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Social justice, health policy, and vaccine-refusing parents


To me, it seems that we are trapped traveling around the world within ‘non-connected circles’ that encompass viewpoints adversely affecting significant scientific immunization advances developed to improve the health and well-being of infants, children, adolescents, their families, and all individuals who interact with them.

To me, it seems that we are trapped traveling around the world within ‘non-connected circles’ that encompass viewpoints adversely affecting significant scientific immunization advances developed to improve the health and well-being of infants, children, adolescents, their families, and all individuals who interact with them.

When belief systems collide

Adults who are vaccine hesitant and, in particular, those who are vaccine refusers are undermining both national and global public health initiatives that enable all individuals and community members to live within a society potentially free of vaccine preventable diseases (VPD). Pediatric nurse practitioners and other pediatric healthcare professionals, all too frequently, encounter vaccine hesitant and vaccine refusers within their day-to-day work and are often frustrated by the parent-professional encounter when parental beliefs and decisions are completely opposite to best practices in pediatric healthcare.

What works

In the article Navigating the antivax movement: 5 experts share their advice, in the July 2019 issue of Contemporary Pediatrics, Ms. Hilton reports on her interviews with 5 pediatric experts who describe various strategies to encourage vaccine hesitant parents to vaccinate their children. These strategies include, but are not limited to, establishing a parent-professional relationship, allowing time to talk within the parent-child-practitioner encounter, patience, acknowledgement of parental feelings with respect and empathic statements, and correction of misinformation with scientifically-validated information. These experts also discuss office-based strategies for talking with vaccine refusers who are spearheading the antivax movement.

Vaccine hesitant parents: Research efforts to combat the issues

Over the past few years, vaccine studies have focused on vaccine hesitant parents, as it was believed that the viewpoints of vaccine hesitant parents, were amenable to change if the parents were presented with scientific information, allowed to discuss their viewpoints with their child’s healthcare providers, and participated in the decision to vaccinate their children. Expert opinion, as described by Ms. Hilton, supports this position to work with vaccine hesitant parents to help them make a reasonable decision to vaccinate their children.

Changing minds via online interventions

Over the past 3-years, I have been studying vaccine hesitancy with colleagues, Altman & Fletcher in both prenatal women and mothers of young infants.1,2 We presented our preliminary data at the Centers for Disease Control and Prevention 2018 National Immunization Conference and at the Eastern Nursing Research Society’s annual research conference (2019) for our studies which investigated online interventions to enable these women to make informed decisions about vaccinating themselves and their infants. Final data results for the prenatal study revealed statistical significance (p = 0.01) in the intervention group for receipt of the influenza vaccine during pregnancy. While we are in the process of final data analysis for the mothers of newborn study and writing the manuscripts for both studies, our results reveal that the population of women who most often are vaccine hesitant, responded positively to interventions which provided them with the skills and ability to make informed decisions based on the analysis of the best-available scientific evidence.

The challenges of vaccine refusers

Vaccine refusers have established a powerful voice within social media and appear to be everywhere when any issue related to immunizations occurs. The 2019 measles outbreak in New York and across the United States is a direct result of parental vaccine refuser deciding to not vaccinate their children. Pediatric healthcare providers tend to agree that we should continue to dialogue with vaccine refusing parents, however, considering the most recent measles outbreak along with the physical and emotional trauma experienced by those who cannot be vaccinated, (eg, immune-compromised children and adults, etc.), it is time for healthcare providers and policy makers to join together to change our current ‘non-connected immunization circular paths’ to interconnected paths that embody the principles of social justice. This means enacting healthcare immunization policies that reflect a system that values the tenets of public health and child health with the right to be raised in a society in which they are safe from vaccine-preventable diseases (VPDs). Why should innocent infants, whose immune systems are in the earliest stages of development, be unknowingly exposed to any VPD?  Bester3 argues for implementation of the principles of social justice for vaccines in his statement: “a just society is obligated to protect its children against serious vaccine preventable diseases such as measles through adequate levels of vaccination.”

Vaccination as a right

Thus, from Bester’s analysis of social justice and vaccine policy, the ethical considerations are moved away from “what is owed parents to focus instead on what is owed to children.” Our patients are the infants, children, and adolescents-not the family members. While we provide care within a family-centered framework, our first obligation is to provide safe, effective, quality healthcare to every child. Vaccines which prevent a child from experiencing the wrath of VPDs are the right of every child!  We, the healthcare providers, must speak with one unified voice to advocate for social justice and healthcare policies that serve the best interests of the children with whom we are charged to serve and protect. 

One final thought on future research

Limited studies are available that have investigated the best practices for understanding the rationale leading to the resistance of vaccine refusing parents. Rigorous studies that investigate the phenomenon of vaccine resistance are needed to adequately address the problem, the issues of social justice, and to foster support for effective public health vaccine policies as well as to inform policy makers.   


1. Hallas, D., Altman, S., & Fletcher, J. (2019). Reducing Vaccine Hesitancy in Prenatal Women Using a Web-Based Informed-Decision Making Intervention. Eastern Nursing Research Society, Providence, R.I. Oral Presentation.

2. Hallas, D., Altman, S., Dalson, R.A.M., & Fletcher, J. (2018). Reducing Vaccine Hesitancy in Prenatal Women: Results of a Web-Based Intervention Study. National Immunization Conference, Washington, D.C. Poster Presentation.

3. Bester, J.C. (2018). Not a matter of parental choice but of social justice obligation: Children are owed measles vaccination. Bioethics, 32, 611-619.

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