured telephone interviews were conducted with 25 parents of children attending childcare centres in Sydney, Australia, between June 2010 and May 2011. Most of the parents interviewed had heard directly about the vaccine suspension from the media, including via television reports, radio, online sources, and newspapers. In short, findings indicated that, for those who recalled the vaccine suspension, there was a lasting sense of uncertainty and confusion and a perceived lack of information.

The researchers note that the scare "did not arrive in a vacuum of perceptions and beliefs about the influenza vaccine. Rather, it interacted with existing views whereby parents used the narrative in diverse ways to make meaning about child health, risk, influenza and its vaccine." Parents’ pre-existing beliefs about influenza disease and the influenza vaccine were an important context in which they interpreted the vaccine suspension. One parent said, "If a child gets polio or rubella, I think the consequences can be life threatening...but my understanding is generally if you treat flu well, and your children don't have any underlying health problems, it's not usually a fatal illness..." Importantly, the impact of the scare was contained to influenza vaccines only, and not other vaccine programmes.

Parents had distinct information needs following the vaccine suspension, especially with regard to vaccine safety, testing, and recommendations. Initial reporting about the suspension but then no further updates left parents unsure what to do, and allowed for the persistence of a negative impression about influenza vaccination of children. Parents did not understand the nuance around one vaccine remaining suspended while the other vaccines were deemed safe, and vaccination intent was affected. For many, influenza vaccination intent was conditional on receipt of information from a trusted, authoritative source allaying safety concerns. (The absence of clear messages from trusted heath authorities via the media at this time created an information void for parents.) Obtaining information from general practitioners (GPs) was not always seen as a practical solution, as GPs were not immediately accessible. Parents mentioned a range of formats and distribution mechanisms useful for suspension-related information. This included broadcasts via traditional media sources such as radio and television, as well as hard copies of information in brochure or poster form at locations including childcare centres, healthcare centres, and libraries. Only a few expressed an intention to actively seek out information.

The researchers offer policy and practice suggestions for proactively managing such incidents. Well-established crisis communication principles should be used, they say. These include keeping the many publics (and professionals) informed, acknowledging uncertainty, and showing respect for concerns expressed. Information should be tailored to different audiences, with a balance of straightforward messages backed by further details for those who require this. Traditional media sources should be used, but given the likelihood that media interest may quickly wane, other trusted sources should also be used, such as distributing information resources via childcare centres and providing authoritative information on government health websites. Trust needs to be rebuilt, including via two-way dialogue with parents. Immunisation providers, such as GPs and nurses, should be specifically reached with up-to-date information, including ready-made resources to discuss with or give to parents. Finally, capacity in health systems should be built to ensure the ability to cope with increased information needs during and after health scares.

"The negative impact of future vaccine scares could potentially be mitigated by the provision of clear, concise information about the progress of investigations, the research and testing undertaken, and by giving clear direction about when vaccination can be resumed."