The Associations between Medical, Allied and Complementary Medicine Practitioner Visits and Childhood Vaccine Uptake

"It is...crucial to explore enablers and barriers to paediatric vaccination in Australia to assist development of appropriate communication strategies for effective parental decision-making."

Despite overall high levels of childhood vaccine uptake in Australia, areas of lower vaccine coverage remain, often clustering in geographical locations. This situation creates practice and policy concerns for public health officials and has led to recent legislative changes termed "No Jab No Pay", which withhold government benefits and rebates if children's vaccinations are not up to date. In that context, this study aims to determine: the attitudes and beliefs of parents towards childhood vaccination, the information sources parents are influenced by when making decisions about vaccination, and the effect of recent Australian legislative changes on parents' intentions to immunise their children.

As noted here, health service use in Australia is often pluralistic, with many Australians seeking care from multiple sources, including medical, allied health, and complementary medicine (CM) practitioners. Data from international studies have shown parents with concerns about vaccination are more likely to trust advice from CM practitioners when seeking information about childhood immunisation. (Qualitative research provides some insight into the continuum of trust, finding that many parents who reject vaccination have an absolute worldview that government, doctors, research and society are tainted and motivated by profit.) Similarly, a recent Australian pilot study found children were less likely to be vaccinated if they had visited a CM practitioner in the past 12 months. Despite this finding and assertions by some that advice given by CM practitioners may be contributing to vaccine rejection amongst parents, the nature of these conversations remains elusive.

A quantitative, cross-sectional survey was piloted amongst 60 individual parents, representing 60 households from an area with low vaccine coverage in New South Wales. Subsequently, Australian parents were recruited nationwide via an online platform. A total of 429 parents participated in the study.

A substantial majority of participants reported having their youngest child's vaccination status up to date (n = 401, 93.5%). The majority of parents agreed with the statement 'Vaccines are important for my child' (87.9%). A substantial majority of participants reported giving their child all vaccinations without having any concerns (76.2%); however, a notable number of parents held minor concerns (15.6%) despite having given all vaccines to their child. The most common reason for not vaccinating was 'I feel the risks associated with vaccination outweigh the benefits' (42.9%), followed closely by 'I am concerned about side effects related to childhood vaccinations' (39.3%) and 'I don't believe vaccines are safe' (35.7%).

Vaccine information sources reported as influential were general practitioners, or GPs (78.3%), friends/family (55.7%), nurses/midwives (43.4%), government websites (33.3%), paediatricians (30.5%), parenting groups (16.8%), non-governmental organisation (NGO) websites (13.1%), newspapers/magazines (8.4%), CM practitioners (6.3%), and pharmacists (4.4%). A child's vaccinations were more likely to be up to date if they had consulted a paediatrician in the previous 12 months (odds ratio (OR) 5.01; 95% confidence interval (CI) 1.05, 23.92; p = .043). They were less likely to be vaccinated if they were influenced by information from a CM practitioner (OR 0.03; 95% CI 0.01, 0.15; p < .001) or had visited a CM practitioner (OR 0.09; 95% CI 0.02, 0.33; p < .001) in the previous 12 months. A total of 2.6% of parents had immunised their child as a result of the No Jab No Pay legislation, while 3.9% stated the legislation had no effect, and 1.2% said it had made them less likely to vaccinate. (This is consistent with recent suggestions that financial incentives are unlikely to influence parents who reject vaccination.) A further 1.2% of parents stated they are considering vaccination as a result of the legislative changes.

Having found that parents who have not vaccinated their children appear to trust non-mainstream sources of information such as CM practitioners, the researchers suggest that future research could determine the character and importance of culturally appropriate resources for parents who prefer CM approaches. The information needs of CM practitioners who are pro-immunisation must also be determined to harness this workforce and enable evidence-based conversations with vaccine-wary parents to improve vaccine uptake.

Another research finding that warrants reflection is that the reason some parents with concerns vaccinate their children while others do not remain intangible. Future research could examine differences between these two groups to determine why some parents with safety concerns vaccinate their children while others reject immunisation.