What Are the Concerns of Providers?

Reasons that healthcare providers are hesitant to recommend vaccines are multifactorial. The causes of vaccine hesitancy can be “described by the epidemiological triad—ie, the complex interaction of environmental (external), agent (vaccine) and host (or parent) specific factors.”4

Misperceptions regarding safety and efficacy of vaccines, or parental acceptance of vaccines: A recent survey5 of 442 pediatricians and family physicians (FPs) found that only 60% of pediatricians and 59% of family practice professionals strongly recommended the HPV vaccine, and only 84% of pediatricians and 75% of FPs frequently or always discussed HPV vaccination with parents at a child’s 11- to 12-year-old visit. Those who only occasionally or rarely discussed the HPV vaccine with parents thought that parents would not accept the HPV vaccine if it was discussed at the same time as other vaccines. These providers reported that a sizeable number of parents opted to defer vaccination, and expressed concern about waning immunity.5 These public perceptions of the vaccine may hinder vaccine uptake. “Our focus on HPV vaccine needs to include the very important message that prevention of HPV infection through vaccination is an important part of lifelong cancer prevention strategies—just like avoiding cigarette smoke, using sunscreen, getting hepatitis B immunized, and maintaining an active lifestyle and healthy diet,” said. Dr. Domachowske.

Differences in recommendations can influence the rate at which a recommendation of the CDC’s Advisory Committee on Immunization Practices (ACIP) is adopted by providers.3 When public health decisions either on the state level or among those in medical professional societies differ from those of the ACIP, confusion may arise and compromise vaccine uptake. For example, prior to 1989, ACIP recommended only one dose of measles vaccine routinely, to be given during a scheduled preschool visit. But when a group of public health officials in New York State sought to implement a second dose regardless of national standards, ACIP released a corresponding statement. However, differences between ACIP’s recommendations and those of the American Academy of Pediatrics (AAP) caused further confusion for public health personnel as well as healthcare providers.3

Cost considerations are taken into account by ACIP prior to making a recommendation, but ACIP has no “cost-effectiveness threshold for decision making.”3 For this reason, cost considerations may be “less influential in crafting new recommendations than safety concerns or new information.”3 Cost considerations are an obstacle to vaccine uptake on the part of healthcare providers.

Vaccine shortages have had a deleterious impact on vaccine uptake, and ACIP actions in response to these shortages have sometimes had a detrimental impact, altering perception of their recommendations. For a vaccine to be used, producers must supply an adequate quantity of doses, and consumers must demonstrate an effective demand for the vaccine.7