Vax hesitancy challenge

SHARED decision-making and communication resources are needed to reduce vaccine hesitancy among parents and to improve physician confidence when it comes to talking about immunisation, according to experts.

Dr Evan Ackermann, chair of the Royal Australian College of General Practitioners’ National Standing Committee for Quality Care, told MJA InSight that the medical community needed to develop a greater understanding of what motivates vaccine hesitant parents, “because we need to appreciate and respect their approaches to managing their children”.

However, he said that “fundamentally, more needs to be done to stop the confusing, non-evidence-based messages being given to patients about vaccinations”.

Dr Ackermann was responding to a US study published last week in Pediatrics that showed a physician-led communication intervention designed to reduce vaccine hesitancy among mothers of infants and increase physician confidence in communicating about vaccines did not improve vaccination rates. (1) 

The intervention also had only a small impact on physician confidence to communicate with parents.

The research authors said that given the null effect on maternal vaccine hesitancy, “we have limited ability to assess where the intervention may have fallen short in its implementation without other measures of physician attitudes or behaviour in clinical interactions with the study parent”.

The randomised trial was conducted across 56 family practice outpatient clinics in 2012‒2013 and included 347 mothers of healthy newborns.

Doctors at clinics in the intervention group received training on a strategy based on best practice in physician–patient communication, delivered in a 45-minute workshop by a paediatrician immunisation expert and a health educator.

The control clinics did not receive any intervention components.

The authors found maternal vaccine hesitancy changed from 9.8% at baseline to 7.5% in the intervention group at 6 months and from 12.6% to 8.0% in the control group.

They said that more work was needed on the optimal approaches to communicating with vaccine-hesitant parents, and “delivering feasible, high dose communications interventions with physicians where the ultimate target is parent behavior”.

Dr Ackerman told MJA InSight he remained doubtful that any single, educational intervention would ever be effective in overcoming this challenge, because “vaccine hesitancy by parents is a complex issue and has multifactorial origins”.

He said future interventions might have to come from non-medical sources because “the medical profession has been somewhat demonised by alternate health care providers”.

“Many of these messages originate from alternate practitioners, who are given credibility because they are registered with the Australian Health Practitioner Regulation Agency”, Dr Ackermann said.

“We are paying the price for this in immunisation-preventable hospital admissions and death.”

Associate Professor Julie Leask, from the University of Sydney’s School of Public Health, coauthored a commentary published with the Pediatrics study, which suggested that the physician training in the intervention group was too short to be expected to change physician behaviour. (2) 

The great challenge in achieving high acceptance rates for vaccines was to find and test interventions that lead to full compliance and parent satisfaction, and also to build trust in the recommendations of physicians.

“Researchers must continue to develop conceptually clear, evidence-informed, and practically implementable approaches to parental vaccine hesitancy, and agencies need to commit to supporting the evidence base”, the authors wrote.

Professor Leask told MJA InSight she was currently working on a project called SARAH (strategies and resources to assist hesitant parents with vaccination), which aimed to move parents towards vaccinating, increase parental satisfaction and build greater trust in health professionals through a “triage and treat” system. (3) 

She said the first aim was to help doctors identify hesitant parents, and then guide them to adapt flexible goals and strategies, including the provision of tailored information.

Professor Leask also hopes to develop a digital package to integrate into primary care practice.

Dr Kerrie Wiley, manager of the social science group at the National Centre for Immunisation Research and Surveillance, agreed with the need for a bigger push towards communication strategies, telling MJA InSight that although the specific intervention in the Pediatrics study was not effective, this did not mean that communication initiatives were not viable.

Dr Wiley is contributing to the development of decision aids to assist doctors in initiating and directing the critical discussion about vaccination with hesitant parents.

“It gives physicians a script and develops that process of shared decision making.”

She said that, ultimately, addressing vaccine hesitancy was about “asking parents what their issue with vaccination really is, and going from there”.

1. Pediatrics 2015; Online 1 June

2. Pediatrics 2015; Online 1 June

3. Improving communication about vaccination — “SARAH”

(Photo: Ian Hooton / Science Photo Library)