Vaccination Refusal and Parental Education: Lessons Learnt and Future Challenges

Robert M Jacobson


Pediatr Health. 2010;4(3):239-242. 

In This Article

Not Refusal, but Hesitancy

Most parents accept the recommendations for routine vaccination. US vaccination rates are at the highest our country has ever achieved.[5,6] School and daycare mandates appear primarily not to drive into the open outright parental refusal, but make parents who thought their children were up-to-date aware of vaccines due.[4]

A more apt term to describe our situation with the majority of parents then is vaccine hesitancy rather than refusal. In 1957, Mitchell and Cu used the term 'hesitancy' in describing acceptance issues with polio vaccination.[7] Parents who delay vaccinations are not necessarily meaning to refuse them. Sometimes parents are merely seeking more time to consider the decision. Sometimes they wish to delay the vaccination based on their concerns of their child's current condition. Even expressions of refusal may represent really what we might better term as vaccine hesitancy. That said, clinicians must recognize that the parents' decisions are more often than not final, but still open for further consideration.

As a recent study shows, even the parents who accept vaccinations are struggling with their decisions.[8] Among the 1491 parents chosen because their children were fully vaccinated, nearly 25% claimed children get "more immunizations than are good for them" and 34% expressed concerns that their children's immune systems "could be weakened by too many immunizations".[8] This undercurrent of parental concern may explain why we cannot move beyond 79.4% up-to-date children aged 19–35 months for a standard set of routine childhood vaccines, a rate we achieved in 2003 and have maintained every year since.[5,6] Certainly, these parental concerns are not conducive to improving the rates or reducing the impact of organized antivaccine movements.


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