Vaccine hesitancy, the increasing parent-provider divide, and the response from researchers and policymakers to stem the growing concerns

From Asia Pacific Media Educator

The vast majority of parents continue to immunize their children against deadly infectious diseases. However, of late, a growing number of them in both developed and developing nations have refused vaccination, forcing the World Health Organization to declare vaccine hesitancy as one of the top ten major threats to global health. 

In the United States, The Centers for Disease Control and Prevention found that the vaccination rate for the measles, mumps, and rubella (MMR) injection in kindergartners in the 2017–2018 school year had slipped nationally to 94.3 percent, the third year in a row it dropped.

Between 2010 and 2017, over half a million French infants did not receive a first dose of the measles vaccine. And last year, France was among the ten countries with the highest year-on-year increases in measles, with confirmed cases jumping from just over 500 in 2017 to nearly 3,000 in 2018 (Whiting, 2019).

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The 2014 Joint Reporting Format (JRF) data from India reported 83% MCV1 coverage at the national level as against the current global target of 95% at the national level as well as state-district. Although it has been more than 2 years post introduction of measles-containing vaccine second dose (MCV2) across the country, the HMIS administrative reported national average for MCV2 is ~66% (in 2014), whereas routine immunization monitoring data show the MCV2 coverage to be ~40%, which is far below the expected 95% in an elimination setting (Ministry of Health and Family Welfare Government of India, 2017).

Nations, big or small, developed or developing, have been found wanting in immunizing their children. A major reason is the public’s’ or parents’ doubts about or reluctance to vaccination. Vaccine hesitancy, a relatively new term coined to explain reluctance, is recognized as a global issue. The Lancet Child and Adolescent Health (2019) states that the phenomenon has been reported in more than 90 percent of the countries in the world (The Lancet Child and Adolescent Health, 2019). The World Health Organization recognizes a ‘delay in acceptance or refusal of vaccines despite the availability of vaccination services’ (WHO, 2014). Other definitions have explained vaccine hesitancy in behavioural terms: ‘[It] is a set of beliefs, attitudes, and behaviors or combination of them exhibited by lay-people regarding their own or their children’s immunization’ (Peretti-Watel, Larson, Ward, Schulz, & Verger, 2015). Policymakers and public health experts agree that vaccine hesitancy is complex and context-specific and varies across time, place, and vaccines (MacDonald et al., 2015; WHO, 2014).

This research commentary attempts to address a seemingly simple question, ‘why do parents (or individuals) hesitate or refuse to vaccinate their children?’. The research reviews literature published in the last few years to understand and explain the phenomenon. It identifies 10 reasons for people’s reluctance for vaccination: parental concerns, perceived disease susceptibility, parent–provider relationship, government policies, the role of school authorities, weak interpersonal communication (IPC) skills of health workers, religious beliefs, the role of media, social media and information on vaccines, and lack of trust. The review categorizes parents who hesitate or refuse vaccination into four categories: obedients, ditherers, doubters, and defiant. This study summarizes recommendations and steps that researchers and policymakers have made to stem the growing concerns regarding vaccine hesitancy.

Article details

Vaccine Hesitancy: The Growing Parent–Provider Divide
Angshuman Kashyap, Sangeeta Shrivastava, Pradeep Krishnatray
First Published February 12, 2020 Research Article
DOI: 10.1177/1326365X19895826
From Asia Pacific Media Educator