Abstract
Rates of delay and refusal of recommended childhood vaccines are increasing in many U.S. communities. Children’s health care providers have a strong influence on parents’ knowledge, attitudes, and beliefs about vaccines. Provider attitudes towards immunizations vary and affect their immunization advocacy. One factor that may contribute to this variability is their familiarity with vaccine-preventable diseases and their sequelae. The purpose of this study was to investigate the association of health care provider year of graduation with vaccines and vaccine-preventable disease beliefs. We conducted a cross sectional survey in 2005 of primary care providers identified by parents of children whose children were fully vaccinated or exempt from one or more school immunization requirements. We examined the association of provider graduation cohort (5 years) with beliefs on immunization, disease susceptibility, disease severity, vaccine safety, and vaccine efficacy. Surveys were completed by 551 providers (84.3% response rate). More recent health care provider graduates had 15% decreased odds of believing vaccines are efficacious compared to graduates from a previous 5 year period; had lower odds of believing that many commonly used childhood vaccines were safe; and 3.7% of recent graduates believed that immunizations do more harm than good. Recent health care provider graduates have a perception of the risk-benefit balance of immunization, which differs from that of their older counterparts. This change has the potential to be reflected in their immunization advocacy and affect parental attitudes.
Highlights
Despite the unparalleled success in improving both individual and population health through vaccination, there is evidence of increasing delay or refusal of some or all childhood vaccines with safety concerns commonly cited as a contributing factor [1,2,3,4,5,6].As vaccination programs succeed in achieving high coverage, the visibility of the disease itself is dramatically reduced [7]
Of the 712 provider surveys sent, 44 did not reach the provider due to death, retirement, or a closed practice, and 14 were sent to a non-health care provider resulting in 654 received surveys
The proportion believing vaccines are safe and efficacious is lower for those clinicians who have graduated in recent decades
Summary
Despite the unparalleled success in improving both individual and population health through vaccination, there is evidence of increasing delay or refusal of some or all childhood vaccines with safety concerns commonly cited as a contributing factor [1,2,3,4,5,6].As vaccination programs succeed in achieving high coverage, the visibility of the disease itself is dramatically reduced [7]. As a result of lower disease prevalence, parents have more familiarity through both experience and media with real or perceived potential adverse events following immunizations than from vaccine preventable diseases. Parental benefit-risk assessments change as both cultural perception of the threat of disease and personal experience with disease decline and some parents come to see the risk of vaccines outweighing the benefits. As cohorts who have forgotten or not experienced vaccine-preventable disease come of childbearing age, their support of vaccines may be less than cohorts who grew up experiencing the effects of polio, measles, rubella, and other infectious diseases. There are a variety of individual, geographic, socioeconomic and other factors associated with vaccine uptake, there is evidence that maternal age (a potential proxy for changing parental perceptions) may be the most important factor determining whether a child is fully immunized
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