'I Think I Made The Right Decision...I Hope I'm Not Wrong'. Vaccine Hesitancy, Commitment and Trust among Parents of Young Children

Although vaccine hesitation (VH) is a worldwide phenomenon, a survey conducted in 2016 across 67 countries found that the VH may be especially prominent in France, with 41% of French respondents considering that vaccines are unsafe (compared with a global average of 13%). The present study investigates VH among French parents of young children, with an emphasis on trust towards physicians and commitment to vaccination issues. The researchers conducted 25 in-depth interviews among two populations with contrasting socioeconomic profiles, asking questions such as: Which resources do these parents mobilise to make a decision about their children's vaccination, and which sources of information do they trust? To what extent are they committed to this issue? How do they get involved?

The researchers conducted the survey in 2014 in a large city from Southeastern France, where the coverage for infant and children vaccines is lower than the national average. Participants were parents of children 3-5 years old attending one of two nursery schools: one a public school located in an economically poor suburb characterised by high rates of unemployment, single-parent families, and migrants (the Gooseberry School, GS), and the other a private school located downtown (Blackberry School, BS).

Vaccination coverage was higher in GS. All participants' children had been vaccinated at least once, but almost none of them had received all recommended vaccines. Many also reported delays in vaccination due to reasons including enduring doubts regarding the vaccine. Their VH also varied depending on the vaccine. Among both GS and BS participants, VH was fuelled by the fear of vaccine side effects. Two other reasons that were mentioned included: (i) Many participants stated that many vaccines were useless, because the corresponding disease was either very unlikely to occur or benign; and (ii) BS parents were more prone to consider vaccination as something invasive and non-natural, especially for vaccines containing aluminum or mercury. Several stated they distrust allopathic medicine and prefer "natural" solutions to strengthen their child's immune system. The researchers also saw acceptance despite enduring doubts, especially for vaccines already provided to older siblings ("vaccine inertia"). Why did parents finally accept shots despite their doubts? Several participants mentioned social pressure.

All participants considered that childhood vaccination was an important issue deserving their full attention, but mothers were more involved in vaccination decision-making. Despite the rise of the internet and social media, the participants still strongly relied on face-to-face interactions with peers and significant others for information about vaccination. In both GS and BS, parents shared the same concerns and doubts regarding vaccination-related information found on the internet, but those interviewed in BS also displayed various strategies to filter and appraise this information. Most participants trusted their own physician, but this was the result of a selection process: They had engaged resources to find a physician they could trust. Participants with contrasted socioeconomic profiles struggled with the same dilemmas, and they committed themselves to the same quest to find the "right" physician. Again, parents with a higher socioeconomic status were able to engage more resources and use a wider repertoire of actions, and they also displayed greater health literacy.

In short, "even though the Internet is definitely part of the picture, one should not conclude too hastily that anti-vaccination websites mechanically fuel vaccine hesitancy by luring naïve people." Regarding vaccination issues, "we have to trust an expert system comprising, among others, those people and organisations who did contribute to conceive, to produce, to distribute a vaccine, as well as those who tested, those who recommended it, and so on, despite the fact they will remain anonymous and distant to us, and we do not understand the technical knowledge they use. Such trust requires a 'leap of faith', but it is much more comforting and rewarding to anchor such trust in a face-to-face relationship, with a flesh-and-blood representative of the expert system: in this case, the GP [general practitioner]."