FA CTORS

I NFL U ENCING
VA CCINE HESITANCY
A MONG PARENTS
E M I LY E C K M A N , K I R S T I E L E W I S , A L E X
R I C H , A M A N D A R U P P, M I C H A E L S H E R I D A N
 DEFINITION OF
VACCINE HESITANCY:
spectrum of behavioral responses
including refusal, delay, and alternative
schedules
 VACCINE HESITANCY
• Growing issue all around the world and especially within the U.S.
• Threatens the success of vaccination programs
• As vaccine confidence decreases, the number of outbreak
occurrences increases
• More and more research is being produced in order to determine
the factors that influence vaccine hesitancy
– From the results, researchers hope to find ways to decrease
vaccine hesitancy
 RESEARCH Q
In parents of children 6 years and younger,
what are factors that contribute to
childhood vaccine hesitancy?
Factors chosen to research:
Trends
Social Influences
Physical Factors
Emotional Fears
 HEALTHY PEOPLE 2020
• Coverage objective is 90% or greater of all vaccination series
– Goal met for Poliovirus, MMR, HepB, and Varicella
– Goal not met for DTaP, Hib, and PCV
• Increased efforts needed to ensure all doses are administered
– Routine visits to family physician decreases during child’s second year of life
 ATTITUDES TOWARDS VACCINES
• 2009 – HealthStyles survey on parents with children under 6 years of age
– 79% of parents were “confident” or “very confident” in the safety of standard immunizations
• 2010 – 72% of parents were confident in vaccine safety
– One in five parents had hesitations about the safety and importance of vaccines
• National study in 2000 showed 19% of parents had concerns regarding vaccines
– In 2010, this percentage had risen by 50% in the same study
• Physician survey in 2010 noted that 89% of participants reported at least one
immunization refusal per month, along with 16% of parents requesting an alternate
schedule
– The same survey conducted in 2012 showed 93% of physicians indicating that parents with
children younger than 2 years of age had asked to delay vaccine administration
• Parents are questioning the need for immunizations against eradicated diseases
– Herd Immunity
– Natural immunity vs. vaccine-induced immunity
2015 CENTERS FOR DISEASE CONTROL
NATIONAL VACCINE DATA
DTaP Hib PCV HepA
Primary Dose 95.0% 94.3% 93.3% 85.8%
Secondary Dose 84.6% 82.7% 84.1% 59.6%
Difference (-10.4%) (-11.6%) (-9.2%) (-26.2%)

2015 Ohio Statistics:

• MMR – 88.1%
• DTaP – 80.9%
• HepA – 53.1%
• Rotavirus – 71.8%
 SOCIAL FACTORS:
OPINIONS OF OTHERS
• Healthcare Providers, including mainly physicians and
nurses, are a key influence of vaccine confidence.
– Within a study that aimed to rank social influences, HCP were found
to be the secmond ost influential factor.
• Family and friends are also a major social factor.
– Results from two different studies ranked spouses as the most
influential factor, while ranking family in third and friends in fourth.
 SOCIAL FACTORS:
SOCIAL NETWORKING SITES
• Social sites have given anti-vaccine activists a platform to speak their opinions
and allow for quicker spreading of inaccurate information.
– Also the narrated stories on these sites add a new dimension to online
health sources, including personal views of vaccine-preventable diseases,
vaccinations and their negative consequences.
• Caregivers who agree that mass media recommendations affect their daily
decisions are significantly less likely to have their children vaccinated.
– A possible explanation for this is that negative information has a stronger
and more lasting impact on parents as opposed to positive information. For
example, parents are more likely to remember reports of adverse reactions
to vaccinations as compared to positive vaccine administration experiences
 SOCIAL FACTORS:
INTERNET SOURCES
• Even when parents discuss childhood vaccine information with their
healthcare providers, majority of them still refer to the internet for
further information.
• A study that aimed to examine internet sources found that around 59%
are against normal childhood vaccinations, while only 20% support it.
– The online sources against it suggested not following an on-time or full
vaccination schedule.
• Study results show that parents who choose to delay or refuse
vaccinating their children are more likely to have searched the internet
for information.
– Also parents who search through anti-vaccination websites for just five
minutes gain a negative view on childhood vaccinations.
 PHYSICAL FACTORS:
EDUCATION
• A study from US National Library of Medicine National
Institutes of Health shows that mothers with little educational
background show higher odds of not getting their child
vaccinated, or not getting their child completely vaccinated.
• The Same article also showed mothers that were asked about
vaccines, and less than half were able to explain what each
vaccine was for which shows little education on how much
they were taught about vaccines.
• As a result, low educational level has a impact on whether a
child receives all vaccinations or not.
 PHYSICAL FACTORS:
RACE AND ETHNICITY
• According to article about racial and ethnic disparities in
vaccination coverage in the U.S. which explained that
vaccination coverage was significantly lower among non-
Hispanic blacks, Hispanics, and non-Hispanic Asians
compared with non-Hispanic whites.
• With lower coverage it makes families have more trouble
with getting their child completely vaccinated, or even if
they have more than one child getting all children
completely vaccinated can be expensive.
 PHYSICAL FACTORS:
INCOME
• Vaccines are expensive to being with, but with low
income or only one source of income in some families
makes vaccines hard to afford.
• Not having health insurance due to low income can make
out of pocket cost for children vaccines even more
expensive. This causes families not to get their children
vaccinated.
• Hard to pay for all children to be vaccinated if mother has
multiple children.
 EMOTIONAL FEARS:
OVERVIEW
• Emotional fears that a parent may have can directly affect the
decisions they make regarding the healthcare of their children.

• As a result of having these fears, parents may choose not to

vaccinate their children
– This increases the susceptibility of their children to a Vaccine
Preventable Disease

• This choice can also have effects on the larger community as it

increases the number of susceptible individuals.
– This explains the increasing number of outbreaks spreading in
largely unvaccinated communities.
 EMOTIONAL FEARS:
SAFETY & SIDE EFFECTS
• Some side effects or negative outcomes that
parents may fear include:
–Development of Autism
–The child will get the disease from the vaccine
• History: Cutter Incident (1980’s)
–Ingredients that harm the child’s immune system
–Suffering/Death from allergic reaction
–Mistrust of pharmaceutical companies
–Needle Size
 EMOTIONAL FEARS:
HEALTHCARE PROVIDER GOAL
• Physician persuasion is the most influential approach to vaccine-
hesitant parents
• Importance of communication with parents
• Understanding specifics of fears
– Pediatricians as well as the nurses administering the vaccinations
are responsible for educating families on
• Severity of the vaccine-preventable disease
– Effective treatments are not realistic once the disease has
developed!
• Accurate, evidence-based facts
• Falsifying the rumors
• Risks vs. Benefits
 NURSING IMPLICATIONS
• Additional training for existing and future nurses
• Rising costs for education, supplies, and longer hospital stays
for preventable illnesses
• Health complications in patients requiring supplemental
treatment
• Extended shifts for nursing staff
• Higher demand for Registered Nurses/Staffing shortages
• Larger nurse-to-patient ratio
• Increased research for evidence-based practice
 CONCLUSION
• Healthcare providers, including all of us as future nurses, must have the
knowledge to discuss the benefits of immunizations, as well as the risks
of delaying and refusing vaccinations.
– Parental apprehensions towards vaccines need to addressed in a more
understanding and educational manner.
• Another common issue found is that parents do not know the full
childhood vaccination schedule.
– Therefore studies suggest that pediatricians and local public health offices set
up a reminder system.
• Also, since social networking sites are increasingly impacting vaccine
hesitancy, a study suggested further and more in depth research of
them.