Why do parents refuse childhood vaccination? Reasons reported in Finland

Understanding barriers to influenza vaccination among parents is important to improve vaccine uptake among children

The COVID-19 pandemic has significantly altered public perceptions of vaccines, particularly among parents. In high-income countries like the United Kingdom (UK) and Australia, factors such as misinformation, the expedited approval process of COVID-19 vaccines and unique local challenges have contributed to vaccine hesitancy, resulting in uneven uptake across various vaccination programs. Despite efforts like school-based influenza vaccination programs in the UK and free influenza vaccines in Australia, vaccination rates continue to decline. This is especially concerning given the concurrent circulation of COVID-19 and influenza during the winter months, which places additional strain on healthcare systems. Drawing on existing evidence, this commentary examines key factors influencing childhood vaccination rates and provides preliminary policy recommendations to address these challenges. Three actionable recommendations are outlined, including strategies to counter misinformation, improve accessibility, and strengthen public trust in vaccination programs. These insights aim to guide the development of effective interventions to increase vaccination uptake.

Conditional adherence after medical recommendation and the attraction of additional information

OBJECTIVE

This study introduces conditional adherence (CA) as the patients' inclination toward additional information sources instead of unconditionally adhering to treatment. The study examined how medical decision-making practices are associated with CA and the intention to turn to various information sources.

METHODS

Scenario survey data (N = 1935) were used to analyse the association between decision-making practices and patients' intentions to seek additional information from either formal or informal sources.

RESULTS

Additional information was preferably acquired from the attending physician without the intention to seek additional information elsewhere. Shared decision-making (SDM) decreased the likelihood of CA and especially the need to consult other formal sources. Other kind of decision-making practices were associated with a higher likelihood of CA. Decisional conflicts from previous medical appointments associated with seeking information from informal sources.

CONCLUSIONS

Turning to additional formal information sources associates with appointments lacking the element of SDM. However, turning to informal information sources is more significantly associated with prior experiences of contradictory treatment recommendations.

IMPLICATIONS

SDM and open communication between the physician and the patient are underscored in the objective of treatment adherence. CA may be prevented by participating patients to decision-making and identifying possible trust issues concerning also prior medical decisions.

What makes an expert in childhood vaccinations? Perceptions of parents in Finland

In Finland, trust in science and research organisations is high. This correlates with the fact that childhood vaccination uptake is generally good in Finland, with vaccine refusal being rare. However, there are differences between vaccines and regions in terms of uptake. Influenza and HPV vaccinations are two childhood vaccinations with suboptimal coverages in Finland. Although science and scientists are generally trusted in Finland, public health experts have been increasingly contested, and their expertise challenged. Little is known about parental vaccination expert preferences. This study explored what makes an expert in childhood vaccinations, according to parents of children aged between 6 months and 14 years of age. The study utilized both quantitative and qualitative data. In total, 415 parents took part in the study. The identified vaccine expert categories were "knowledge and experience", "institutional authority", "ethics and integrity" and "communication and interaction". We also found statistically significant differences between vaccine accepting, hesitant and refusing parents in terms of expert preferences. In conclusion, parents did not grant the expert the status of an authoritarian vaccine expert solely due to their qualifications and knowledge, but the expert was also needed to be accessible and actively engage and convince the parent.

Parental experiences of caring for their preschool children after declining vaccines: a qualitative systematic review

OBJECTIVE

This review synthesizes qualitative research about the experiences of parental caregivers enhancing their children's health after making the decision to not vaccinate their preschool children. This review aims to help health care providers understand the parental work involved in caring for under-vaccinated or unvaccinated children.

INTRODUCTION

Much of the current qualitative research literature about parents who are vaccine-hesitant or who decide not to vaccinate their children focuses on parental perceptions about the safety and efficacy of vaccines and decision-making. However, limited attention has been paid to measures taken by parents to help their young children avoid contracting vaccine-preventable communicable diseases, promote resistance, and enhance their children's health.

INCLUSION CRITERIA

This review considered qualitative studies that described parents' experiences of caring for their young children, aged 0 to 6 years, after making the decision not to vaccinate. Studies undertaken in any context were considered. Studies that focused on young children who were unvaccinated or not fully vaccinated for reasons not related to parental refusal were excluded.

METHODS

The JBI methodology for systematic reviews of qualitative evidence was followed. Databases were searched from 1998 onward, and included Web of Science Core Collection, MEDLINE (Ovid), CINAHL Complete (EBSCOhost), PsycINFO (EBSCOhost), Google Scholar, and ProQuest Dissertations and Theses, with no language limits. Following critical appraisal, findings that described parental experiences and the care activities they performed relating to their young children were extracted. The JBI process of meta-aggregation was used to identify categories and synthesize findings. The ConQual approach was used to assess confidence in the findings.

RESULTS

Forty studies met the criteria for inclusion. The studies were conducted in 14 countries across 4 continents, with approximately 676 participants. From these studies, 115 findings were extracted and combined to form 12 categories based on similarity in meaning and 3 synthesized findings: i) Parental care strategies in the home-focused on the individual and family, ii) Parental care strategies in the community-managing social interactions and community networks, and iii) Parental care strategies at the systems-level-challenging societal discourses and institutional work processes.

CONCLUSIONS

The major conclusions from this review highlight the laborious activities that parents undertake to care for their children's health after declining vaccines. Care activities extended from the household to the community, encompassing myriad anticipatory and reactive measures. Parents demonstrated a strong commitment to their children's health and well-being while responding to stigma they experienced among their friends, children's teachers, and health care providers. While facing or expecting penalties related to their vaccine choices, parents reached out to like-minded peers for support and planned next steps should punitive measures become overwhelming.

REVIEW REGISTRATION

PROSPERO CRD42021241781.

SUPPLEMENTAL DIGITAL CONTENT

A Farsi-language version of the abstract of this review is available at: http://links.lww.com/SRX/A78 .

Surge in Eye Drop Safety Concerns and Interest in Alternative Dry Eye Disease Therapy Following Eye Drop Recalls: A Cross-Sectional Google Trends Analysis

OBJECTIVES

Beginning in January 2023, numerous eye drops were recalled following reports of contamination. To investigate hesitancy in topical therapies for dry eye disease (DED), we analyzed trends in Internet search traffic for alternative DED therapies and eye drop safety concerns following initial recalls.

METHODS

Google Trends (GT) was used to measure the popularity of specific search terms during a given time period. The main GT output metric for gauging interest in a search term is the Search Volume Index (SVI). We collected worldwide SVI data for terms "dry eye vitamin," "are eye drops safe," "stop eye drops," "lipiflow," "ilux treatment," "dry eye mask," "dry eye warm compress," "omega-3 for dry eyes," "dry eye plugs," "dry eye humidifier," "itear," and "IPL dry eye" from April 24, 2022, to October 29, 2023. Statistical analysis was performed with Microsoft Excel v.16.77.1, and comparisons between groups were performed using paired t tests.

RESULTS

A significant increase in SVI was observed for most keywords. When comparing the 40-week period before and after the initial recall, 7/10 alternative DED therapies demonstrated a statistically significant surge in Internet search traffic after recall ( P < 0.05). Furthermore, 2/2 keywords pertaining to eye drop safety concerns demonstrated an increase in SVI ( P < 0.0001).

CONCLUSIONS

We identified a significant surge in Internet search activity for eye drop safety and alternative DED therapies following eye drop recalls. Public health agencies and physicians may find this information valuable while attempting to address safety concerns and navigating noncompliance of routine eye drop therapy.

Parental perceptions of chickenpox and the varicella vaccine: A qualitative systematic review

BACKGROUND

In countries where varicella vaccination is not on the routine childhood immunisation schedule, such as those in the United Kingdom (UK), chickenpox is an almost universal disease of childhood. Chickenpox can cause serious complications, particularly in infants, pregnant women, and the immunocompromised. In November 2023 the varicella vaccine was recommended for inclusion in the UK routine childhood immunisation schedule. Successful rollout of the vaccine may be hindered by parental concerns about vaccine safety and efficacy, and perceptions of chickenpox as a mild illness.

OBJECTIVE

To examine parental perceptions of chickenpox and varicella vaccination, which may be crucial to effective vaccination campaigns.

DESIGN

Qualitative systematic review and thematic analysis.

METHODS

Six electronic databases were systematically searched for studies published between 2016 and 2023: CINAHL, EMBASE, MEDLINE, PsycInfo, PubMed, and Web of Science. The included studies were appraised against the Critical Appraisal Skills Program checklist for qualitative studies. Thematic analysis was used to analyse qualitative data, through the development of themes.

RESULTS

22 articles were included in this review, and five themes identified: perceptions that chickenpox is a mild illness, that parents have concerns about varicella vaccine efficacy and safety, a notion of natural immunity as superior, social determinants of health influence vaccine decision making, and vaccination is overwhelming perceived as a parental decision.

CONCLUSIONS

Whilst some parents displayed an acceptance and willingness to vaccinate against chickenpox, many expressed concerns, and perceived chickenpox as a routine unworrying childhood illness. Analysis demonstrated a knowledge gap in understanding UK parental opinions regarding chickenpox and varicella vaccination, highlighting the need for research in this area, particularly given ongoing reconsideration for inclusion in the UK vaccination schedule.

REGISTRATION

The review was registered on PROSPERO, registration ID CRD42021236120.

Eradicating Atherosclerotic Events by Targeting Early Subclinical Disease: It Is Time to Retire the Therapeutic Paradigm of Too Much, Too Late

Recent decades have seen spectacular advances in understanding and managing atherosclerotic cardiovascular disease, but paradoxically, clinical progress has stalled. Residual risk of atherosclerotic cardiovascular disease events is particularly vexing, given recognized lifestyle interventions and powerful modern medications. Why? Atherosclerosis begins early in life, yet clinical trials and mechanistic studies often emphasize terminal, end-stage plaques, meaning on the verge of causing heart attacks and strokes. Thus, current clinical evidence drives us to emphasize aggressive treatments that are delayed until patients already have advanced arterial disease. I call this paradigm "too much, too late." This brief review covers exciting efforts that focus on preventing, or finding and treating, arterial disease before its end-stage. Also included are specific proposals to establish a new evidence base that could justify intensive short-term interventions (induction-phase therapy) to treat subclinical plaques that are early enough perhaps to heal. If we can establish that such plaques are actionable, then broad screening to find them in early midlife individuals would become imperative-and achievable. You have a lump in your coronaries! can motivate patients and clinicians. We must stop thinking of a heart attack as a disease. The real disease is atherosclerosis. In my opinion, an atherosclerotic heart attack is a medical failure. It is a manifestation of longstanding arterial disease that we had allowed to progress to its end-stage, despite knowing that atherosclerosis begins early in life and despite the availability of remarkably safe and highly effective therapies. The field needs a transformational advance to shift the paradigm out of end-stage management and into early interventions that hold the possibility of eradicating the clinical burden of atherosclerotic cardiovascular disease, currently the biggest killer in the world. We urgently need a new evidence base to redirect our main focus from terminal, end-stage atherosclerosis to earlier, and likely reversible, human arterial disease.

Losing trust: Processes of vaccine hesitancy in parents' narratives

Lack of trust is central in becoming hesitant towards vaccines, but research on vaccine hesitancy lacks detailed examination of the processes of losing trust. Based on ethnographic interviews with 38 parents in Finland, we explore how and why they have lost their trust in vaccination. We identified two paths to losing trust in vaccination. One was connected to mistrust - a cumulating suspicious attitude toward vaccines and related institutions. The other was associated with distrust - a more sudden loss of trust. We identified four ideal type narratives of losing trust: the activist, the hesitant, the disillusioned and the negotiator. The narratives of the activist and the hesitant were connected to mistrust. The activists were certain of their vaccination decisions whereas the hesitant parents were not. The narratives of the disillusioned and the negotiator were connected with distrust. The disillusioned parents had lost their trust due to adverse effects of vaccination and a lack of institutional support. The negotiators suspected adverse effects and were less certain about their decisions. The article provides insight into the ways in which people lose trust in vaccination, which is crucial for supporting trusting relationships between vaccine-advocating institutions and the publics.

Spillover effects of the COVID-19 pandemic on attitudes to influenza and childhood vaccines

The current study sought to determine whether public perceptions of other vaccines and diseases than COVID-19 have been impacted by the COVID-19 pandemic. We longitudinally examined whether there had been a change from before the COVID-19 pandemic to during the pandemic in: (a) influenza vaccination behaviour and intentions; (b) the perceived benefit of childhood vaccines and influenza vaccines; (c) the perceived safety of childhood vaccines and influenza vaccines; (d) the perceived severity of measles and influenza; and (e) trust in healthcare professionals in two samples of Finnish adults (N = 205 in Study 1 and N = 197 in Study 2). The findings showed that during the pandemic, more people than before had received or wanted to receive the influenza vaccine. The respondents also believed that influenza was more dangerous during the pandemic and that vaccinations were safer and more beneficial. On the other hand, for childhood vaccines only perceived safety increased. Finally, in one of the studies, people had more confidence in medical professionals during the pandemic than they had before. Together, these findings imply a spillover of the COVID-19 pandemic on how people view other vaccines and illnesses.

Predictors of Real-World Parents' Acceptance to Vaccinate Their Children Against the COVID-19

Background

As the COVID-19 pandemic continues to threaten public health, the vaccination of children against the disease appears to be a key factor to control the pandemic. Our aim was to investigate the prevalence of parents who have vaccinated their children against the COVID-19 and the factors influencing this decision.

Materials and Methods

We conducted a web-based cross-sectional study in Greece during the first week of September 2021. The study questionnaire was distributed through social media and a convenience sample was obtained. Only parents with children aged 12-17 years old could participate in the study. We collected socio-demographic data of parents and we measured their attitudes towards vaccination and COVID-19 pandemic.

Results

Study population included 656 parents. Regarding vaccination, 27.1% of parents had their children vaccinated against the COVID-19, while almost all children had a complete vaccination history (98.9%). The most important reasons for decline of COVID-19 vaccination were doubts about the safety and effectiveness of COVID-19 vaccines (45.3%) and fear of side effects (36.6%). Regarding the information about the COVID-19 vaccines, parents showed more trust in family doctors than in scientists and the government. We found that increased parents' age, increased trust in COVID-19 vaccines, and positive attitude of parents towards vaccination had a positive effect on children's vaccination.

Conclusions

Understanding the factors influencing parents' decision to vaccinate their children against the COVID-19 is crucial to increase the COVID-19 vaccination coverage rate. Implementation of public health policies is necessary to spread knowledge about COVID-19 vaccines and to regain vaccine confidence.

Attitudes and perceptions of mothers towards childhood vaccination in Greece: lessons to improve the childhood COVID-19 vaccination acceptance

BACKGROUND

Maternal attitudes and beliefs have been shown to influence childhood vaccination coverage, resulting in under-vaccination, non-vaccination, and vaccination delay. This study aimed to investigate the mothers' attitudes and perceptions about vaccination for their children in Greece.

METHODS

This was an online cross-sectional study, conducted from 4 April to 8 June 2020. A self-administered questionnaire was used to collect information about mothers' and their children's socio-demographic characteristics, previous vaccination behavior, and mothers' attitudes and perceptions about childhood vaccination. Participants included adult mothers with at least one minor child.

RESULTS

One thousand eight hundred eighty-five mothers participated, with the majority (91.7%) believing in the usefulness of vaccines and that vaccines protect children from serious and life-threatening diseases. A larger percentage of mothers with higher educational attainment agreed/absolutely agreed that all vaccinations provided by the National Vaccination Program must be offered to their children (91.6%) (p = 0.02) and that vaccines protect children from serious and life-threatening diseases (92.9%) (p = 0.01). Significant more married/in cohabitation and not single-parent mothers agreed that vaccines are safe (53.5% and 53.4%, respectively). There were also several significant associations between maternal attitudes toward childhood vaccination and previous maternal vaccination practices [(e.g., adherence to recommended vaccination dosages (all p-values < 0.01), vaccination delays (all p-values < 0.05), and vaccination during pregnancy (all p-values < 0.01)].

CONCLUSION

Maternal attitudes and perceptions toward childhood vaccination are significantly influenced by sociodemographic factors and maternal vaccination practices. Revealing those is essential for public health officials in developing future strategies to improve childhood vaccination coverage and acceptance of new vaccines such as the COVID-19 vaccine.

Parental category B vaccine hesitancy and associated factors in China: an online cross-sectional survey

BACKGROUND

Vaccine hesitancy is one of the top ten health threats. We aimed to (1) assess parental Category B vaccines hesitancy and associated sociodemographic factors in China, and (2) explore the association between attitude toward vaccines and self-reported hesitant behavior.

METHODS

A cross-sectional study was performed through a web-based anonymous online questionnaire survey between 9 February and 7 April 2021. Chinese parents aged ≥ 18 years with one child aged < 6 years were included to assess vaccine hesitancy using the vaccine-hesitancy scale (VHS). Structural equation model was used to determine relationships between variables.

RESULTS

Of 2952 Chinese parents included in the analysis, 17.5% were highly hesitant in Category B vaccines. Parents who were younger, less educated, engaged in health-related occupations, and had been vaccinated against influenza in the past year were more hesitant when vaccinating their children (P < 0.001). VHS score accuracy to identify vaccine-hesitant behavior was acceptable, and the optimal cutoff was 37.50 (with 61.96% parental vaccine hesitancy). Parents who lack confidence or believe vaccines were risk were more likely to show vaccine hesitant behavior (P < 0.001).

CONCLUSIONS

In China, effective interventions need to be implemented to eliminate parental Category B vaccines hesitancy.