VAIL, COLO. — Never underestimate the power of a physician's strong personal recommendation of a vaccine in influencing parents' decisions to get their children vaccinated and perhaps themselves as well.
“It has been shown time and time again in multiple studies that one of the most critical factors in parents' acceptance of vaccines either for themselves or for their child is a personal physician recommendation for that vaccine,” Dr. Marsha Anderson said at the conference, sponsored by the Children's Hospital, Denver.
This point has been brought home in studies involving several different vaccines, most recently in a national survey regarding uptake of the 2009 monovalent vaccine against pandemic H1N1 influenza, noted Dr. Anderson, a pediatric infectious disease specialist at the hospital and the University of Colorado.
The C.S. Mott Children's Hospital National Poll on Children's Health conducted a national survey of H1N1 vaccination rates as of January 2010. The survey, conducted by professional pollsters on behalf of the hospital, which is a part of the University of Michigan Health System, included a nationally representative sample of 2,246 adults. The results showed that as of last January, 29% of children and 16% of adults had received the pandemic H1N1 vaccine.
Among the 38% of participants who reported that their children's health care providers strongly recommended the vaccine, the vaccination rate was 66% in their children and 57% among the parents themselves.
With less emphatic endorsements by the physician or another health care provider, vaccine uptake rates fell off sharply. For example, when parents reported that the provider “somewhat” rather than “strongly” recommended the H1N1 vaccine, the vaccination rate was 30% for their children and 19% for the adults.
And when the health care provider was seen as “neither for nor against” the H1N1 vaccine, as was the case for the physicians of 35% of the children and 55% the adults, the vaccine uptake rate plunged to 11% among the youngsters and 7% for adults.
When Dr. Anderson polled her Vail audience of general pediatricians and family physicians as to how frequently they experienced frustrating conversations with “vaccinophobic” parents, 35% indicated it happened at least once per day on average, and another 37% said it occurred 3-4 times per week.
In a recently published survey of a nationally representative sample of more than 1,500 parents, 54% strongly agreed with the statement, “I am concerned about serious adverse effects of vaccines.” One-quarter believed some vaccines cause autism, a figure that climbed to 37% among Hispanic parents. Particularly disturbing, in Dr. Anderson's view, was the finding that 11.5% of parents had refused at least one physician-recommended vaccine (Pediatrics 2010;125:654-9).
Among parents who had refused the measles-mumps-rubella (MMR) vaccine, 42% indicated they did not think enough research had been done on the vaccine. This was also the case among 55% of those who refused the varicella vaccine, 67% who declined the meningococcal vaccine, and 78% of parents who refused the human papillomavirus (HPV) vaccine.
When counseling parents who question the need for immunizations, Dr. Anderson said, take the time to explain why you personally recommend the vaccines—not just that it's a national recommendation and therefore it is the right thing to do, but why it's going to benefit the child. Include an explanation of the benefits versus the sometimes exaggerated risks of immunization. Include the importance of maintaining herd immunity, a description of the vaccine approval process, and the mechanisms in place to monitor vaccine safety, such as the Vaccine Safety Datalink and the Vaccine Adverse Event Reporting System, she said.
Many parents love to do their research at what she called “the University of Google,” where they can encounter biased and inaccurate sites that focus on rare negative events. She provided a list of alternative sites where they can find more reliable information. (See sidebar above.)
Dr. Anderson disclosed that she has served as a speaker for Merck & Co., Novartis, and Sanofi Pasteur, all of which make vaccines.
Useful Web Sites for Vaccination Information
▸ Centers for Disease Control and Prevention vaccine safety:
www.cdc.gov/vaccinesafety/index.html
▸ CDC Vaccine Information Statements:
www.cdc.gov/vaccines/pubs/vis/default.htm
▸ National Vaccine Advisory Committee Vaccine Safety Working Group:
www.hhs.gov/nvpo/nvac/vaccinesafety.html
▸ “Vaccine Safety Research, Data Access, and Public Trust” (Washington: Institute of Medicine, 2005):
www.nap.edu/catalog/11234.html
▸ Clinical Immunization Safety Assessment:
www.cdc.gov/vaccinesafety/Activities/cisa.html
▸ Children's Hospital of Philadelphia Vaccine Education Center:
www.chop.edu/service/vaccine-education-center/home.html
Source: Dr. Anderson