Why Do Parents Who Usually Vaccinate their Children Hesitate or Refuse? General Good vs. Individual Risk

"[T]he case of the polio outbreak in Israel emphasizes the importance of transparency and credibility in risk communication."

This study examines parents' refusal or hesitancy to vaccinate their children following the 2013 polio outbreak in Israel. While no clinical cases of paralytic polio were recorded during the outbreak, the Israeli Health Ministry launched a campaign to immunise children under the age of 10, who were already protected with the standard inactivated polio vaccine (IPV), with a bivalent oral polio vaccine (OPV) designed to protect others who were not already vaccinated against the disease. In short, it found that even parents who are not "vaccine refusers" and who usually comply with routine vaccination programmes may hesitate or refuse to vaccinate their children based on poor communication from the relevant healthcare provider, as well as concerns about the safety of the vaccine.

Drawing on results from a questionnaire survey (n=197), and content analysis of parents' discussions in blogs, on websites, and on Facebook pages (n=2,499), the study was based on two theoretical models:

1. Sandman's theoretical model, which holds that risk perception is comprised of hazard plus outrage. "The public's view of risk (as opposed to that of the experts) reflects not just the danger of the action (hazard), but also how they feel about the action and what emotions it produces (outrage). Lack of agreement between experts' and the public's perception of hazard and outrage can lead to controversy. According to Sandman, one of the most important ways to deal with negative feelings of a population toward a certain issue is continuous communication with that population..."
2. Alhakami and Slovic's affect heuristic that explains the risk/benefit confounding. "The process of 'affect heuristic' suggests that if a general affective view guides perceptions of risk and benefit, then perception regarding risk can be changed (affected) by receiving information about benefit - and vice versa."

Although the rate of children vaccinated during the campaign was high, the study's findings indicate that for the first time, parents who are not characterised as vaccine refusers and who usually comply with the routine vaccination programmes hesitated or even refused to vaccinate their children. One-third of parents surveyed who refused or were hesitant to vaccinate their children reported that the safety of the vaccine was a concern and that they were not convinced by the information communicated by the Health Ministry or the explanation of why this vaccine was necessary. Over one-third of all respondents strongly disagreed that the Health Ministry had provided comprehensive and clear information about the reasons for giving children the vaccine, and almost 28% of parents who vaccinated their children indicated that they did not actually understand that the purpose of the vaccine was not to protect their own child. ("This study highlights the difficulty of framing the subject of vaccinations as a preventive measure, especially when the prevention is for society at large and not to protect the children themselves.") The theme of distrust in the medical establishment recurred in the analysis of 35 respondents who had refused or were hesitant about vaccinating their child.

To explain the results in another way, the researchers say: "Whereas the experts viewed the spread of polio as a dangerous threat, the parents who chose not to vaccinate their children were not convinced of its severity, or of a genuine reason for vaccination. Moreover, according to Sandman, experts are driven mainly by hazard (conveying scientific information) when they approach the public, and do not take into account the affect which may influence the public’s risk perceptions. Our findings reveal that the public is actually driven by both sides of the equation (hazard and outrage), since it explains its attitudes both emotionally (outrage) and analytically (hazard) - the latter being generally thought of as the territory of the experts. According to our findings from the social media, the public actually feels that the explanations they are offered were not analytical enough and the explanations from the Health Ministry were neither satisfactory nor convincing."

"The recommendation for the risk-communicating organizations is to expose the dilemmas, communicate facts and talk 'science' even to laypeople, especially in conditions of uncertainty: the communicators must educate the public and include it, and not speak in all-or-nothing slogans."