Growing vaccination skepticism: influencing factors and countermeasures to increase willingness to vaccinate in Germany.

Growing vaccination skepticism: influencing factors and countermeasures to increase willingness to vaccinate in Germany.

Reluctance to vaccinate among parents: causes and possible solutions

Vaccines are among the most effective preventative measures against infectious diseases. Thanks to a concerted global vaccination campaign, diseases such as smallpox have been eradicated worldwide. Polio and measles have also become rare in many parts of the world. Still, rising conspiracy theories have undermined trust in vaccination efforts, particularly during the current COVID-19 pandemic.

A new study published in Advances in Pediatrics examines notable risk factors associated with vaccine hesitancy, particularly for influenza and human papillomavirus vaccines. However, claims in connection with the SARS-CoV-2 virus are excluded.

Children are under the care of their parents, which is why parental consent to vaccinating children is crucial. However, parental trust in vaccines is significantly impaired by the spread of myths about harmful vaccination consequences. These conspiracy theories are often supported by the fact that vaccine-preventable diseases have become extremely rare in many developed countries and thus account for only a small proportion of childhood morbidity and mortality.

The tragic consequence of these conspiracy theories is a growing distrust among parents in the effectiveness and benefits of vaccines. In the United States, for example, up to one-seventh of preschool-aged children do not receive their recommended vaccinations due to parental opposition, while more than 25% of US parents delay vaccinating their children. Children who are not vaccinated because of their parents' opposition are at increased risk of contracting vaccine-preventable diseases, which in turn can lead to outbreaks, as has happened in recent years with measles and whooping cough.

Vaccine hesitancy is defined by the World Health Organization (WHO) and its Strategic Expert Group on Immunization (SAGE) as “delayed acceptance or rejection of vaccines despite availability of immunization services.” Parental attitudes toward vaccinations vary depending on time, place, and the vaccines involved. The WHO names three C’s in this context: convenience, complicity and trust. Attitudes towards vaccination range from absolute rejection of all vaccines to a willingness to accept all recommended vaccines without question.

There are various reasons why parents refuse vaccinations for their children. These include fear of side effects, the perception that vaccinations are not really necessary due to the current low prevalence of vaccine-preventable diseases, doubts about the effectiveness of vaccines, individualistic thinking, moral concerns, and opinions for or against vaccinations. Many parents believe that vaccines cause disease rather than prevent it. Some even claim that a child's immune system can be weakened by too many vaccines, that there are alleged toxins in vaccines, and that the entire vaccination movement is being driven by unscrupulous manufacturers who are only interested in their profit margins. Over a third of parents believe that children receive too many different vaccines within the first two years of life, while over 90% of parents believe that a maximum of three vaccines should be given in a single day.

There is a clear connection between alternative medicine, nature-oriented living and vaccine hesitancy among parents who refuse to vaccinate their children. These parents, who are up to four times more likely to use alternative medicine systems, often believe that contracting a vaccine-preventable disease is better for the child than vaccination. In this group of parents, such preferences are also expressed in relation to organic food and alternative school approaches.

Despite the official retraction of the influential 1998 article that claimed a link between autism spectrum disorders and the measles-mumps-rubella (MMR) vaccine and the discrediting of author Andrew Wakefield, millions of parents continue to believe such a link. These parents also claim that this connection applies not only to the MMR vaccine, but to vaccines in general.

An inherent error in attempting to correct false beliefs is to assume that providing information will correct those false beliefs. People accept or reject information based on their ideologically influenced acceptance of the information source. In particular, the pharmaceutical industry, which is more interested in profits than general benefits in drug development, has largely lost credibility with the public. Their connections to the research, medical and government communities are also seen as a disadvantage. When people lose trust in their government, it leads to a feeling of oppression. This in turn can lead to conspiracy theories, which ultimately contribute to many parents' reluctance to vaccinate.

The widespread use of vaccinations has also led to uncertain parents viewing the recommendation to vaccinate their children as a form of social pressure. These parents then also magnify the side effects of these vaccinations instead of seeing their benefits. This is particularly true for parents who have an intensive parenting style and those who receive worrisome vaccination information from family, friends, or books rather than from doctors. Vaccine safety concerns are highlighted primarily in print, broadcast, social media and online.

It is particularly concerning that social media and the internet often provide misleading or inaccurate information. Unfortunately, this information is often posted alongside accurate information without verifying the sources. Researchers have hypothesized that web-based interventions that provide factual vaccination information via social media could counteract the effects of misleading or inaccurate posts.

Needle phobia and painful local reactions to vaccinations also play a role in up to 10% of parental rejections, especially if they themselves experienced painful childhood vaccinations. This must be combated by sedation, pressure at the injection site, the use of local anesthetics, and distraction of the child during the vaccination process.

The best way to respond to vaccine hesitancy and refusal is through a variety of approaches, including in-person meetings to provide educational information for those who accept vaccinations but want a delayed schedule. However, this technique would not be effective if rejection was based on religious beliefs, perceptions of vaccine-related dangers, or vaccine ineffectiveness. Historically, social motivations for vaccination have not played a significant role in changing parental views on vaccination, particularly in societies that value individual freedom over community responsibility. A systematic review has shown that while parents view the concept that vaccinations “benefit others” as important, their decision is ultimately based on the perceived benefit to their own child.

Health professionals continue to play an important role as trusted sources of information. In fact, talking to doctors about vaccine concerns and providing factual, easy-to-understand information has a positive impact on parents' attitudes toward vaccinations. An empathetic and communicative approach on the part of medical professionals is therefore essential to ensure parents' trust in