Guest commentary: Combating fear of childhood vaccines

Kristen Feemster
Kristen Feemster

Parents are often bombarded with information on how to steer their child's health in the right direction. Few of the decisions they make rise to the level of controversy that has surrounded childhood vaccination over the past few years.

Though medical groups like the AAFP have long maintained that vaccines are safe, a new round of the debate began when reports surfaced that Robert F. Kennedy Jr. , a proponent of scientifically disproven claims about the safety of vaccines, said he was asked by then President-elect Donald J. Trump to chair a commission about vaccine safety. The reports raised concerns among infectious disease experts that the incoming administration was taking a dangerous anti-science position on immunization.

A recent study in Pediatrics suggested that mothers may delay vaccinating their children if they receive discouraging information about the process.

“Most future parents make their decisions regarding the immunization of their infant before that child’s birth,” Priya Veerasingam, MBChB, department of general pediatrics at Starship Children’s Hospital, Auckland New Zealand, and colleagues wrote. “It is unknown whether receiving encouraging information increases or receiving discouraging information decreases the likelihood of timely immunization.”

In this guest commentary, Kristen Feemster, MD, MPH, MSHP, an assistant professor of pediatrics in the division of infectious diseases at the University of Pennsylvania Perelman School of Medicine, and the director of research at the Vaccine Education Center at The Children’s Hospital of Philadelphia, discusses Veerasingam and colleagues’ findings, what primary care providers can do with this information , and the conversations PCPs should have with their patients about vaccinations. – by Janel Miller

Fear is a powerful motivator. That’s certainly what Dr. Veerasigam and colleagues suggest in their paper, “Vaccine Education During Pregnancy and Timeliness of Infant Immunization” In this study, pregnant mothers who reported receiving discouraging information about vaccines were less likely to have their infant vaccinated on time compared to pregnant mothers who received no information about vaccines. Furthermore, encouraging information about vaccines seemed to have no impact on whether a mother vaccinated her child.

In many ways, these results are not surprising. The success of immunization programs means many of us have never experienced the diseases that vaccines prevent, making the benefits of vaccination intangible for most young parents, while concern for any perceived risks from vaccination becomes more prominent. While the majority of U.S. adults believe that the benefits of vaccines outweigh risks, trends are shifting for parents of young children who rate the risk of vaccination higher and the benefits lower. So discouraging information – even misinformation not based in evidence – can tip the scales, particularly for parents who have questions about vaccine safety or effectiveness.

What should we do with these results? The first step is to better understand the source and content of discouraging information sought out by parents that, in this study, was more likely to come from family and friends or the media. The internet is a primary source of health information for the majority of U.S. adults, many of whom trust the internet as an information source without verifying the validity of the information that they find. Social media sites, used by nearly 70% of U.S. adults, provide individuals with a platform to share compelling stories, even if they are grounded in misinformation. Negative messages about vaccines are more prevalent than positive messages through these widely used web-based resources that can distort perceived risk.

Why didn’t encouraging messages increase the likelihood of timely vaccination? This finding could reflect the influence of beliefs that are a powerful mediator of how information is interpreted. As pointed out by the authors, study participants may have been more likely to recall the information that was most salient to their existing beliefs about vaccines. The mothers who recalled encouraging information may have already intended to vaccinate their child, while hesitant mothers were primed to respond to negative information and make a decision to forgo vaccines for their child.

Yet, this does not mean that we should stop providing positive, accurate information about vaccines. What we should focus on is how information is delivered and how to optimize opportunities to communicate about vaccines. Primary care providers are one of the most important influencers in vaccine decision-making. Studies have shown that for an effective communication strategy, primary care providers should identify parents’ specific concerns early and address them with a targeted, personalized message. Effective communication also includes a strong recommendation that conveys the importance of vaccination and confidence in vaccine safety and effectiveness. Beyond primary care providers, we can use public health communication to leverage social media and other web-based sources of information to increase the presence of compelling, positive voices outside of clinical settings. Combined, these efforts can help tip the scales back so that parents can understand and value the benefits of vaccination more than they fear their perceived risks.

References:

Stat News. As White House appoints pro-vaccine officials, plan for safety commission appears stalled. Available at: https://www.statnews.com/2017/08/21/trump-vaccine-commission-robert-kennedy/ Accessed Aug. 28, 2017.

Pew Research Center. Vast Majority of Americans Say Benefits of Childhood Vaccines Outweigh Risks. Available at: http://www.pewinternet.org/2017/02/02/vast-majority-of-americans-say-benefits-of-childhood-vaccines-outweigh-risks/ Accessed Aug. 28, 2017.

Pew Research Center. Health Online 2013. Available at: http://www.pewinternet.org/2013/01/15/health-online-2013/ Accessed Aug. 28, 2017.

Pew Research Center. Social Media Fact Sheet. Available at: http://www.pewinternet.org/fact-sheet/social-media/ Accessed Aug. 28, 2017.

Addressing Vaccine Hesitancy. Publication of the Children’s Hospital of Pennsylvania.

Disclosure: Feemster is the medical director for the Philadelphia Department of Public Health Immunization Program and is on the board of directors for both the Pennsylvania and the Philadelphia Immunization Coalitions.

Kristen Feemster
Kristen Feemster

Parents are often bombarded with information on how to steer their child's health in the right direction. Few of the decisions they make rise to the level of controversy that has surrounded childhood vaccination over the past few years.

Though medical groups like the AAFP have long maintained that vaccines are safe, a new round of the debate began when reports surfaced that Robert F. Kennedy Jr. , a proponent of scientifically disproven claims about the safety of vaccines, said he was asked by then President-elect Donald J. Trump to chair a commission about vaccine safety. The reports raised concerns among infectious disease experts that the incoming administration was taking a dangerous anti-science position on immunization.

A recent study in Pediatrics suggested that mothers may delay vaccinating their children if they receive discouraging information about the process.

“Most future parents make their decisions regarding the immunization of their infant before that child’s birth,” Priya Veerasingam, MBChB, department of general pediatrics at Starship Children’s Hospital, Auckland New Zealand, and colleagues wrote. “It is unknown whether receiving encouraging information increases or receiving discouraging information decreases the likelihood of timely immunization.”

In this guest commentary, Kristen Feemster, MD, MPH, MSHP, an assistant professor of pediatrics in the division of infectious diseases at the University of Pennsylvania Perelman School of Medicine, and the director of research at the Vaccine Education Center at The Children’s Hospital of Philadelphia, discusses Veerasingam and colleagues’ findings, what primary care providers can do with this information , and the conversations PCPs should have with their patients about vaccinations. – by Janel Miller

Fear is a powerful motivator. That’s certainly what Dr. Veerasigam and colleagues suggest in their paper, “Vaccine Education During Pregnancy and Timeliness of Infant Immunization” In this study, pregnant mothers who reported receiving discouraging information about vaccines were less likely to have their infant vaccinated on time compared to pregnant mothers who received no information about vaccines. Furthermore, encouraging information about vaccines seemed to have no impact on whether a mother vaccinated her child.

In many ways, these results are not surprising. The success of immunization programs means many of us have never experienced the diseases that vaccines prevent, making the benefits of vaccination intangible for most young parents, while concern for any perceived risks from vaccination becomes more prominent. While the majority of U.S. adults believe that the benefits of vaccines outweigh risks, trends are shifting for parents of young children who rate the risk of vaccination higher and the benefits lower. So discouraging information – even misinformation not based in evidence – can tip the scales, particularly for parents who have questions about vaccine safety or effectiveness.

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What should we do with these results? The first step is to better understand the source and content of discouraging information sought out by parents that, in this study, was more likely to come from family and friends or the media. The internet is a primary source of health information for the majority of U.S. adults, many of whom trust the internet as an information source without verifying the validity of the information that they find. Social media sites, used by nearly 70% of U.S. adults, provide individuals with a platform to share compelling stories, even if they are grounded in misinformation. Negative messages about vaccines are more prevalent than positive messages through these widely used web-based resources that can distort perceived risk.

Why didn’t encouraging messages increase the likelihood of timely vaccination? This finding could reflect the influence of beliefs that are a powerful mediator of how information is interpreted. As pointed out by the authors, study participants may have been more likely to recall the information that was most salient to their existing beliefs about vaccines. The mothers who recalled encouraging information may have already intended to vaccinate their child, while hesitant mothers were primed to respond to negative information and make a decision to forgo vaccines for their child.

Yet, this does not mean that we should stop providing positive, accurate information about vaccines. What we should focus on is how information is delivered and how to optimize opportunities to communicate about vaccines. Primary care providers are one of the most important influencers in vaccine decision-making. Studies have shown that for an effective communication strategy, primary care providers should identify parents’ specific concerns early and address them with a targeted, personalized message. Effective communication also includes a strong recommendation that conveys the importance of vaccination and confidence in vaccine safety and effectiveness. Beyond primary care providers, we can use public health communication to leverage social media and other web-based sources of information to increase the presence of compelling, positive voices outside of clinical settings. Combined, these efforts can help tip the scales back so that parents can understand and value the benefits of vaccination more than they fear their perceived risks.

References:

Stat News. As White House appoints pro-vaccine officials, plan for safety commission appears stalled. Available at: https://www.statnews.com/2017/08/21/trump-vaccine-commission-robert-kennedy/ Accessed Aug. 28, 2017.

Pew Research Center. Vast Majority of Americans Say Benefits of Childhood Vaccines Outweigh Risks. Available at: http://www.pewinternet.org/2017/02/02/vast-majority-of-americans-say-benefits-of-childhood-vaccines-outweigh-risks/ Accessed Aug. 28, 2017.

PAGE BREAK

Pew Research Center. Health Online 2013. Available at: http://www.pewinternet.org/2013/01/15/health-online-2013/ Accessed Aug. 28, 2017.

Pew Research Center. Social Media Fact Sheet. Available at: http://www.pewinternet.org/fact-sheet/social-media/ Accessed Aug. 28, 2017.

Addressing Vaccine Hesitancy. Publication of the Children’s Hospital of Pennsylvania.

Disclosure: Feemster is the medical director for the Philadelphia Department of Public Health Immunization Program and is on the board of directors for both the Pennsylvania and the Philadelphia Immunization Coalitions.