Understanding Parental Decision-making about Vaccines: A Neglected Research Area

In February 1998, Andrew Wakefield published what was eventually shown to be a fraudulent paper speculating on a possible link between the measles component of the MMR vaccine and autism spectrum disorders.  On the day the paper was released, Wakefield stood at a lectern at London’s Royal Free Hospital and told the assembled news media, “I cannot support the continued use of [the measles, mumps, and rubella] vaccines given together.”  The response of the majority of the medical and scientific communities at the time ranged from mild concern to shrugging indifference: Wakefield’s research was so obviously shoddy, his conclusions so demonstrably unsupported by the evidence, who could possibly take him seriously?  Lots of people, it turned out—and in the coming years, MMR uptake dropped to as low as 54 percent in some areas of the UK.

The following summer, the Centers for Disease Control and Prevention and the American Academy of Pediatrics released statements explaining why they were recommending that the mercury-based preservative thimerosal be removed from most pediatric vaccines.  The language used in those statements—there was “no evidence of harm”; the move would “make safe vaccines even safer”—were meant to reassure the public.  They did the opposite, sparking a parent-led movement whose members remain convinced to this day that mercury is a leading cause of autism—despite the fact that thimerosal has been absent from standard pediatric vaccines for more than a decade.

Medical interventions do not take place in a vacuum – they occur in particular societal frameworks at specific moments in history.  Without scientific advances these interventions would not be possible—but without effective communications strategies, they will never reach their full potential.  Perhaps nothing illustrates this better than the ways in which the two events described above—events  that occurred across an ocean from each other, well over a decade ago—continue to influence public sentiment about vaccine efficacy and safety even today.  In the late 1990s, it was difficult to find reliable, evidence-based information about vaccines that could be easily understood by the layperson.  When misinformation began to spread, there was no way to contain it—and no plans in place as to how best to combat it.

Today, that is no longer the case.  This welcome new reality is illustrated by the projects and programs that have emerged out of Goal 3 of the 2010 National Vaccine Plan, including the development of vaccines.gov as an easy-to-navigate web portal for reliable, straightforward information about vaccines.

But producing reliable content is only one part of the challenge.  Even more important are the ongoing efforts to understand how and why people make the decisions they do. We wouldn’t, after all, rely on guesswork when making decisions about vaccines, so why should we depend on informed speculation when coming up with effective communications strategies?  Ongoing, sophisticated research programs that examine people’s attitudes and beliefs about vaccination, as well as the factors that influence these sentiments will determine whether we’ll be successful in inoculating ourselves against the misinformation and propaganda campaigns of the future.