Parental vaccine hesitancy in Italy – Results from a national survey
Introduction
The World Health Organization (WHO) describes vaccine hesitancy as the “delay in acceptance or refusal of vaccination despite availability of vaccination services. Vaccine hesitancy is complex and context specific, varying across time, place and vaccines. It is influenced by factors such as complacency, convenience and confidence” (page 4163) [1]. This phenomenon is globally increasing in the general population [2], [3], [4], [5], [6].
Research has identified several factors associated with parental vaccine refusal and hesitancy [7], [8], [9]. In order to map these factors, the WHO SAGE Working Group classifies them under three categories: contextual (due to historical, socio-cultural, environmental, institutional, economic or political factors), individual and group (e.g. personal beliefs and attitudes about prevention or previous experiences with vaccinations), and vaccine/vaccination-specific (e.g. concerns about a new vaccine or formulation or about mode of administration or delivery) [1].
In 2013, staff from the WHO regional offices conducted interviews on reasons for vaccine hesitancy with immunization managers of thirteen countries, representing the six WHO Regions, confirming that causes of vaccine hesitancy varied in the different countries and also through-out the same country. This indicates a need to strengthen the capacity of countries to locally identify the relevant causal factors of vaccine hesitancy and to develop tailored strategies to address them [10].
In Italy, childhood vaccination coverage rates for various vaccine-preventable diseases have been decreasing since 2013. In 2016, the vaccination coverage rate for poliomyelitis in children at 24 months of age was below 95% [11]. This comes at a time when the WHO European Region is at risk for a poliomyelitis outbreak [12,13]. Moreover, in 2016, the vaccination coverage rate for measles in children at 24 months of age was only 87.3% [11] and a large measles epidemic occurred in Italy in 2017, with more than 4885 cases reported from January to December 2017 [14].
We carried out a cross-sectional survey to estimate the degree of parental vaccine hesitancy existing in Italy and investigate its determinants among parents of children aged 16–36 months.
Section snippets
Study population and data collection
The survey, coordinated by the Italian National Institute of Public Health (Istituto Superiore di Sanità), was conducted in the period December 2015 – June 2016, among parents of children aged 16–36 months. Data were collected: (i) through a Computer/Mobile Assisted Web Interviewing survey performed by an external research company that sampled participants from an online panel of Italian families, stratified to reflect the geographical distribution of the reference population by macro area
Results
A total of 3230 questionnaires were collected: 1924 (59.6%) from pediatricians and nurseries and 1306 (40.4%) from the online survey. Most questionnaires (72.5%) were completed by the mothers. One hundred questionnaires were excluded because of incomplete/missing information about tetanus and/or measles vaccinations, leaving 3130 questionnaires available for the analysis. Socio-demographic characteristics of the sample are presented in Table 1.
Discussion
In our sample the proportion of vaccine-hesitant parents was 16%, whereas less than 1% of parents are fully opposed to vaccinations; 39% of all the parents had had some doubts about vaccinating their children. These results are in agreement with two surveys carried out in Canada in 2014 and Australia in 2012, respectively. According to these surveys, 19% and 8% of parents, respectively, reported that their children were unimmunized or partially immunized and 40% and 52%, respectively, declared
Conclusions
Vaccine safety is perceived as a problem by all parents, although hesitant and anti-vaccine parents appear more concerned than pro-vaccine parents, as well as less favorable to using combined vaccines and to vaccine co-administration. Like pro-vaccine parents, vaccine-hesitant parents still consider vaccination an important prevention tool and trust family pediatricians, suggesting that appropriate communication and information interventions aimed at increasing trust in vaccination may improve
Acknowledgments
We wish to thank all those were involved in the survey for the active collaboration: coordinators of the Regions that participated in the project, health professionals working at the local level, operators of nursery schools and kindergartens and all the parents who filled in the questionnaire without whom the conduction of the study would not have been possible.
Funding
The study was conducted in the framework of the CCM project “Chi dovrebbe essere vaccinato e perchè: toolkit per la società in evoluzione” (fasc. ISS: j3b), funded by the Italian Ministry of Health.
Competing interests
The authors declare that they have no competing interest.
Authors’ contributions
CG designed the study, prepared the material, coordinated and monitored the study activities, analyzed the data, interpreted the results, drafted and edited the manuscript. MCR designed the study, prepared the material, interpreted the results and edited the manuscript. MF designed the study, analyzed the data, interpreted the results and edited the manuscript. AF designed the study, interpreted the results and edited the manuscript. AB, FD, MD and CR designed the study, interpreted the results
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- 1
Present address: Department of Infectious Diseases, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
- 2
Present address: Office 05, Communicable Diseases and International Prophylaxis, Directorate General Health Prevention, Ministry of Health, Via Ribotta 5, 00144 Rome, Italy.