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Provider Education
The CDC offers educational programs, materials, and strategies for healthcare providers in a variety of media and formats regarding vaccination. They are free of charge and offer continuing education credits.7,8
Knowledge of the principles of vaccination, the recommended vaccine schedules, and the effects of vaccinations are critical in conveying information to confused or reluctant parents.9 It is equally important to understand parental concerns and know how to address them.10 Communication skills are key to conveying the information to parents and, when relevant, adolescents.11 Communication goes beyond the imparting of information. Parents must feel heard and respected.12 Pressure to vaccinate can be counterproductive, while listening and dialogue can support individual decision-making and more effectively inform the public health community of the issues and concerns influencing vaccine hesitancy.13 A group of Australian researchers have developed a useful framework for communicating with parents, including what information to include in the discussion, and how to present it.13 (Table 1) “Motivational interviewing, where the discussion begins with points and concepts on which the provider and parent agree, and builds using consensus, is a growing technique used by providers to improve how their vaccine message is conveyed,” adds Dr. Domachowske.
Conclusion
New vaccines under development are likely to be more expensive than existing vaccinations, and be recommended for more “obscure” indications or narrower populations.3 The increasing number of vaccines increases the concerns of parents and providers who already feel there are too many vaccinations. New challenges on the horizon concern not only the number of vaccines, but also their nature and cost. Understanding the history, landscape, and causes of vaccination hesitation will facilitate future lessons in dealing with this “increasingly complex playing field.3 Vaccine hesitancy is a “dynamic issue.” Future vaccination programs need to reflect and address context-specific factors in both their design and evaluation.5
References
1. Siddiqui M, Salmon DA, Omer SB. Epidemiology of vaccine hesitancy in the United States. Hum Vaccin Immunother. 2013;9(12):2643-8.
2. Suryadevara M, Handel A, Bonville CA, et al. Pediatric provider vaccine hesitancy: An under-recognized obstacle to immunizing children. Vaccine. 2015;27;33(48):6629-34.
3. Walton LR, Orenstein WA, Pickering LK. Lessons learned from making and implementing vaccine recommendations in the U.S. Vaccine. 2015;33 Suppl 4:D78-82.
4. Kumar D, Chandra R, Mathur M, et al. Vaccine hesitancy: understanding better to address better. Isr J Health Policy Res. 2016 Feb 1;5:2.
5. Allison MA, Hurley LP, Markowitz L, et al. Primary care physicians’ perspectives about HPV vaccine. Pediatrics. 2016 Jan 4. [Epub ahead of print]
6. Lieu TA, McGuire TG, Hinman AR. Overcoming economic barriers to the optimal use of vaccines. Health Affairs. 2005;24(3):666-679
7. Centers for Disease Control and Prevention (CDC). Vaccines and immunizations. Available at: http://www.cdc.gov/vaccines/ed/. Accessed: February 13, 2016.
8. Centers for Disease Control and Prevention (CDC). Immunization Strategies for Healthcare Practices and Providers. Available at: http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/strat.pdf. Accessed: February 18, 2016.
9. Blendell RL, Fehr JL. J Perinat Neonatal Nurs. 2012;26(3):230-41. Discussing vaccination with concerned patients: an evidence-based resource for healthcare providers.
10. Tafuri S, Gallone MS, Cappelli MG, et al. Addressing the anti-vaccination movement and the role of HCWs. Vaccine. 2014;32(38):4860-5.
11. Benin AL, Wu AC, Holmboe ES, et al. How can we communicate about vaccines with adolescents and their parents? Clin Pediatr (Phila). 2010;49(4):373-80.
12. Larson HJ. Negotiating vaccine acceptance in an era of reluctance. Hum Vaccin Immunother. 2013;9(8):1779-81.
13. Leask J, Kinnersley P, Jackson C, et al. Communicating with parents about vaccination: a framework for health professionals. BMC Pediatr. 2012;12:154.
