Immunization Refusers: Acknowledge Contributing Experiences


What does it take to move the small but important proportion of those who refuse or delay immunization away from skepticism and into acceptance?

Better living through science is almost a mantra among health care providers. We increasingly rely on science—or evidence—to structure effective interventions. That’s why we often have a difficult time when it comes to vaccine refusal. The evidence shows that vaccines are life-saving. What does it take to move the small but important proportion of those who refuse or delay immunization away from skepticism and into acceptance?

Maternal and Child Health Journal has published a study conducted by researchers at Emory University in Atlanta, GA.

The researchers included 5121 parents of children aged 7 years or younger, and asked them about their information sources regarding immunization. Their goal was to determine the most important influences in the decision to vaccinate. They also identified provider selection factors and personal-network characteristics.

The researchers categorized respondents as non-hesitant acceptors, hesitant acceptors, delayers, and refusers. The results indicated some factors that health care providers may not know about or discuss.

Knowing someone—usually a friend, but sometimes a family member or self—whose child experienced a severe reaction to a vaccine was a significant influence for delayers and refusers.

Among delayers, parents were most likely to select pediatric health care providers who would allow them to delay/refuse vaccines, or in other words, were sympathetic to their ideas. The researchers noted that providers sometimes have policies that exclude parents who refuse immunization from their practices; this limits care for children of refusers. The researchers encourage clinicians to engage parents in discussion rather than dismiss them.

All parents reported trusting health care as information and advice sources most often, but as expected, acceptors were more likely to trust providers than refusers. Hesitant acceptors were heavily influenced by health care providers.

Refusers were least likely to turn to health care providers. They were most likely to trust Internet sources, books, spouses, and friends.

The authors encouraged training that helps clinicians increase communication with parents who delay or refuse immunizations for their children. In particular, the authors suggested that providers discuss past experiences that may have contributed to the parent’s beliefs.


Chung Y, Schamel J, Fisher A, Frew PM. Influences on Immunization Decision-Making among US Parents of Young Children. Matern Child Health J. 2017;21(12):2178-2187.

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