Practical framework to address childhood vaccine hesitancy

A new clinical practice review sets out evidence-based approaches GPs can use in everyday consults to improve childhood vaccine uptake, while maintaining trust.
 
Co-led by paediatricians at the Murdoch Children’s Research Institute (MCRI) and published in the New England Journal of Medicine, the paper provides a structured, stepwise approach for vaccine-hesitant conversations, as misinformation continues to hamper uptake.
 
The authors ask why parents are still questioning the safety of vaccines and often declining them, when the science is ‘abundantly clear’ the benefits of vaccines far outweigh the potential risks.
 
‘Today, some parents fear vaccines more than the diseases they prevent, often because of widely debunked falsehoods, such as the myth that vaccines cause autism,’ they write.
 
While the paper is a partnership between Australia and the United States, the principles for the communication apply to both countries. Underpinned by the Vaccine Champions Program, its approach uses an evidence base from Australia.  
 
Dr Jessica Kaufman, MCRI Principal Research Fellow, told newsGP the paper is aimed at clinicians to support effective conversations and provide a consult-ready framework.
 
‘Paediatricians, GPs, practice nurses, anybody who’s talking to parents could use the paper to get a sense of the effective communication strategies to address hesitancy,’ she said.
 
‘It gives an overview of some of the evidence around what drives hesitancy or lower uptake, as well as a structured approach to having effective conversations, and points clinicians to resources and examples they can use to guide their discussion.’
 
Despite the rise in vaccine hesitancy, the paper reiterates that clinicians remain the ‘most trusted influence’ on parental vaccine decisions, and details the evidence for different approaches, such as empathy based and patient-centered communication to build trust, address misinformation, and support informed decision making.
 
‘The information and recommendations provided by trusted healthcare providers is still the biggest driver of uptake,’ Dr Kaufman said.
 
‘While we’re aware of this worrying indication, it remains that the most important place where we combat vaccine hesitancy is in those one-on-one conversations with healthcare providers.
 
‘We’re really emphasising that remains our best strategy to combat misinformation concerns about vaccines, coming back to that trusted relationship with the patient.’
 
The paper suggests a ‘presumptive communication’ approach by the doctor, rather than an open-ended approach, followed by respectful engagement if concerns arise, to maintain the therapeutic relationship.
 
Even if vaccination is declined, the authors say that continuing the conversation can influence future acceptance and broader community protection.
  
Dr Kaufman is also involved in the National Vaccination Insights Project which looks at the barriers to uptake among parents, and says these insights can be used in tandem with the new paper to further combat hesitancy and increase childhood vaccine uptake.
 
‘We’ve just conducted the second year of the [National Vaccination Insights] survey and identified a worrying increase in people’s concerns about vaccine safety,’ she said.
 
‘As well as some decrease in people’s purported trust in the information they get about vaccines from their child’s ordinary doctor – which is a very concerning development.
 
‘It’s really important to shore up that trust through effective conversations, and this paper puts all of that in one place, along with the evidence. It’s a useful tool to draw clinicians’ attention to, so they can deliver those conversations in the most effective way possible.’
 
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childhood vaccination GP–patient relationship medical misinformation vaccine hesitancy vaccine uptake