Immediately after the birth of a baby the gynecologist notes down the baby’s vital statistics such as birth weight, height, head circumference, mode of delivery (normal or C section) and APGAR score. He/she also lists down the vaccination shots that must be administered to the infant at different stages of the child’s development cycle. Nowhere does the doc ask for the parent’s permission to write down these details and it goes as an unwritten rule that vaccination must be given to the baby for his/her well-being. This has been the scenario for quite a long time but since the 1990s there have been growing concerns over the reestablishment of the anti-vaccine ideologies by a section of the population who started questioning the adeptness and safety of the vaccines. But every reaction does have a background action and the cause for such a reaction among public over vaccination efficiency could be linked to the 1998 incident-where the measles-mumps-rubella (MMR) vaccine was blamed as the cause for autism. But a single incident cannot determine the course of action of millions of parents. When probed into this, researchers were able to classify the reasons given by parents into four basic categories-religious reasons, personal beliefs or philosophical reasons, safety concerns and a desire for more explanation from the healthcare provider. A hesitation to vaccinate grows from social norms, beliefs in science and the attitude of the individual towards vaccination which makes more and more parents either skip vaccination or delay the process. When we better understand the reasons for parental hesitancy and the decision to stay away from vaccination healthcare providers can take steps to minimize this unrest in parents and eliminate the hesitancy in providing the safety measure needed to safeguard their little ones altogether.
Establishing Beliefs Over Life-Saving Vaccines
Grave diseases such as polio and smallpox have been eliminated in many countries in the past two centuries due to effective vaccination programs and there is a definite decrease in mortality and morbidity rates of infectious diseases too which is due to high rates of vaccination coverage (more than 95%). Most physicians today haven’t witnessed a case of measles or diphtheria and the public aren’t scared anymore of polio attacks that can leave their kids with debilitating disabilities. But our glorious years are fast dulling away and decreased vaccine intake is showing its true color on the society. In 2017 alone measles attacked 21,315 people causing 35 deaths (WHO reports)-15 of the 53 European countries witnessed this outbreak, Italy staying among the top orders. This means that vaccination coverage has slipped below 95% (minimum coverage required to maintain herd immunity) in many regions of the world reopening cases of infectious diseases. Though statistics show that vaccination coverage is above 95% in developed countries recent studies show a different picture-1 in 8 children <2 years old are under-vaccinated in the United States due to the choice of their parents.
Beliefs Shadowed by Doubts Over Vaccination Benefits
Its true that some children cannot be vaccinated due to certain medical conditions, some areas don’t have ready availability of essential vaccines and some people are not aware of the benefits of these vaccines but now increasing number of kids are not vaccinated due to the conscious decision of their parents. While refusal remains on one side some parents resist or delay vaccination irrespective of the availability of the vaccine and this is termed as ‘vaccine hesitancy’. Some parents refuse certain vaccines but accept certain others. Most of them are hesitant to try newer vaccines and healthcare providers play a critical role here. There are numerous studies that have promoted the important role of physicians’ attitude and knowledge, their intention to advise parents for choosing vaccination and playing a vital role in the decision-making process regarding vaccination.
Parents are the key players here as they determine the decision against vaccination but kids are the key victims here as they are the ones affected by the decision. Parents these days are overprotective of their children, interfere in every aspect of the child’s development and live with a feeling that they are extremely capable of bringing up their child as excellent adults without the need for vaccines or other interventions. Some parents cannot see their child suffer through the vaccination day but avoiding vaccines too puts their children at a high risk of contracting vaccine-preventable diseases. They give justifications in terms of side effects of vaccination (such as swelling, fever or rashes) and use these to decide against vaccination. Some decide against vaccination depending on the consequences of the decision to previously vaccinate their kids. Both, psychological and social factors relate to vaccine hesitancy of parents and studies have been conducted to detect the factors affecting the decision of parent with regards to vaccination.
Psychological & Social Factors Determining Parental Involvement
Parents make decisions regarding vaccination influenced by their strong views on others. Several factors determine their choice of action regarding vaccination:
Parents love to do what is best for their kid and every action taken by them mostly comes after deep thinking and consideration. Many studies have probed into the reasons why parents deny, hesitate or delay vaccination process and one study saw 77% parents reporting that they had concerns regarding one or more childhood vaccinations. When healthcare providers are better informed about the various reasons quoted by parents for choosing not to vaccinate, they can take better steps to educate the parents to choose vaccination.
Most common reasons quoted by many parents according to a study include:
Religious reasons: This is the strongest and most difficult reason to resolve as this does not erupt as a result of ignorance but is an informed choice where the parent understand the nuances of the situation still chooses to go against vaccination quoting staunch convictions. Those quoting this mostly completely refuse to vaccinate rather than hesitate. Many who believe in religious reasons mostly quote the use of gelatin (animal-based) in producing vaccines or the use of human fetus tissue (as in rubella) primarily as their concern.
Personal beliefs or philosophical reasons: Some parents believe that acquiring natural immunity is the best way to safeguard their children against diseases. They see benefits in allowing certain preventable diseases from attacking their children as this allows the child to develop natural immunity. Some parents believe that most of the diseases that fall under vaccination category are rarely present and that their kids are at a minimal risk of contracting them. They feel that the side effects of vaccination outweigh the benefits. Some parents don’t see preventable diseases to be life-threatening and wish to avoid the addition of extra chemicals into the child’s body. Others feel that a healthy diet and an active lifestyle puts their children at a minimal risk of diseases.
Safety Concerns: The media, Internet and social sites constantly come up with one news or the other that makes the parent question the safety of the vaccinations dispensed. Many of the reports are sensationalized and the media often brings into limelight the rarest of the rare effect that’s happened on a child and takes it on a mainstream debate which makes the parent hesitate to vaccinate the kid. Some parents feel that administering multiple vaccines simultaneously is not safe for the child’s immune system and hence delay the vaccination schedule.
Desire for Additional Information: Many parents wish for a much more elaborate explanation regarding vaccinations. They wish to know both the advantages and disadvantages of the process and then make an informed choice. Some feel their healthcare provider to be non-approachable hich makes them decide against vaccination as they are unaware of its side effects. One study showed that 81.7% parents reported their child’s healthcare provider as the most important source of information. When they fail to meet their expectations, these parents seek for information elsewhere and are often misled resulting in poor decision-making abilities.
Arguments Against Vaccination
There are several arguments against vaccination that include:
Parents with lower education levels were likelier to vaccinate whereas parents with higher education levels were much concerned about the safety of vaccination on their children. Many parents believe that vaccine preventable diseases are not a threat to their children as they no longer exist and there is no need for their children to be vaccinated as they assume that their children will benefit from herd immunity. One research shows that 18% physicians suggested only strongly recommended vaccinations while 47.5% said that it was the physician who advised them against vaccination. Many parents did admit that 79.5% physicians were for choosing vaccination and provided satisfactory information regarding vaccination.
While hesitations to vaccinate do exist most of the families abide by the norms of vaccination. A recent study shows that 88% agree that advantages of vaccination outweigh the risks. While those stories that had caused infections or death risks are the ones that attract attention there is no harm in posting your vaccine-positive stories on social media. Antivaccine movements have not gained prominence but they are slowly evolving. Advocating for vaccination is also not all that easy. The situation calls for the help of subject experts who are best suited to explain the benefits of vaccination and provide a platform to help individuals realize its benefits.
At the end of the day every parent wants to offer the most secure, safe and best future for their children. Healthcare providers must sit down with these parents and discuss every concern of the parent and guide him/her to make the right decision regarding vaccination-to vaccinate. Health education is the best way to curb vaccine hesitation in parents and improve overall vaccine coverage rates.
Parental Decision Making on Childhood Vaccination: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6008886/#B33
Exploring the Reasons Behind Parental Refusal of Vaccines: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869767/
Vaccine Rejection & Hesitancy: A Review & Call to Action: https://academic.oup.com/ofid/article/4/3/ofx146/3978712
Vaccine Hesitancy: An Overview on Parents’ opinions about Vaccination & Possible Reasons of Vaccine Refusal: https://www.jphres.org/index.php/jphres/article/view/1436/461
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Dr. Nafeesa Imteyaz of First Eat Right clinic, is the Best Dietitian Nutritionist in Bangalore. Best Dietitian Nutritionist in Pune. Best Dietitian Nutritionist in Hyderabad. Best Dietitian Nutritionist in Chennai. Best Dietitian Nutritionist in Mumbai. Best Dietitian Nutritionist in Delhi. Best Dietitian Nutritionist in Kolkata.