ATLANTA – Childhood immunization programs in the United States have been "a remarkable success" when it comes to vaccine coverage and disease prevention, but an increasing threat to this success is "vaccine hesitancy" – the term applied to concerns about safety and efficacy of vaccines that lead some parents to resist vaccination of their children as recommended, according to Dr. Arthur Reingold.
Although the vast majority of unimmunized children are unimmunized not as a result of vaccine hesitancy, but as a result of a failure of immunization programs to reach them (which itself is often a factor of socioeconomic status), there does exist a genuine anti-vaccine movement involving people who "see the world differently in terms of whether vaccines are a good thing or a bad thing," Dr. Reingold, professor of epidemiology and associate dean for research at the University of California, Berkeley, said at the International Conference on Emerging Infectious Diseases.
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Lack of trust, along with misinformation, lack of information, and fear resulting from the belief that a child has died or been injured as a result of vaccination are the major contributors to vaccine hesitancy, Dr. Arthur Reingold said.
The problem of unreached children is something that increased resources and attention can certainly do a great deal to eliminate; the increasing problem of vaccine hesitancy requires something more – the building of trust, he said.
Some parents may be accepting of vaccines, but may have questions or concerns about safety. Others may reject vaccination due to religious or other personal beliefs, or they may accept some, but not all vaccinations because they believe the current schedule is "somehow an affront to the immune system," Dr. Reingold said.
"Increasingly, many parents are anxious and have questions, so we can’t assume that they will accept vaccination," he said, noting that addressing these concerns is time-consuming and challenging for the pediatrician or family doctor, but taking the time is an important aspect of building trust.
Trust-building is one of the best approaches to overcoming vaccine hesitancy, he said.
Lack of trust, along with misinformation, lack of information, and fear resulting from the belief that a child has died or been injured as a result of vaccination are the major contributors to vaccine hesitancy, he said.
Those most likely to refuse vaccination for their children are those with a higher income and mothers who are married and who have a college degree – and who have doubts about the effectiveness of vaccines, Dr. Reingold noted, adding that these are parents who "generally don’t necessarily trust the government or their physician to provide them with accurate information."
This is a very different group from those whose children are unimmunized due to lack of access, he said.
Adding to the concerns about vaccine hesitancy is the fact that several states already allow for exemptions based on religious or personal convictions, and a recent report said that seven states are weighing making it much easier to opt out.
Data show that rates of vaccine-preventable disease are higher in states that make it easy to opt out. Pertussis and measles are two examples of diseases that increase as vaccine rates decrease.
"Making it easier will certainly have effects," Dr. Reingold said.
Again, the key is trust-building, and there are approaches – as demonstrated world-wide through successful vaccination programs among initially resistant populations – that can be quite successful, he said.
He cited the polio vaccination program in India, where the disease has been eliminated.
Quite a bit of resistance was initially encountered among Muslim populations in North India, but a plan that involved community-level action and inclusion of local residents on leadership teams and as community organizers proved successful in winning support for the program.
The results in India show that compulsory vaccination – an approach that has been attempted periodically throughout the history of immunization programs – is not necessary for success.
"It is possible to build trust and to get people to accept vaccination, but it is hard work, and it takes resources," he said.
To build trust, a program requires transparency, accurate information, avoidance of financial conflicts of interest on the part of those promoting the program or a specific vaccine, a good system of monitoring and investigating adverse events, and a reasonable compensation program for those who are injured as a result of vaccination, he said.
The adverse event monitoring and investigation aspect is of particular importance given the fears that parents increasingly have regarding vaccines, and that means making the most of existing systems, including passive surveillance and the Vaccine Adverse Event Reporting System, he said.