By: Lewis First, MD, MS; Editor-in-Chief
Recently several states have been engaged in legislative debates regarding whether to pass legislation that would improve vaccination rates, such as removing philosophical exemptions. Why parents opt for such exemptions is concerning and not well understood. One thought is that perhaps our communication with families might be a way to improve vaccine rates in children assuming we had a successful way to improve such communication with vaccine-hesitant families.
Interestingly enough, Dr. Henrikson et al. (doi:10.1542/peds.2014-3199) share the results of a randomized trial using a physician-targeted communication intervention to reduce vaccine hesitancy and improve physician confidence in talking about vaccines. 56 clinics and almost 350 mothers participated in this study with 30 clinics getting the intervention trainings and the rest being controls. So did the intervention reduce vaccine hesitancy and improve physician confidence in talking about vaccines? Sadly—not really—but please read this study to understand why the desired results may not have been achieved.
So if better targeted communication strategies don’t work, what can we discern at a population level as to what groups of patients are asking for philosophical exemptions and how have these patterns changed over time with the hope that perhaps by targeting specific populations in the community, one could learn more about these populations and in turn develop better ways or legislation to make philosophical exemptions less possible.
Doctors Carrel and Bitterman (doi:10.1542/peds.2015-0831) opted to look at schools in California with high, medium and low rates of personal belief or philosophical exemptions and look at differences in those populations in an interesting study also being released this week in our journal. While some of the highest philosophical exemptions occur in public schools with high percentages of white students, charter status as well as in private schools, there was also a high rate of personal or philosophical exemption when a school also had a high number of medical exemptions—setting that community up for being at risk due to possibly diminished herd immunity.
So should we give up on our quest to improve the declining vaccination rates in this country? Not so fast—as per the opinion of Drs. Julie Leask and Paul Kinnersley who comment on the role of physician communication and vaccine-hesitant parents in a commentary accompanying the Henrikson study. Inject some time in reading both studies and the commentary and hopefully you’ll be reenergized to continue to educate your patients and populations of patients at school meetings as well as your legislators on the importance of making sure our children are vaccinated.