1. Experts Forum on Vaccine Hesitancy David Bibus, MPH Krista Rietberg, MPH Lauren Greenfield, BSN, RN Julie Nugent-Carney, RN Betsy Hubbard, MSN Jeff Duchin, MD

2. Background Previous studies showed: 85% of sampled pediatricians report encountering partial vaccine refusal* 54% encounter total vaccine refusal* Rate of completely unvaccinated children has risen significantly since 1995.** Vaccine safety continues to receive a high level of media coverage. * Flanagan-Klygis, Arch Pediatr Adolesc Med/Vol 159, Oct 2005 ** Smith et al, Pediatrics/Vol 114 No1, July 2004

3. Background (continued) King County ranks 8 th among 30 counties in a national survey for the number of unvaccinated children 19-35 mo.* King County school exemption rate increased from 2.9% in 1999 to 4.5% in 2004 * Smith et al, Pediatrics/Vol 114 No1, July 2004

4. Objectives of Experts Forum Identify trends and factors contributing to vaccine hesitancy Identify strategies for individual health care practitioners and public health agencies to improve immunization rates among children of hesitant parents

5. Participants Eight health care practitioners: Five pediatricians One family practice physician Two naturopathic physicians Three Public Health staff Additional written comments submitted by ten physicians

6. Forum Structure Facilitated by public health staff using a structured set of questions Observers from: Immunization Action Coalition of Washington Washington State Department of Health Public Health – Seattle & King County

7. Results Part 1 Experts’ opinions on Contributing factors to vaccine hesitancy among parents Common parent concerns

8. Factors Contributing to Vaccine Hesitancy among Parents Prevalence of misinformation Parents can’t or don’t evaluate information sources Mainstream messaging vs. anti-vaccination messaging Lack understanding of societal benefits Parents don’t consider of risk to those who cannot be vaccinated Entrenched beliefs influence decision- making Not vaccinating congruent with lifestyle choice; alternative parenting styles

9. Factors Contributing to Vaccine Hesitancy among Parents (continued) Ineffective Communication from Health Care Professionals Parents want a non-judgmental atmosphere, not patronizing Vaccine proponents Use of scare tactics, manipulation

10. Common Concerns of Vaccine Hesitant Parents Fearful about vaccine safety issues Autism, mercury, additives, immune system “overload” View vaccination as unnecessary risk Diseases are rare: no perceived imminent threat Desire choices/alternatives regarding vaccination schedule

11. Results Part 2 Experts’ opinions on: What Works in Clinical Practice Healtcare community strategies for addressing vaccine hesitancy

12. What Works in Clinical Practice Create atmosphere of respect & rapport Take time to listen and have dialogue Acknowledge and directly address concerns Provide objective information and resources Many parents respond to data (i.e., info on risks and benefits; lack of evidence on autism theory) Share personal experiences handling Vaccine Preventable Diseases

13. What Works in Clinical Practice (Continued) Selective vaccination is an acceptable starting point Start with vaccines acceptable to family Discuss vaccines of concern Work towards additional vaccinations through a specific plan Provider’s strong recommendation important If provider is hesitant, parent will be hesitant

14. Healthcare Community Strategies for Addressing Vaccine Hesitancy Professional education Risk communication for immunization providers Create ways to keep providers current with vaccine issues Formalize approach: Can we treat hesitancy like other medical problems and develop a specific “treatment plan” for vaccine hesitancy cases with structured “interventions”? Communicating with Parents Get information to groups that influence parents (e.g. prenatal, parenting groups, peer educators) Early education takes burden off providers

15. Community Messaging from community leaders, include complementary healthcare providers Community organizing/grass roots approach Establish “social norm” Use of the Media Work with local media on coverage of disease outbreaks to establish relevance of immunization Vaccines need a more effective image in the public consciousness, e.g. “infection prevention” Healthcare Community Strategies for Addressing Vaccine Hesitancy (cont.)

16. Conclusions: Where do we go from here? Further assessment is needed to understand behavioral/social factors and other issues contributing to vaccine hesitancy. Is there a way to identify hesitant parents for early interventions? Develop informational resources and clinical strategies for immunization providers Develop communication channels for vaccine providers

17. Conclusions: Where do we go from here? Pilot and evaluate educational programs and clinical strategies. Conduct outreach with high-exemption schools Interact with media to promote data-based communications about immunizations. Continue the work of the Experts Forum.

18. Contact David Bibus, MPH, Deputy Division Manager David.Bibus@metrokc.gov (206)-296-7442 Krista Rietberg, MPH, Epidemiologist Krista.Rietberg@metrokc.gov (206) 296-4980