Parental decisions about vaccination: Collective values are important

Abstract

Tarrant and Thompson report a study of parental perceptions and attitudes to vaccination in a highly immunised population. Such information is important in understanding and drawing out elements of a successful immunisation programme. What then are the insights from this study that might translate to other population settings? This study, looking at childhood immunisation through the lens of the parent, supports the existing knowledge on what makes an immunisation programme successful.1 These ranged from individual cognitions and attitudes to family and social factors to system factors. Individuals perceived the benefits of vaccines as outweighing the risks. These positive perceptions were supported by aspects of the social environment, including beliefs about infectious disease threats, ideas of social responsibility, high levels of declared trust in authorities, a willingness to conform and a strong sense of societal responsibility. Finally, success was achieved with system factors, including free, comprehensive and accessible child health services and mandatory vaccination for school entry. Australia's success in achieving high immunisation rates, at least 93% for two-year-olds,2 is a result of a similar range of factors, with the exception of mandatory vaccination. Of note, mandatory vaccination may offer little advantage when other system factors and inducements contribute to timely high coverage of vaccines in young children.3 However, in societies with high vaccination rates, and a low incidence of vaccine-preventable diseases, the perceived threat of disease may be lower and people may see immunisation as unnecessary. Clearly, an understanding of vaccination as a wider social good is important, and countries such as Hong Kong appear to have key cultural elements to support this. Do parents in Western countries like Australia lack the same kind of ideological support for vaccination as the authors suggest? We would argue that notions of social responsibility and the collective good are important, but less manifest aspects of vaccine decision making. Studies from the USA and Australia have revealed what many health professionals assume to be the ‘missing elements’ in cognitive processes regarding vaccination.4,5 That is, decisions to immunise are mediated in part by what other parents are perceived to be doing, by what one feels he or she should do and by notions of what it means to be a ‘good’ citizen and parent. A US study by Hershey et al. tested the extent to which a regard for others influenced vaccination decisions. They concluded that people were more likely to vaccinate if they perceived others were doing so (known as bandwagoning). Parents could also be motivated by altruism if vaccination was urged in that way.4 A 1999 Sydney study found that, in their support for vaccination, parents not only valued the benefits of protecting their own individual child but mothers from a range of socio-economic and educational backgrounds also understood and appreciated the social nature of the vaccination decision.5 For some, vaccination was a way of contributing to the health of the broader community and future generations. As a result, some conveyed a strong intolerance of people who forego vaccination for their children because unvaccinated children were seen as a threat to others. These findings challenge the assumption that parents in developed countries are ‘more focused on individual rights’ and are not able to see value in the contribution to the health of others that vaccination brings. What does this mean for the clinician encountering a parent who is not sure about vaccination? For parents to make informed decisions about vaccination, they need to understand both its risks and benefits, including societal benefits. Informing parents that their decision to have their children vaccinated will provide protection for their own children and others is an important aspect of vaccine-risk communication and should not be overlooked on the assumption that parents in Western countries might only consider their own children when deciding about vaccination.