Vaccinations have been hailed as one of the greatest public health advancements in the 20th century, credited with greatly reducing the incidence of childhood diseases and deaths. However, this very success may have softened the perceived seriousness of these diseases in the eyes of many parents, leading them to question the benefits of immunizing their children.
To examine the extent of immunization concerns, the U.S. Centers for Disease Control and Prevention (CDC) worked with Gallup to conduct the 2003 Immunization Encounter Survey*. This study took an in-depth look at 778 immunization encounters involving children aged 24 months and younger. Both parents and physicians were asked about their experiences when parents take their children to the doctor's office for vaccinations.
Pre-Vaccination Encounter Results
What do parents worry about when they take their children to be immunized? The survey results show that about one in five parents (21%) who take their children to be vaccinated are concerned about the recommended vaccinations on several fronts.
The three major concerns in the eyes of these parents:
- That children will receive too many vaccinations during one office visit (47%).
- That too many vaccinations will be administered during the first two years of the child's life (39%).
- The possibility that children will experience side effects (44%).
Vaccination Encounter Results
Gallup asked physicians to recall which vaccination concerns were discussed during the visit, and who initiated the discussion. Parents were also asked which vaccination concerns they discussed with their child's physician.
The results suggest that physicians are more likely than parents to initiate conversations about immunization issues or concerns. For each topic measured, physicians reported that they, rather than the parent(s), initiated the discussion. It is possible that recall bias occurred (that is, the physician remembered initiating a discussion that the parent actually started), but according to physicians, parents initiated discussion about each issue less than 20% of the time. This finding indicates that physicians tend to perceive themselves as proactive and comprehensive when they discuss vaccination issues and concerns with parents.
Nearly all parents (89%) appear to be concerned about the number of injections that their children receive in a single visit, but less than half of the physicians (43%) participating in the survey recall that they discussed this anxiety. Physicians seem to be either underestimating parents' concerns about this (and therefore don't tend to bring it up), or they believe that they are addressing the issue when they discuss a different topic.
Results also show that parents are concerned about the immediate consequences or reactions to vaccinations. Issues such as short-term side effects, pain or discomfort associated with vaccinations, and the general safety of recommended vaccines are raised and discussed more frequently than concerns about vaccine effectiveness or long-term side effects.
Finally, conversations about specific vaccine-related concerns appear to be more memorable to physicians than to parents. On average, physicians participating in the survey indicated that four or five topics were discussed during visits, while parents recalled talking about only two or three.
Bottom Line
Many parents have questions related to the safety and effects of vaccines on their children. If these attitudes result in reduced participation in the vaccination schedule, the potential public health consequences could be serious. However, the survey results show that physicians are trying to take a proactive role in educating parents on vaccination issues -- an important factor in maintaining high vaccination rates.
*Ninety-five family practices and pediatric medical practices were randomly selected from a pool of 300 practitioners from the physician survey component of the National Primary Care Immunization Study. To qualify, each physician practice had to average weekly vaccinations to nine or more children aged 24 months and younger. Each participating practice was assigned a week in June 2003 when all parents of children receiving vaccinations would be asked to answer a confidential survey consisting of pre- and post-visit vaccination questions. Responses were received from 778 vaccination encounters.
Physicians were also asked to complete a post-vaccination survey for each encounter. Participating practices were asked to complete a series of questions about the patient's vaccination history, vaccine administered, and practice demographics.
At the completion of the vaccination encounter, each parent placed his or her survey in a sealed envelope and returned the envelope to the practice. At the end of the week, the practice returned all practice, physician, and patient surveys to Gallup.