Public Trust in Vaccines: Defining a Research Agenda

"There is evidence that for some parents simply providing accurate information about vaccines is not enough. How can physicians, nurses, and other health professionals engage the growing ranks of 'vaccine-hesitant' parents? And what is at stake if our public health and scientific leadership do not respond to this worrisome turn of events?"

The premise of this report is that scientists and federal institutions in the United States (US) need to go beyond issuing recommendations to eliminate, via vaccination, infectious diseases (such as: diphtheria, measles, mumps, polio, rubella, and Haemophilus influenza type b meningitis). Instead, according to the US-based American Academy of Arts & Science, they need to develop evidence-based communication strategies and implement them via dialogue between citizens and scientists. For instance, the 2010 report Do Scientists Understand the Public? [PDF] concluded that "just as the public must be educated on scientific topics, so too must the scientific community be educated on public attitudes and opinions....Taking the 2010 report as its inspiration, the American Academy convened a workshop of leading researchers, practitioners, and policy-makers across a range of disciplines, from anthropology and communications to pediatric medicine and public health. The goal was to delineate the types of research that would yield insights to inform evidence-based strategies for effective communication about childhood vaccination." The workshop was held September 26-27 2013.

The "Key Issues" section of the report explores the reasons why some US parents are deliberately deferring or declining vaccines - exploring communication strategies to address this. For example: "One of the liveliest workshop discussions focused on the importance of the vaccine conversations that doctors, nurses, pharmacists, and other providers have with parents - both because it is a time when parents can receive accurate information and because it is a chance for providers to gain insight into parents' vaccine knowledge, attitudes, and beliefs. Workshop participants discussed the types of research that would help physicians best prepare for this conversation. Is one type of vaccine-hesitant parent more likely to respond to an argument about societal obligations while another type responds most strongly to a discussion of the diseases themselves? Is there any way to identify vaccine-rejecting parents whose minds will never be changed? Workshop attendees also discussed a finding that has emerged from recently published research: Parents who are told by providers what vaccines their children will get are less likely to resist those recommendations than parents whose providers ask them for their input on vaccines."

The report notes that the public health and medical communities in the US have begun to examine ways to communicate with anxious or wary parents. However, there has not yet been a concerted effort to develop an evidence-based toolkit to guide these discussions. Areas of research suggested here include:

• Parental attitudes and knowledge, which will "require longitudinal studies within individual communities to assess how and when parents arrive at vaccination decisions, how their attitudes and beliefs change over time, and what information sources (e.g., primary care physicians, Internet/television, social media, local social networks, family and friends, etc.) most strongly influence their decisions."
• The medical encounter: "Researchers should evaluate the effectiveness of communication strategies, including negotiation, used by all clinicians when discussing childhood vaccination with parents. A clearinghouse of vaccination-related interventions and innovations, drawing on data from state and local immunization managers and from other countries, and how these interventions affect uptake of childhood vaccinations, would facilitate such studies."
• At-risk communities: Sample questions that researchers might ask: "Do social networks play a different role in these communities than in communities at lower risk for vaccine-preventable disease outbreaks? How does peer-to-peer communication influence vaccine acceptance and uptake?"

The report concludes with the suggestion that "it is critical that government agencies and private foundations support and prioritize cross-disciplinary research on immunization decision-making, as well as evaluate the effectiveness of health communication strategies."

Click here to access the report online.

Click here for the 24-page report in PDF format.