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Getting to the Root of Vaccine Refusal

One in five parents changes their mind about vaccination during pediatrician visit, new study finds

Innovations in Pediatrics - Spring 2017 


Pediatrician, UH Rainbow Babies & Children’s Hospital; Assistant Professor of Pediatrics, Case Western Reserve University School of Medicine

More and more pediatricians are encountering parents who refuse to vaccinate their children. In a recent study in the journal Pediatrics, 87 percent of pediatricians reported the phenomenon – up from 75 percent a decade earlier. Now, a new study from University Hospitals Rainbow Babies & Children’s Hospital points to the importance of the office visit itself in countering this trend. In analyzing surveys from 316 parents from both an urban hospital setting and a suburban ambulatory care setting, researchers found that more than 20 percent changed their mind about vaccination during their child’s office visit.

Half of these parents opted for vaccination during the office visit after previously planning to decline. Unfortunately, the other half declined vaccination during the office after previously planning to accept.

“Previous vaccine refusers did change their minds,” says pediatrician Sara Lee, MD, lead author of the UH Rainbow study. “But we also showed some people who had not previously refused or not intended to refuse a vaccine did refuse the vaccine. There’s definitely something that happens at the visit where parents change their mind.”

The group published its results recently in the journal Clinical Pediatrics.

According to Dr. Lee, these results emphasize the need for pediatricians to move beyond simply providing vaccine information and education to parents.

“There have been studies showing that information and education are not the key factors,” she says. “Instead, we need to ask other questions. Is it provider recommendation? Amount of trust in the provider? We’re not sure what it is that is causing people to accept vaccines or change their minds. Is it something in your social network that primes you to be more willing to accept what the physician provider tells you? We really need to look more closely to determine what the factors are.”

Dr. Lee and her colleagues will be working to determine whether there are certain vaccines parents are more likely to refuse. The HPV vaccine, for example, remains controversial for some parents. They’ll also be interviewing parents who changed their mind about vaccination to identify the underlying reasons for the decision.

In the meantime, she says a “presumptive” approach to talking with parents about vaccines -- speaking matter-of-factly about the vaccines the child needs at the visit -- may yield greater acceptance than a more “participatory” discussion.

With specific vaccines, there are also certain strategies that are helpful. Presenting the HPV vaccine as a cancer vaccine can be a beneficial approach, Dr. Lee says.

Clearly, there is still much work to do to understand and effectively counter the anti-vaccination trend.

“No parents are trying to harm their child,” Dr. Lee says. “There’s a lot of information to the point of information overload and it’s hard for parents to know what sources of information to trust. At the same time, we need to better understand what’s going on at the visit. More research definitely needs to be done to delineate the key factors that are nudging parents in making a decision.”

For more information on this study, email