vaccine hesitancy, measles, MMR, immunizations


Background: Although national and state immunization coverage rates are high, the resurgence of measles points to local pockets of under-vaccination that correspond with higher non-medical exemptions and lower parental confidence on vaccines. The reported geographic clustering of vaccine hesitancy, particularly against MMR, points to social drivers that shape parental perceptions and decisions on immunization.

Objectives. To analyze: (1) why parents delay or refuse vaccination, specifically MMR; (2) social context of vaccine hesitancy and perceived reliable sources of vaccine information between vaccine-hesitant and vaccine-compliant parents/guardians; (3) role of families in countering vaccine hesitancy; (4) strategies at the public health, primary care, and government levels.

Methods: Seven databases (Web of Sciences; Scopus; Medline/PubMed; Embase; CINAHL; PsycINFO; and Proquest) were reviewed systematically yielding 828 scholarly articles on vaccine hesitancy published between 2000 to 2019.

Results. Vaccine hesitancy spans a spectrum from delay and selective adherence to total refusal of vaccines. Pain, adverse reactions, safety, schedule, internet information, and MMR link to autism were among the reasons for vaccine hesitancy. Parents feared vaccine ingredients, such as thimerosal, more than vaccine-preventable diseases. Vaccine-hesitant parents were in middle-income/affluent areas, with college education or higher, and preferred internet personal vaccine narratives over physician-based information. The literature lacked family-centered approaches to vaccine hesitancy.

Conclusions. Vaccine hesitancy creates a problem for highly contagious diseases, such as measles, particularly in under-vaccinated communities that serve as hotspots for transmission. Tailoring vaccine messaging to parents and addressing the gaps in family-centered approaches may counter the social determinants that influence parental assent.

Original Publication Citation

Novilla, M. L. B., Goates, M. C., Showalter, M., Novilla, L. K., Doria, R., Dang, M., Leffler, T., Aldridge, K. (2020, October). Why parents say no to having their children vaccinated against measles: Social determinants of parental perceptions to vaccine hesitancy. Presented at the American Public Health Association Annual Meeting (online).

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Harold B. Lee Library

University Standing at Time of Publication

Associate Professor