Facilitating Intent to Vaccinate, Knowledge, and Change in Vaccine Belief

Saturday, 7 November 2015

Amy Z. Eby, MSN, RN, APN
Desert Shores Pediatrics, Chandler, AZ, USA


The first vaccine was released over 200 years ago and has forever changed the world we live in today (Stern & Markel, 2005). With the help of vaccines, people are able to build antibodies which enable and create a defense against illnesses such as rabies, tetanus, typhoid fever, influenza, measles, pneumococcal, meningococcal disease, hemophilus influenza, and other vaccine preventable illnesses. Vaccination efforts and health policy have been an integral component in the prevention and the fight of unwanted infectious diseases in our local communities. Unfortunately, with the success of vaccines, the fear of contracting a vaccine preventable disease has diminished (Offit, 2011).

Over the past 10 years, the rate of parents refusing vaccines has increased causing the risk of infectious disease to the young and old to also increase (Dempsey et al., 2011). Currently 1:10 parents are reporting the use of an alternative vaccine schedule (Cooper, Larson, & Katz, 2008). Furthermore, in a typical month, 89% of medical providers report parents request to follow an alternative schedule, administer one vaccine per visit, or refuse vaccines altogether (Kempe et al., 2011). As a result, 95% of medical providers state that the amount of time to discuss parent’s concerns about vaccines is a major barrier to practice (Kempe et al., 2011).

While the current national vaccine rate remains high enough to develop herd immunity, there are growing pockets in the US with low vaccination rates making herd immunity nearly impossible to obtain (Centers for Disease Control and Prevention, 2014). Parents of today are more concerned with the possible side effects from vaccines and are refusing to vaccinate their children from the deadly diseases of our past and the present (Offit, 2011). The increased rate of refusal and use of alternative vaccine schedule is a threat to our communities. Once the vaccine rate falls below 95%, a community loses its herd immunity and outbreak will occur (Mennito & Darden, 2010). When compared to parents who follow the Centers for Disease Control and Prevention (CDC) schedule, only 28% of parents who follow an alternative vaccine schedule strongly agreed that their child was more at risk for contracting disease and contributing to the spread of vaccine preventable diseases (Dempsey et al., 2011).

In the United States (U.S.), there are current vaccine laws that require vaccinations upon kindergarten entry (Birnbaum, Jacobs, Ralston-King, & Ernst, 2013). Nineteen U.S. states, including the state of Arizona, allow personal beliefs exemptions (Vaccine Exemptions, 2012).  School exemption rates, in the state of Arizona, have doubled in the last 10 years and increased 0.8% in one year from 2012-2013 since the implementation of personal belief exemptions (Centers for Disease Control and Prevention, 2012; Arizona Department of Health, 2014). In the 2013-2014 Arizona school year, a total of 4,035 kindergartners, 4.7%, filed for vaccine exemption (Arizona Department of Health Services, 2014). In fact, in 2013 only 69% of children in Arizona were protected from the seven vaccines series compared to 72% nationally (Arizona Department of Health, 2013). A study by Birnbaum et al. (2013) from the University of Arizona found that schools with significantly higher rates of personal belief exemptions included schools with the highest proportion of higher income white students and lowest proportion of free and reduced lunches.

The above statistics are concerning and definitely affect other communities across the United States. As of January 30, 2015, there was one large measles outbreak at a Disney theme park contributing to smaller outbreaks in 14 states causing a total of 102 cases of measles this year (Centers for Disease Control and Prevention, 2015). Unfortunately, this latest outbreak includes 16% of the total cases documented in 2015 (Centers for Disease Control and Prevention, 2015). The cost to treat a child with measles is 23 times the amount spent on the MMR vaccine (Armstrong, 2007). Vaccinating a child against DTaP, HIB, MMR, and Hepatitis B provides a cost savings of 5:1 in direct health care spending and 17:1 in societal costs (Lieu, McGuire, & Hinman, 2005). As a result, vaccinating 90% of children from 1994-2013 is estimated to have saved society $1.38 trillion dollars in total societal cost over the lifetime of children born during this time span (Centers for Disease Control and Prevention, 2014). The current CDC immunization schedule could prevent approximately 322 million illnesses, 21 million hospitalizations, 732,000 deaths, and save the U.S. 69 billion dollars spent by the health care industry treating vaccine preventable diseases (National Committee for Quality Assurance, 2012)(Centers for Disease Control and Prevention, 2014).

Pediatricians and other healthcare providers are concerned with the increased number of families choosing to not vaccinate or follow an alternative vaccine schedule (Committee on Practice and Ambulatory Medicine and Council on Community Pediatrics, 2010). The U.S. government has noticed these changes and has set vaccine goals in the Healthy People 2020 report. In addition, the state of Arizona in 2014 implemented an action plan to decrease vaccine exemptions affirming the state’s commitment to help educate the public on vaccine preventable diseases (Arizona Department of Health Services, 2013).  


Arizona Department of Health. (2013). Immunications. Retrieved from http://azdhs.gov/phs/immunization/documents/newsletters/immunications/13-fall-immunications.pdf

Arizona Department of Health Services. (2013). Action Plan to Address Increasing Vaccine Exemptions. Retrieved from http://azdhs.gov/phs/immunization/documents/statistics-reports/action-plan-address-vaccine-exemptions.pdf

Arizona Department of Health Services. (2014). Arizona kindergarten immunization coverage levels2013 - 2014 school year. Retrieved from http://azdhs.gov/phs/immunization/documents/statistics-reports/kindergarten-coverage-2013-2014.pdf

Armstrong, E. P. (2007, September). Economic benefits and costs associated with target vaccinations. Journal of Managed Care Pharmacy, 13(7), S12-S15.

Birnbaum, M., Jacobs, E., Ralston-King, J., & Ernst, K. (2013). Correlates of high vaccination exemption rates among kindergartens. Vaccine, 31, 750-756.

Centers for Disease Control and Prevention. (2012). National, state, and local area vaccination coverage among children aged 19-35 months- United States, 2011. Morbidity and Mortality Weekly Report, MMWR, 61, 689-696.

Centers for Disease Control and Prevention. (2014). National, state, and local area vaccination coverage among children aged 19-35 months-United States, 2013. Morbidity and Mortality Weekly Report, MMWR, 63, 741-748.

Committee on Practice and Ambulatory Medicine and Council on Community Pediatrics. (2010). Policy statement: Increasing immunization coverage. PEDIATRICS, 125, 1295-1304.

Cooper, L., Larson, H., & Katz, S. (2008). Protecting public trust in immunization. Pediatrics, 122(1), 1-5.

Dempsey, A., Schaffer, S., Singer, D., Butchart, A., Davis, M., & Freed, G. (2011). Alternative vaccination schedule preferences among parents of young children. Pediatrics, 128, 848-856.

Kempe, A., Daley, M., McCauley, M., Crane, L., Suh, C., Kennedy, A.,...Dickinson, M. (2011). Prevalence of parental concerns about childhood vaccines: The experience of primary care physicians. American Journal of Preventive Medicine, (40)5, 548-555.

Lieu, T. A., McGuire, T., & Hinman, A. R. (2005). Overcoming economic barriers to the optimal use of vaccines. Health Affairs, 24(3), 666-679.

Mennito, S. H., & Darden, P. M. (2010). Impact of practice policies on pediatric immunization rate. Journal of Pediatrics, 156, 618-622.

National Committee for Quality Assurance (2012). The state of health care quality 2012. NCQA, 1-228. Retrieved from www.ncqa.org

Offit, P. A. (2011). Deadly Choices: How the anti-vaccine movement threatens us all. New York: Basic Books.

Stern, A., & Markel, H. (2005). The history of vaccines and immunization: Familiar patterns, new challenges. Health Affairs, 24, 616-621. http://dx.doi.org/10.13771hlthaff.24.3.611

Vaccine exemptions. (2012). Retrieved from http://www.vaccinesafety.edu/cc-exem.htm