Perspective

French GPs show vaccine hesitancy, discrepancy in recommendations

In France, where the public is highly skeptical of vaccines, 14% of general practitioners, or GPs, are at least moderately vaccine-hesitant and many vaccinate their patients differently compared with their own children, according to the results of two related surveys.

“Our results underline the need to better coordinate the mobilization efforts by public health institutions and other actors to address [vaccine hesitancy (VH)] among GPs in France,” Pierre Verger, MD, epidemiologist at Inserm, and colleagues wrote in Eurosurveillance. “Efforts should be directed with priority to GPs with moderate-to-high VH. Nonetheless, efforts to inform and support GPs with no-to-low VH are also warranted to prevent some of the existing reservations and the expansion of VH in this group.”

Telephone survey reveals vaccine-hesitant GPs

Between April and July 2014, Verger and colleagues conducted a telephone survey of 1,582 GPs culled from a panel of 1,712 GPs in private practice in France. They excluded GPs who planned to retire within 6 months or who exclusively practiced acupuncture, homeopathy, or other alternative medicine. The survey included questions about vaccine recommendations and perceptions about vaccine risks and usefulness.

Verger and colleagues identified three clusters of GPs. Those who were either not hesitant or only slightly vaccine-hesitant made up 86% of respondents (95% CI, 84-88). However, 11% (95% CI, 9-12) were moderately hesitant and 3% (95% CI, 3-4) were highly hesitant or opposed to vaccinations, they said.

The results were “worrying,” Verger and colleagues said, because GPs play an essential role in vaccinating patients in France, which has experienced wide skepticism about vaccine safety.

Earlier this year, the results of the largest ever global survey of public confidence in vaccines found that Europeans were the most skeptical about vaccine safety. France topped the list among European countries, with 41% of people disagreeing that vaccines were safe.

Verger and colleagues said VH in GPs can impede their ability to alleviate a similar feeling among their patients.

“Despite the moderate prevalence of VH among GPs, our results are troubling because GPs play an essential role in vaccinating their patients, answering their questions and addressing their VH,” Verger and colleagues wrote. “Evidence indicates that most parents seek information and advice from their health care provider regarding [vaccine-preventable diseases], vaccines and the recommended vaccination schedule.”

Recommendations different for patients, children

In a survey of the same panel of GPs in private practice in France, Verger and colleagues found that more than half do not vaccinate their patients the same way they treat their children.

“The most frequent type of discrepancy, by far, concerned GPs who reported that their children were vaccinated, but who did not systematically recommend the same vaccines to their patients,” Verger and colleagues wrote in Clinical Microbiology and Infection.

They noted that official vaccination policy in France mandates vaccines against diphtheria, polio and tetanus, and recommends vaccines for hepatitis B virus, HPV, measles-mumps-rubella (MMR) and meningococcus C.

Among 1,038 GPs who reported having at least one child aged between 2 and 26 years, 47% said all their children were vaccinated against hepatitis B but they did not always recommend that vaccine for their patients, Verger and colleagues reported. Such discrepancies also were seen among GPs for vaccinations against MMR (36%), HPV (27%), and routine and catch-up vaccinations for meningococcal C (19% and 28%).

According to Verger and colleagues, 60% of GPs showed a “high level of discordance” — they reported that their children were vaccinated, but did not always recommend the same vaccines to their patients.

“The comparison of GPs’ reported vaccination practices for their children and recommendations to their patients might help us to draw assumptions about GPs’ reasons for non-vaccination and to distinguish those who do not trust the vaccine from those who face patient-related barriers to vaccination,” they concluded. “Further investigations are however needed to confirm our findings and in other countries, and to explore the reasons underlying these vaccination behaviors and to assess whether these might be a marker of vaccine hesitancy.” – by Gerard Gallagher

Reference:

Agrinier N, et al. Clin Microbiol Infec. 2016;doi:10.1016/j.cmi.2016.08.019.

Verger V, et al. Euro Surveill. 2016;doi:10.2807/1560-7917.ES.2016.21.47.30406.

Disclosures: The researchers report no relevant financial disclosures.

In France, where the public is highly skeptical of vaccines, 14% of general practitioners, or GPs, are at least moderately vaccine-hesitant and many vaccinate their patients differently compared with their own children, according to the results of two related surveys.

“Our results underline the need to better coordinate the mobilization efforts by public health institutions and other actors to address [vaccine hesitancy (VH)] among GPs in France,” Pierre Verger, MD, epidemiologist at Inserm, and colleagues wrote in Eurosurveillance. “Efforts should be directed with priority to GPs with moderate-to-high VH. Nonetheless, efforts to inform and support GPs with no-to-low VH are also warranted to prevent some of the existing reservations and the expansion of VH in this group.”

Telephone survey reveals vaccine-hesitant GPs

Between April and July 2014, Verger and colleagues conducted a telephone survey of 1,582 GPs culled from a panel of 1,712 GPs in private practice in France. They excluded GPs who planned to retire within 6 months or who exclusively practiced acupuncture, homeopathy, or other alternative medicine. The survey included questions about vaccine recommendations and perceptions about vaccine risks and usefulness.

Verger and colleagues identified three clusters of GPs. Those who were either not hesitant or only slightly vaccine-hesitant made up 86% of respondents (95% CI, 84-88). However, 11% (95% CI, 9-12) were moderately hesitant and 3% (95% CI, 3-4) were highly hesitant or opposed to vaccinations, they said.

The results were “worrying,” Verger and colleagues said, because GPs play an essential role in vaccinating patients in France, which has experienced wide skepticism about vaccine safety.

Earlier this year, the results of the largest ever global survey of public confidence in vaccines found that Europeans were the most skeptical about vaccine safety. France topped the list among European countries, with 41% of people disagreeing that vaccines were safe.

Verger and colleagues said VH in GPs can impede their ability to alleviate a similar feeling among their patients.

“Despite the moderate prevalence of VH among GPs, our results are troubling because GPs play an essential role in vaccinating their patients, answering their questions and addressing their VH,” Verger and colleagues wrote. “Evidence indicates that most parents seek information and advice from their health care provider regarding [vaccine-preventable diseases], vaccines and the recommended vaccination schedule.”

Recommendations different for patients, children

In a survey of the same panel of GPs in private practice in France, Verger and colleagues found that more than half do not vaccinate their patients the same way they treat their children.

“The most frequent type of discrepancy, by far, concerned GPs who reported that their children were vaccinated, but who did not systematically recommend the same vaccines to their patients,” Verger and colleagues wrote in Clinical Microbiology and Infection.

They noted that official vaccination policy in France mandates vaccines against diphtheria, polio and tetanus, and recommends vaccines for hepatitis B virus, HPV, measles-mumps-rubella (MMR) and meningococcus C.

Among 1,038 GPs who reported having at least one child aged between 2 and 26 years, 47% said all their children were vaccinated against hepatitis B but they did not always recommend that vaccine for their patients, Verger and colleagues reported. Such discrepancies also were seen among GPs for vaccinations against MMR (36%), HPV (27%), and routine and catch-up vaccinations for meningococcal C (19% and 28%).

According to Verger and colleagues, 60% of GPs showed a “high level of discordance” — they reported that their children were vaccinated, but did not always recommend the same vaccines to their patients.

“The comparison of GPs’ reported vaccination practices for their children and recommendations to their patients might help us to draw assumptions about GPs’ reasons for non-vaccination and to distinguish those who do not trust the vaccine from those who face patient-related barriers to vaccination,” they concluded. “Further investigations are however needed to confirm our findings and in other countries, and to explore the reasons underlying these vaccination behaviors and to assess whether these might be a marker of vaccine hesitancy.” – by Gerard Gallagher

Reference:

Agrinier N, et al. Clin Microbiol Infec. 2016;doi:10.1016/j.cmi.2016.08.019.

Verger V, et al. Euro Surveill. 2016;doi:10.2807/1560-7917.ES.2016.21.47.30406.

Disclosures: The researchers report no relevant financial disclosures.

    Perspective
    Roman Prymula

    Roman Prymula

    Although the recently published study about discrepancies between GP’s vaccination recommendations for their patients and practices for their children in France brings interesting results, they are far from possible generalization. Serious risk for substantial bias may interfere with the conclusions. The major bias originates from the cohorts not being matched by age. Children of GPs are clearly aged 2 to 25 years; the age of their patients is however not specified. Various age cohorts are at different risk and this also puts different stresses on specific recommendations. The paper does not address this issue. Also, immunization in children and recommendations for patients are not the same entity. Besides, of those limitations, the conclusion with better results in GP’s kids is not so bad. It means GPs at least trust in immunization. Opposite results would be less encouraging.

    • Roman Prymula, PhD
    • Secretary for the European Society of Clinical Microbiology and Infection vaccines study group

    Disclosures: Prymula reports no relevant financial disclosures.