Parental Trust and Beliefs after the Discovery of a Six-Year-Long Failure to Vaccinate

"Our study suggest[s] the possibility to use traditional and new media to cope with vaccine hesitancy and stresses the importance of an active presence of healthcare institutions on multiple communication channels to restore threatened trust and herd immunity."

Vaccine hesitancy is a complex problem influenced by many factors, including the context, time, place, and specific vaccine. It can be exacerbated by specific incidents, such as one examined in this article: Italy's "Codroipo case". Between 2009 and 2015, failure to vaccinate episodes occurred in a specific FVG (Friuli Venezia Giulia) local health district (AAS3 - Azienda per l'Assistenza Sanitaria no.3). This six-year-long event was linked to professional misconduct consisting in improper vaccine administration by a public health nurse. It raised the epidemic risk for the local population, as it left 5,444 children potentially unprotected from vaccine-preventable diseases (VPDs). The aims of the present study were to evaluate whether a multi-channel vaccination campaign that was implemented after the Codroipo case reached the intended population by estimating parental adherence to recommendations to get their children revaccinated and to investigate parental vaccine confidence levels and trusted sources of information after the failure to vaccinate event.

Specifically, the Codroipo case prompted the "Vaccinare-sì" campaign, planned by a multi-stakeholder working group (see Related Summaries, below). The aim of this campaign was to recover herd immunity by administering 20,441 missing vaccine doses, supported by:

• information release management, such as press conferences, public meetings, public notices, and collaborations with mayors;
• the creation of a dedicated toll-free number, an institutional email address, and a WhatsApp® channel; and
• active re-enrollment of families in the vaccination programme through phone calls and letters by mail.

For the study, between May and June 2017, 2,557 parents were surveyed at the local vaccination clinic. While 279 parents were non-hesitant (10.9%) and 1,491 were hesitant acceptors (58.3%), 38 (1.5%) refused to have their children revaccinated. The majority of parents considered vaccination to be a fundamental practice (73.9%), but many were worried about potential side effects (38.8%) or doubtful about the effectiveness of some vaccines (11.0%). According to parents, 19.7% of them (57) changed their opinion about vaccines after the Codroipo case.

The proportion of parents looking for more information was considerable, as the data showed that 54% of them agreed to revaccination only after counseling. Respondents obtained information about the "Vaccinare-sì" vaccination campaign most frequently from: print media (18.8%), physicians (16.0%), and relatives and friends (12.1%). On the other hand, sources of information reported as the most reliable were institutional ones: healthcare professionals and ad-hoc services such as the AAS3 email address, website, and toll-free number. When considering trusted sources of information after the Codroipo case, the level of trust toward health professionals again is notable in light of the fact that a professional misconduct emerged as the main cause of the failure to vaccinate. The researchers suggest that the inclusion of a Web 2.0 strategy may have helped in strengthening the relationship between citizens and healthcare institutions, enabling parents to interact with healthcare professionals in a tailored manner.

In conclusion, this study found that, after the Codroipo case, most parents chose to have their children re-vaccinated. Nevertheless, this result cannot be definitively ascribed to the revaccination campaign; the underlying behaviour of individuals and the community could have played an important role as well, the researchers stress. "More studies are needed to confirm the importance of a coherent multi-channel communication strategy in order to counteract vaccine hesitancy."