Medscape Vaccine Acceptance Report 2016

Noting that "[t]he personal and public health impact of vaccine hesitancy, if it culminates in refusal, is substantial", the online global destination for physicians and healthcare professionals worldwide, Medscape, surveyed more than 1,500 paediatricians, family medicine physicians, public health physicians, nurse practitioners, and physician assistants in the United States (US) to gain insights into clinician perceptions about the current levels of vaccine acceptance, refusal, and requests to delay the vaccine schedule from parents. In the report, Medscape authors note that the reasons behind vaccine hesitancy or refusal range from religious objections to personal beliefs, safety concerns, a preference for "natural" immunity, and a lack of accurate information about vaccines from a trusted source.

They found that, despite the fact that 1 in 3 clinicians have seen no change in parental acceptance of childhood vaccinations in the past year, there is an increase in parents' agreeing to have their children immunised. In the 2016 survey, 46% of clinicians reported more acceptance of vaccines overall in their practice. Only 12% of clinicians reported less vaccine acceptance than the year before. However, clinicians did report that many parents remain reluctant to vaccinate their children for some diseases like human papillomavirus (HPV), which 61% cited as the most frequently refused or delayed vaccination, followed by influenza (39%) and measles, mumps, and rubella, or MMR (37%). Acceptance for the MMR vaccine did increase by 15 points over 2015.

When asked to identify the reasons for refusing or delaying vaccines, more than half of all clinicians who noted less vaccine acceptance reported parental fears of adverse events, concerns about added ingredients in vaccines, and fear of overwhelming a child's immune system with too many vaccines. The reasons clinicians cited for parents' refusal or delay of the HPV vaccine included a lack of concern about the risk of their child contracting a sexually transmitted disease (71%) and the view that the vaccine promotes sexual activity (46%). Still, the clinicians who reported an increase in vaccine acceptance overall in 2016 cited a number of key factors, including a growing concern among the majority of parents (72%) about the increased outbreaks of infectious diseases and denial of admission to school, daycare, or camp (44%). (For example, California's law, effective July 1 2016, eliminates philosophical/personal belief and religious exemptions to school-mandated vaccines). A significant proportion of respondents (39%) believe that increasing acceptance is a consequence of parents becoming more educated about the safety and efficacy of vaccines The influence of other parents ("peer pressure") to have their children vaccinated was cited least often (12%).

Clinicians recognise their pivotal role in encouraging vaccine acceptance, and they employ a variety of approaches to educate parents and address specific concerns. The report found that clinicians most often use evidence-based information to educate their patients about the benefits of vaccinations, as well as to correct misinformation or misunderstandings about the potential risks. Although many clinicians advocate the educational route to vaccine compliance, many of their comments suggest that they are skeptical that anything they say to these parents will make any difference in their decisions about vaccines. It is viewed by some as an emotional issue that is not susceptible to logic or evidence. More than one half of the respondents attempt to increase parental confidence in vaccines by sharing that their own children are vaccinated on the recommended schedule. One-fourth of respondents find that offering or agreeing to administer vaccines on an alternative schedule satisfies hesitant parents.

According to the report, "[c]linicians are clearly frustrated about the media's mixed messages about vaccines. They believe that the lay media could support vaccination efforts by disseminating better information to combat the misinformation found on the Web." More than half of all clinicians (and 74% of paediatricians) believe that state laws should be passed or made stronger that mandate certain vaccinations and remove exemptions for school admission. As stated here, the World Health Organization (WHO) maintains that no single intervention strategy can address all reasons for vaccine hesitancy, and that the most effective interventions are multicomponent and should address the specific reasons a parent gives for refusing vaccines.

The report notes that vaccine hesitancy exists among healthcare providers, too, and some share the same concerns about vaccines as vaccine-hesitant parents. A lack of confidence in vaccines can be unconsciously communicated to parents, influencing their vaccine decisions. In the case of the HPV vaccine, the report revealed that despite evidence-based information about the benefits, 7% of clinicians indicated they remain ambivalent about the vaccine, and as a result, don't promote it as strongly as other vaccines. Other research has shown that this provider hesitancy may contribute to high rates of refusal of the HPV vaccine. Nationwide, only 40% of girls and 21% of boys receive the recommended three doses of HPV vaccine. The vaccine is recommended for preteen girls and boys beginning at age 11 or 12. Several survey respondents suggested focusing on the role of HPV in preventing cancer when counseling parents as a strategy to mitigate resistance to the vaccine.

Despite the risks associated with refusing or delaying vaccinations, the vast majority of respondents (90%) said they continue to allow these parents and their children to remain with their practice. This approach is consistent with guidelines from The American Academy of Pediatrics, which recommends against dismissing families that refuse vaccines from the practice, based on the belief that future visits offer opportunities for continued parental education. While this approach holds promise, risks remain. According to respondents, 82% make no modification in office procedures to prevent other children from contracting vaccine-preventable diseases.

"Despite changes in policy, the availability of information, and significantly greater awareness about the risks associated with vaccine refusal, the modest increase in acceptance we saw this year suggests that work still needs to be done to improve vaccination acceptance," said Hansa Bhargava, MD, pediatric editor for Medscape and WebMD. "While there is no one solution, it's important that clinicians pro-actively address parental concerns while educating their patients about the fact that vaccines not only help keep their family safe, but they also protect others by making diseases less likely to spread."