Update on parental vaccine refusal

February 1, 2010

Childhood immunizations are one of the most successful public health interventions of all time.

Keypoints:

Childhood immunizations are one of the most successful public health interventions of all time. However, as the threat of vaccine-preventable diseases has decreased, an increasing number of parents are raising concerns about the safety and necessity of vaccination.

How many parents actually refuse vaccines? It's difficult to know for sure. One survey found that more than 90% of pediatricians had at least 1 parental vaccine refusal during the previous year,1 and another found that 50% had a family who refused all vaccines.2 At the same time, overall immunization rates in the United States are at an all-time high; the latest National Immunization Survey (NIS) reports that more than 90% of children received most recommended vaccines.3

The good news is that many families who initially refuse vaccines do go on to have their children vaccinated at a later date, so vaccine refusal at 1 visit does not necessarily mean that children will remain unvaccinated. On the other hand, the NIS data may not be as reassuring as they appear. The NIS uses a complex random sampling formula to estimate national immunization rates. It is not particularly sensitive to vaccination rates at the local level and may not detect small communities with high rates of undervaccination. The mere fact that the United States recently experienced the largest measles outbreak in more than a decade suggests that immunization rates may be lower than we think.4

Regardless of how vaccine refusal rates are measured, the increasing number of parents who refuse vaccines is concerning. This article explores some of the reasons why parents may choose to refuse vaccination, offers suggestions for addressing these worries, and discusses specific vaccine safety concerns.