Falling rates of vaccination have opened the door to outbreaks of diseases long eliminated from those parts of the world with strong health systems. However, the reasons people are failing to vaccinate their children vary. A paper published in Policy Insights from the Behavioral and Brain Sciences provides a taxonomy of non-vaccinators, along with ideas on the approaches most likely to change the minds of each.
Most of the attention non-vaccinators receive focuses on those who are certain that protecting children against diseases like measles and mumps is dangerous, often adding that those viruses don’t exist or aren’t really that bad anyway. Such people tend to be vocal, after all, and draw the focus to themselves.
However, these individuals, placed in the “confidence” camp by the paper’s authors are only a small proportion of those with unvaccinated children. They are also the hardest to convince, leading to suggestions that everyone who wants to stop the return of epidemics should ignore them and focus on those with other barriers to vaccination.
First author Cornelia Betsch of the University of Erfurt categorizes the three other obstacles as complacency, convenience and calculation.
The complacent are not particularly concerned by scare campaigns about mercury in vaccines (removed decades ago in most cases) and other non-existent risk factors. Unfortunately, they are also not sufficiently worried about the diseases vaccines protect against to get their children immunised. Betsch and her fellow authors suggest that many different approaches can be effective here, including raising awareness of disease outbreaks and having doctors be firmer in their recommendations.
For some families, particularly located in remote areas or without regular housing, vaccination has practical difficulties that don’t affect most of their fellow citizens. For those whose motivation to vaccinate is low, particularly younger parents who have never seen outbreaks of the relevant diseases, this may be enough to prevent getting the full schedule of shots. Increased access to medical attention can help here, as well as providing plenty of other health benefits. However, in the absence of the money required to make this happen the authors recommend doctors engage in interventions such as “asking individuals to pre-commit to vaccination and issuing phone and SMS appointment reminders.”
The final group are calculators who have worked what they think are the risks and benefits of vaccination. However, either through decision-making paralysis or an irrational fear of dangers, real or imagined, this group never go through with getting vaccinations. Greater exposure to reliable, clear information – for example, epidemiological evidence or Monday’s announcement that monkeys given a full dose of vaccinations show no behavioural changes, is the most effective solution in these cases.
"Efforts should be concentrated on motivating the complacent, removing barriers for those for whom vaccination is inconvenient, and adding incentives and additional utility for the calculating," the authors write. "These strategies might be more promising, economic and effective than convincing those who lack confidence in vaccination."
A suggested checklist of methods that can overcome vaccine hesitancy in people motivated by different sorts of opposition. Credit: Betsch et al.