Vaccination Refusal and Parental Education: Lessons Learnt and Future Challenges

Robert M Jacobson


Pediatr Health. 2010;4(3):239-242. 

In This Article

What Parents are Thinking

All 50 states have school and daycare rules; 48 permit religious exemptions and 16 permit philosophical exemptions.[4] Overall, less than 1% of children entering school had an exemption to any of the vaccines, although those rates vary from state to state, and certain localities have much higher rates.[4] A British study published in 1995 indicated that, among 106 children who had received no vaccines whatsoever, 16% of those claimed religious reasons.[9] But such children are quite rare. With the exception of the Church of Christ, Scientist (the Christian Science Church), religious organizations support vaccination.[9] In fact, the vast majority (>90%) of parents believe vaccines important, whether these parents' children are up-to-date or not.[10] In a survey published in 2004, investigators found that when studying those children who were not up-to-date, some parents express concerns with trust with government and the pharmaceutical industry, this distrust is not emerging as a reason parents express in explaining a decision to hesitate with vaccination.[10]

Furthermore, in that survey, investigators found no differences between those whose children were up-to-date and those who were not with the percentages expressing general safety concerns with vaccines.[10] What the investigators did find, however, was that among the cases (those households where a child was not up-to-date) compared with the controls, case-parents were more likely to have delayed a vaccine because of a specific concern with a side-effect. Case-parents were also more likely to believe their children already received too many vaccines.[10] These results are frankly reassuring. Their reasons for vaccine hesitancy appear to be questions of fact (about safety and need), and thus should represent opportunities for education and persuasion.

That is precisely what Serpell and Green argue in their 2006 essay,[11] and Omer and colleagues echo in their commentary in 2009.[1] Parents who refuse (or hesitate) are in fact making decisions, balancing the perceived benefits and risks on both sides of vaccinating versus not.[11] Often parents must do so estimating these benefits and risks and often from faulty sources of information.[11] Nonetheless, they are indeed weighing the evidence.[11] Of course, the success of vaccination efforts have eliminated the experience parents would otherwise have with the diseases the vaccines prevent.[11,12] Furthermore, the media focuses on the coincidentally linked adverse events that parents take into consideration when weighing benefits and risks.[11,12] Fortunately, parents express distrust of media and rely instead on their clinicians for information regarding vaccinations.[1,13]


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