Going back to school: promoting vaccine acceptance by reaching the parents of tomorrow

Author: Robb Butler, August 15 2017: Are current efforts to promote parental vaccine acceptance, shore up community support and educate parents and health workers on the value of immunization paying off? Or, should we be looking at a longer-term investment case - one where future generations are more resilient to vaccine safety scares, fake vaccine news, rumours and allegations?

Despite the fact that vaccines are the safest and most effective tools for preventing infectious diseases, some parents and individuals are skeptical of vaccines, doubting their benefits and safety, and questioning the need for them.

Addressing this starts with understanding the context of vaccination decision-making. Vaccination decision-making is complex. Influencing it requires local insight and perspective, community mobilization, resources and political support. It is also a time-bound action - where we make a decision to take action in a short window of time - and one that for the overwhelming majority of people (thankfully) results in them vaccinating their children, or themselves. The context, the environment and the 'moment' influence the decision, to varying degrees.

Typically, national health programmes attempt to define the determinants of vaccine acceptance and 'hesitancy', to understand how they influence a decision to vaccinate, and then go about addressing, modifying or levering them to achieve a positive outcome - where every individual benefits from the vaccines available in the national immunization schedule. But can we confidently argue that such efforts are sufficient?

In a region with sufficient resources and capacity to tackle sub-optimal vaccine coverage and uptake, vaccine skepticism and a lack of parental and health practitioner confidence (among other factors) have resulted in a failure to achieve the desired protective coverage levels in Europe, resulting in vaccine-preventable disease resurgence, hospitalizations and deaths, and outbreak-associated economic costs. Conventional methods to tackle vaccine hesitancy may be failing to produce any diligent long-term result, as the population again start making inferences based on rumour, information, allegation, and media articles after the effects of conventional campaigns diminish. The expectations that frontline health care practitioners will possess the skills in the future to more effectively communicate and counsel, provide facts and information and will dedicate more time to vaccine-skeptical or hesitant parents that they encounter, is probably unreasonable. That said, we need to reconsider what approach might build the longer-term resilience of a community.

Maybe a change of tack is required - maybe more time and effort should be invested in reaching individuals in a community before the health care practitioner, general practitioner or pediatrician ever meets them in their parental role: targeting them before they become adults and before they assume the role of parents or caregivers. The lessons learned by the scientific community on addressing vaccine hesitancy among the parents of today should pave the way to design interventions for the parents of tomorrow.

Vaccine education warrants a broader coalition of actors if we are to ensure that future parents are wiser immunizers. Schools are the primary source of knowledge in a community, and there is evidence that the school setting offers a unique opportunity to reach important target groups with nuanced and comprehensible health information and to promote positive behavior change for children themselves and their families. Targeting school children provides an opportunity to create an understanding of immunization at an early age, fostering life-long acceptance of immunization, and to prepare them for the vaccines they will receive as teenagers and adults. Sexual and reproductive health, alcohol and substance abuse, anti-smoking messaging, road safety, these topics all feature in my children’s school curriculum before they turn 13 years of age. Immunization does not. This is a missed opportunity, depriving the children of the vital knowledge about the life-saving potential of vaccines beneficial both to them and also protecting the next generation in their role as parents and/or caregivers.

I am excited by the prospects and potential of the inter-sectoral approach, by the efforts of a few entities across Europe to engage children in classrooms and beyond, and to my own team here at WHO [World Health Organization]/Europe and their efforts to introduce game-based learning techniques to create commitment and motivation for kids to learn through personal experiences in the classroom and with their parents at home. However, more needs to be done. Our objective should not be to merely teach children about vaccination and the immune system; but to build scientific literacy and their ability to understand the difference between evidence and personal experience or emotions. These are the competences that will build resilience against vaccine safety scares and allow these children, throughout their lifetime, to make informed decisions about the health and wellbeing of themselves and their children.

This is not a call to abandon vaccination communications and awareness, advocacy and social mobilization programmes, initiatives and projects; we should collectively continue to advocate for increased support, commitment and resources towards effective targeted approaches but also acknowledge that the health sector alone may not assure that we meet disease control, elimination and eradication targets. Let's complement efforts and expand the base of vaccination education in an attempt to dampen the skepticism and complacency that amplify disease outbreaks today, in the decades to come.

Maybe it's time we went back to school.

Note: The views and comments here are those of the author and do not necessarily reflect those of World Health Organization or any other organization.

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