Over the past two decades, the number of vaccinations for infants has more than doubled in most industrialized nations. With the development of additional vaccines and their potential implementation on the horizon, especially into increasingly crowded immunization schedules, additional vaccination visits or co-administration of multiple vaccines will be needed in order to accommodate such medical advances. In this context, it is helpful to confirm the attitudes toward new vaccinations among parents of young children, as well as among the HCPs who will recommend and/or administer these vaccines. Whereas other surveys have focussed on attitudes to vaccination at the national level, for example in Italy [1
], Belgium [10
], Germany [6
], the Netherlands [5
], and the USA [7
], this New VIP survey represents the first comprehensive, multinational investigation of contemporary attitudes and preferences toward vaccination and its related issues.
The New VIP survey illustrates the interdependence among parents, HCPs, and decision-making bodies with respect to infant immunizations in general. Three quarters of parents accept all of the vaccines according to their country’s recommended immunization schedule (and a large majority cite it as a top reason to vaccinate), and a similar proportion of parents trust their doctors’ or nurses’ recommendations regarding vaccinations. Fortunately, for the remaining 25 % of parents whose education will be an important factor in achieving high rates of vaccine coverage, 85 % of HCPs recognize that they are responsible for educating parents on vaccines and the diseases they prevent, and they also recognize that their strong recommendation impacts parental acceptance of vaccination. A study in Italy [1
] found that 82.7 % of pediatricians routinely educate parents about the recommended vaccinations for their children, while 95 % of German parents “regard their pediatrician as the most important source of information regarding immunization” [6
], and US parents who hesitated to have their child vaccinated tended to follow the physician’s recommendation [7
It is interesting then that HCPs rate the inclusion of a vaccine on the official schedule as only the second-highest-rated factor impacting their decision to recommend a new vaccine; the severity/lethality of the prevented disease was actually rated as the main factor by a wide margin. One might consider the decision process of the surveyed HCPs quite appropriate because it is, in fact, those diseases that are perhaps the most difficult to treat adequately that one should most attempt to prevent. In fact, physicians rated disease severity far higher than they did either the disease incidence or their need to have personal experience with the disease. Furthermore, a large majority of physicians did not feel that they needed to wait for broad community experience before they were ready to recommend new vaccines to their patients.
Governmental bodies and health care policy makers who formulate recommendations as part of national immunization programs, in turn, are reciprocally influenced by the guidance from the medical community, typically via specific expert advisory panels as well as by the likelihood that the general public will accept a potential new vaccine. Furthermore, such vaccination recommendations are typically accompanied by public funding, which is often justified by the knowledge that parents would be willing to pay for such vaccines themselves, if need be. Hence, it is comforting to see that a majority of parents would be equally accepting of a vaccine even if they had to pay out of pocket.
It is also notable that while parents tend to cite inclusion on the vaccination schedule as a key reason to vaccinate, the converse is apparently not true. Specifically, lack of inclusion of a vaccine on the immunization calendar was noted by only a small fraction of respondents to indicate that the vaccine would not be worth getting.
In the countries surveyed, infants typically received a PCV vaccine as well as vaccination against DTaP, IPV, HepB, and Hib in different combinations, typically resulting in two or three injections per infant visit. Parents and HCPs felt most comfortable with the number of injections per visit that corresponded to the current official recommendations and currently available vaccine combinations in their country. Our data are consistent with those from Belgium [10
] and the Netherlands [5
] where most parents do not want their child to receive more than two injections per visit, so if a new vaccine were then to be introduced into the schedule, it would most likely require either (a) concomitant administration with the existing vaccinations during these HCP visits or (b) additional office visits for vaccination. Based on the survey responses, parents seem to balance, relatively equally, two primary factors against each other: the wish to ensure that the child receives the necessary vaccinations vs. the desire to avoid too much discomfort at any given office visit.
This survey has revealed that any theoretical “overworking” of a child’s immune system resulting from too many vaccines at once is only a concern for 38 % of parents, and such a view among parents about this topic was even less of an issue than the HCPs’ perceptions of such parental concern. This contrasts with German parents, of whom only 21 % were worried about overloading their child’s immune system [8
]. However, a majority of HCPs perceived the main reason for parents choosing not to vaccinate their child was the belief that the vaccines may be unsafe and could trigger serious long-term diseases, but over 91 % of German parents trust that recommended vaccines are safe [6
]. Yet, HCPs are ideally positioned to understand the clinical data demonstrating vaccine safety and efficacy and to therefore provide reassurance and strong recommendations for a vaccine to the parents.
Finally, using the currently relevant example of an upcoming new vaccine, even while some parents may have been confused about which vaccines their children have already received, this survey revealed that even a brief, objective education of the parents on this vaccine-preventable disease could significantly increase their likelihood of adoption of a new vaccine. Furthermore, a nearly equal number of parents would be in favor of additional, separate office visits to accommodate the new vaccinations as would be the number of parents who would wish to keep the current number of office visits and administer the new vaccine concomitantly with those currently on the schedule.
It should be noted that this survey has a number of limitations. This questionnaire included realistic, but hypothetical, scenarios, and it is not possible to ascertain whether parents or HCPs would actually follow through with their stated intentions. As with any survey, our findings may be influenced by the recall bias and response bias of the surveyed individuals. This may result in a possible tendency of some survey participants to overstate their experience or interest in a desire to please the surveyor. Finally, our online survey involved parents and HCPs with internet access, implying a higher socioeconomic and educational level; this potential selection bias might impact the generalizability of our result to the whole population, although our data are consistent with those of an internet-based survey of German parents [6
]. The survey of highly educated Dutch parents indicated that their unwillingness to accept new vaccines was due to lack of education about them [5
In conclusion, these survey findings suggest that a population-wide effort to improve global awareness of a specific vaccine-preventable disease would be required for any successful vaccine initiative, and these data may be useful for public health officials and policy makers as they update existing infant immunization schedules to accommodate new vaccines. Notably, both HCPs and the public in general seem to be open to the introduction of new vaccinations (especially for those that help to protect against diseases with a high degree of severity or mortality) and their inclusion on the immunization calendar, even if it requires co-administration with current vaccines or introduction of new office visits. However, not only would public disease awareness campaigns be helpful to achieve widespread acceptance of changes to vaccination schedules, but also HCPs would ideally provide disease education to their patients’ parents to accompany their strong professional recommendations for a new vaccine.