Emphasizing societal benefits of vaccines has been linked to increased vaccination intentions in adults. It is unclear if this pattern holds for parents deciding whether to vaccinate their children. The objective was to determine whether emphasizing the benefits of measles-mumps-rubella (MMR) vaccination directly to the vaccine recipient or to society differentially impacts parents' vaccine intentions for their infants.
In a national online survey, parents (N = 802) of infants <12 months old were randomly assigned to receive 1 of 4 MMR vaccine messages: (1) the Centers for Disease Control and Prevention Vaccine Information Statement (VIS), (2) VIS and information emphasizing the MMR vaccine's benefits to the child, (3) VIS and information emphasizing societal benefits, or (4) VIS and information emphasizing benefits both to the child and society. Parents reported their likelihood of vaccinating their infants for MMR on a response scale of 0 (extremely unlikely) to 100 (extremely likely).
Compared with the VIS-only group (mean intention = 86.3), parents reported increased vaccine intentions for their infants when receiving additional information emphasizing the MMR vaccine’s benefits either directly to the child (mean intention = 91.6, P = .01) or to both the child and society (mean intention = 90.8, P = .03). Emphasizing the MMR vaccine’s benefits only to society did not increase intentions (mean intention = 86.4, P = .97).
We did not see increases in parents’ MMR vaccine intentions for their infants when societal benefits were emphasized without mention of benefits directly to the child. This finding suggests that providers should emphasize benefits directly to the child. Mentioning societal benefits seems to neither add value to, nor interfere with, information highlighting benefits directly to the child.
Re:Role of Pediatricians in Tackling Vaccine Hesitancy
We thank Dr. Wales for pointing out that more work is needed to understand how parents make decisions about vaccinating their children. Indeed, our study only explores one facet of this complex topic - the relative importance of societal benefits, such as herd immunity, in influencing vaccine decision making. We especially appreciate Dr. Wales's point about the importance of the pediatrician's advice in helping parents make vaccine decisions for their children. We look forward to much more research on parents' vaccine decision making and effective vaccine communication approaches.
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Role of Pediatricians in Tackling Vaccine Hesitancy
Re: Hendrix, et. al., Vaccine Message Framing and Parents' Intent to Immunize their infants for MMR. Pediatrics 2014;134;e675; originally published online August 18, 2014;
I applaud the author's conclusion that parents respond to personal health benefits of their child to MMR immunization. However, it is not yet clear if this study can be generalized to the real-world. Although a small minority of parents distributed across each intervention arm had refused vaccines for another child, it is possible that many more parents had considered an alternative immunization schedule, which could also leave their child more susceptible to vaccine-preventable diseases . It is not clear whether the intervention arms had similar proportions of parents who had considered or enacted alternative immunization schedules, and it is also not clear whether their intent to immunize with MMR was an intent to immunize on time.
As the authors discussed, there may be a role for the pediatrician to have an influence on vaccine decision-making, which has been seen in prior studies [2, 3]. In a local qualitative study of immunization habits of parents of children with Autism-Spectrum Disorders (who report concern regarding symptoms of Autism-Spectrum Disorders at the same time as they make the decision to immunize), over half of parents cited their pediatrician as primary sources of trusted immunization information (unpublished data). When it came to identifying sources of trusted immunization information, these parents consistently ranked their pediatrician over written information from any other source. A previous systemic review has also not found any evidence that written materials help to improve rates of vaccine hesitancy .
I believe that further understanding the reasons why parents immunize (or do not immunize) can help pediatricians tailor interventions to tackle vaccine hesitancy, and we applaud any efforts to elucidate these reasons. Ultimately we hope this leads to effective interventions to address vaccine hesitancy.
Danielle P. Wales, M.D., M.P.H.
 Glanz JM, Narwaney KJ, Newcomer SR, Daley MF, Hambidge SJ, Rowhani-Rahbar A, et. al (2013). Association between undervaccination with diphtheria, tetanus toxoids, and acellular pertussis (DTaP) vaccine and risk of pertussis infection in children 3 to 36 months of age. JAMA Pediatrics, 167(11): 1060-1064.
 Mergler MJ, Omer SB, Pan WKY, Navar-Boggan AM, Orenstein W, Markuse EK, et. al (2013). Association of vaccine-related attitudes and beliefs between parents and health care providers. Vaccine, 31(41): 4591- 4595.
Benin AL, Wisler-Scher DJ, Colson E, Shapiro ED, Holmboe ES (2006). Qualitative Analysis of Mothers' Decision-Making About Vaccines for Infants: The Importance of Trust. Pediatrics, 117(5): 1532-1541.
 Sadaf A, Richards JL, Glanz J, Salmon DA, Omer SB (2013). A systematic review of interventions for reducing parental vaccine refusal and vaccine hesitancy. Vaccine, 31(40): 4293-4304.
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