Adjusting Attitudes About The Vaccination Schedule
Oct 05, 2011

On Monday morning, many health reporters and news stations covered the release of a survey published in Pediatrics that addressed “Alternative Vaccination Schedule Preferences Among Parents of Young Children.”   The survey results, which are a representation of 748 respondents, seem to provide a better understanding of who is using an alternative vaccination schedule, why they are choosing to do so, and what influences are swaying parents to either follow the recommended schedule or adopt their own alternative.
As we engage with other parents, it’s important that we not assume that those who use an alternative schedule are opposed to immunizations. In this particular survey, an alternative vaccinator was a parent who failed to follow the exact recommendations of the CDC, regardless of their reasoning.   This survey may have even encompassed parents who skipped or delayed a vaccine because of vaccine shortages, illness or missed appointments or, more likely, parents who consciously chose to delay or decline one or more vaccines.
While it is true that 13% of the survey respondents reported following an alternative vaccination schedule, it was also noted that only 2% reported refusing all vaccines for their young children.  That leaves the remaining 11% who have obviously deviated from the schedule, but are still vaccinating their children to some extent.
Interestingly enough, I get to hear from parents almost daily, through my work on this blog and in reading comments on our Vaccinate Your Baby Facebook page.  What I have found is that many of the parents who admit to declining, or delaying, one or more vaccines, share many of the same concerns.

 “We give too many vaccines in one visit.” 

“We give too many vaccines when the child is still so young.” 

“I don’t feel this disease poses a serious risk to my child.”

“I am not convinced that this particular vaccine is safe or effective.”

However, the question remains.  If we explain why these parental fears are unfounded, will it make a difference?  On the Vaccinate Your Baby website, many of these concerns are answered by Q&A videos with immunization experts, in hopes that parents with questions will come to better understand the recommended schedule.   Yet, for some people, despite the evidence that suggests otherwise, fears will persist, vaccines will be rejected and alternative schedules will continue to be utilized.
What the survey tells us is this:  among parents who don’t adhere to the recommended schedule, 41% say they have developed their own schedule and 15% say they used one developed by a friend.  This seems to suggest that many of these parents are simply making up a schedule to suit their own needs; trying to personalize a program that will provide them with enough peace of mind where they don’t have to make the choice not to vaccinate, but that they can retain the choice as to when to vaccinate and which vaccines to receive.  Parents who make these choices are often heard explaining that immunizations should not be on a “one size fits all” schedule.
Fortunately, some parents using an alternative schedule responded to the survey by saying that they had “worked with their child’s physician” to develop a plan.  Under these circumstances, we remain hopeful that with a physician’s continued interest, patience and guidance, that these parents will eventually complete the recommended immunizations for their children’s – otherwise known as the “better late than never”, or “better some than none” philosophy.  In these cases, repeated face time with the physician can help to overcome vaccination barriers and at least help ensure that the child remains in good health.
Regardless of the reasons why some parents chose an alternative schedule, the concern here is that under-immunization has been shown to significantly increase the risk of contracting and spreading vaccine-preventable diseases. After all, isn’t this the basis of the recommended schedule?  To immunize children at an age when their immune response from the vaccine will be most effective, while still early enough to prevent them from contracting diseases at a time when they are most susceptible?
Interestingly enough, a large proportion of the alternative vaccinators in this survey agreed that under-vaccination of children increases the risk of infection and the spread of disease.  At the same time, 28% of the parents who currently follow the recommendations believe a delayed schedule may be safer, and 22% weren’t convinced the recommended schedule was the best to follow.  These figures seem to suggest that there is a contradiction between beliefs and actions that is not limited to parents using alternative schedules, but is more clearly defined overall.
Whether parents decide to vaccinate or not, one thing is for sure!  Parents want to do what they feel is best for their children.
But let’s face it…A big part of being a parent is the fact that we worry about our children and the decisions we make that pertain to them.  The way I see it, some take that worry and suppress it, choosing to critically evaluate the information that has been presented, trusting in the work of the immunization experts and following the suggestions of their own doctors.  Others, take that worry and inject a level of doubt that is difficult to overcome.
The truth is that parents can, and do, continue to change their views.  For instance,  30% of those following an alternative schedule had initially followed the recommended schedule but then changed their minds.  Similarly, 11% reported changing from an alternative schedule to the one recommended by the CDC.  Of those who switched to the CDC recommendations, 61% said they did so because it “seemed” safer.  Based on these responses, it appears that many parents haven’t received enough convincing information to be confident in their decisions.
Additionally, we see why a good parent-physician relationship is not only important, but influential.  For instance,  one of the only factors that was significantly associated with higher odds of using an alternative schedule was not insurance, gender, education, age, marital status or geographic location.  Rather, it was not having a regular health care provider for their children.  Among alternative vaccinators who did see regular providers, 30% said the doctor agreed but was “hesitant”, 40% said their child’s doctors “seemed supportive” and 22% indicated that the doctor had been the one to suggest an alternative schedule (which could have been due to concurrent illness or vaccine shortages).
So the unanswered questions remain.   Are parents who tend not to engage in regular care just more likely not to follow the schedule as suggested?  Or are parents who want to follow an alternative schedule choosing not to see a provider or are they having a difficult time finding one who supports their beliefs?
While the survey concludes that some 1 in 10 parents are using an alternative vaccination schedule, it also suggests that many parents seem to be “at risk” for switching to an alternative schedule.  However, in identifying parents who deviate from the recommended schedule as vaccine hesitant, we must also consider that some parents who follow the schedule may be just as hesitant.  If we can continue to encourage parents to seek out answers to their questions from credible sources, and to critically evaluate that information, than perhaps we can help all parents to become confident in the benefits of the recommended schedule and to better understand the unnecessary risks of delaying or refusing specific vaccines.

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