Some Clinicians Still Consider Themselves "Vaccine Hesitant"

Significant obstacles remain to immunization implementation
Significant obstacles remain to immunization implementation

Despite the well-established data demonstrating that pediatric vaccines are life-saving, safe, and effective, significant obstacles remain to their implementation, on both patient and provider levels.1,2 Data from several studies have shown that there is a strong correlation between provider and parent attitudes and that one of the strongest factors associated with parental vaccine acceptance is the recommendation of the healthcare provider.2,3

On the part of parents, hesitation to accept some vaccines and refuse or delay others, include past history with health services, family histories, confidence in science and medical authorities, and media influence.1 Healthcare providers—especially pediatricians—are generally advocates of vaccination, but the factors contributing to hesitation on their part are less well understood. Moreover, vaccine hesitancy among pediatricians is underrecognized.1

A recent study examines rates of vaccine hesitancy among pediatric providers, the reasons for these concerns, and suggested educational interventions that might improve vaccine confidence and adherence to guidelines.2

The researchers administered a one-page questionnaire regarding healthcare provider vaccine attitudes and practices to 680 attendees at American Academy of Pediatrics (AAP)-sponsored vaccine conferences between June and November of 2013. Participants included physicians and nurses and encompassed practitioners in rural, suburban, and mixed geographical regions.

The researchers found that 99% of participants routinely recommended standard pediatric vaccines, but 5% stated that they did not routinely recommend influenza and/or human papillomavirus (HPV) vaccines. The most often-stated concerns focused on vaccine efficacy (31%) and safety (13%). Providers demonstrated “misperceptions” regarding vaccines, including the belief that vaccines cause autism (5%).  

"I find it alarming that 5% of the providers self-reported their belief that vaccines can cause autism. This hypothesis has been disproven, and while I understand that we need to do a better job at educating our families on how to interpret and understand evidence based medicine, our colleagues should be able to do so," said study author Joseph Domachowske, MD, Professor of Pediatrics and Professor of Microbiology and Immunology at the State University of New York Upstate Medical Center in Syracuse, NY.

Other misperceptions revealed in the survey include administering multiple vaccines at a single visit reduces vaccine efficacy (6%) or overwhelms the immune system (9%), and administering the HPV vaccine increases the likelihood of unprotected adolescent sexual activity (4%). Six percent of providers who did not routinely recommend all pediatric vaccines described themselves as “vaccine hesitant.

"The self-reported belief that administering multiple vaccines at a single visit can overwhelm the immune system is also troubling. Each and every new vaccine added to the pediatric schedule is required (by the FDA) to be tested for this possibility. Any research vaccine that is shown to reduce the immune response of any of the standard vaccines does not meet the FDA requirements for approved human use. While this has been shown for a few research vaccines, the majority of new vaccines studied do not demonstrate any interference," said Dr. Domachowske. "Four percent of providers in our study believed that HPV vaccine receipt would increase adolescent sexual activity. This notion is completely counter to everything we now about how and when adolescents make their sexual debut. Teens certainly do not report that they need to wait until the HPV vaccine series is completed before entering into a sexual relationship." 

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