Concern
Response
Babies’ immune systems encounter trillions of bacteria, each of which has between 2,000 and 6,000 immunological components. Today’s vaccines contain 150 immunological components [13]. Babies’ immune systems respond to many more germs in their day to day lives than they do when they get vaccines.
All ingredients in vaccines are safe [17]. Vaccines are made of:
antigens—the thing that shows the body how to respond to specific viruses and bacteria—the representative of the virus or bacteria
adjuvants—make vaccines work better than they used to. Ingredients added to vaccines to make them work
preservatives—keep vaccines free of germs
additives—keep vaccines effective when not used right away
residuals—needed to make the vaccines; largely filtered out, but tiny amounts remain
Some vaccines, including the influenza vaccine, do contain trace amounts of mercury [16]. The kind of mercury in vaccines is also found in water, air, soil, and breast milk [18]. Infants who breastfeed receive 15 times the amount of mercury found in one influenza vaccine from their mothers’ milk. The less safe form of mercury is found in fish [18].
Thimerosal is a residual in the influenza vaccine, and it does contain small amounts of safe mercury [18]. Thimerosal used to be in more vaccines [16]. Despite having no evidence it was unsafe, the AAP and Public Health Service asked for its removal [16]. Parents are now subsequently skeptical that it is safe, because it has been removed from so many vaccines.
Aluminum is in vaccines because it makes them work better [16]. Aluminum is in air, water, food (including breast milk), and human blood. Researchers tested babies’ blood after receiving a vaccine to see if the normal aluminum level (5 billionths of a gram per milliliter of blood) increases after getting a vaccine. It does not.
Gelatin is an additive in vaccines [16]. It is safe and found in many dietary products. Because gelatin comes from skin or hooves of pigs, some people are uncomfortable with it and some religions prohibit consumption of pig byproducts. Gelatin in vaccines is purified and broken down by water, so it resembles nothing like skin or hooves. Religious leaders have spoken out in favor of vaccines with gelatin because: the component has been broken down, the amount of gelatin in vaccines is smaller than any amount found in nature, it is not ingested, and encountering gelatin in this format is unimportant when weighed against saving the lives of children.
Vaccines do not contain antifreeze (ethylene glycol, which is unsafe). They do contain polyethylene glycol, which is safe. Polyethylene glycol is also found in toothpaste [17].
Vaccines either contain or are packaged in four things that can cause allergic reactions in individuals with these allergies: gelatin, antibiotics, egg protein, and latex (packaging). Doctors ask about these allergies before administering vaccines that contain these ingredients. Children with these allergies cannot receive all their vaccinations, so they depend on children who can to protect them via herd immunity [16].
Vaccines do not protect children from disease; they alert children’s bodies to make antibodies to the disease. Children’s bodies create these antibodies in the same fashion whether prompted to by a vaccine or contracting the illness [14].
On a broader note, everyone engages in “unnatural” activities every day, such as washing hands, using electricity, and sleeping on mattresses. Natural is not necessarily safer or better.
Babies do experience distress associated with vaccines, such as pain and stress, which lead to crying. To find out if multiple vaccines given at once caused babies more stress than one, researchers looked at their levels of cortisol (a marker of stress) in their saliva. Babies who received two shots were not more stressed than those receiving one [13].
Only one vaccine might give a child the disease: the oral polio vaccine, which is no longer administered in the United States [14]. No other vaccine gives the child the disease. In some cases, the child’s body may show it is making antibodies in response to the vaccine [14]. These indicators appear like minor aspects of the disease, such as a small rash [14].
That vaccines cause autism is a myth based on the activities of one fraudulent researcher. This researcher received payments from lawyers of parents who were suing companies who made vaccines [20]. The researcher manipulated his selection of 12 children (some of whom were parties in the lawsuit), to publish a paper suggesting there may be a link between the MMR vaccine and autism [20].
Vaccination is just one of many modern practices performed to protect against unlikely but grave events. Another example is wearing seatbelts. Some of the diseases vaccines protect against are rare. But vaccination is recommended for two reasons: to protect the vaccinated child and to protect other children who are medically vulnerable and cannot be vaccinated [14].
Many diseases that parents may have lived through (chickenpox, influenza) are dangerous because of their potential for devastating complications [14]. True influenza kills 36,000 Americans per year, and children are particularly vulnerable [14]. Before the varicella vaccine, chicken pox used to kill 1 child per week in the United States [14]. These deaths stemmed from complications such as infections of the brain, flesh-eating strep, toxic shock syndrome, hepatitis, and pneumonia [14].
Pharmaceutical companies would not be as rich as they are if they relied on vaccinations for their profits. Vaccines make up a very slim proportion of overall sales [21]. This figure is reduced further after factoring in the costs of an average of 15 years’ worth of research and development per vaccine, only 10% of which ultimately enter the market [21, 22].
Vaccines have been extensively tested, and each time a new vaccine combination is recommended, it is tested in concomitant use studies. These studies determine that not only is the vaccine safe, but that it is safe to be given with the other vaccines administered at the same time [13].
True. Many laws disregard the rights of the individual, such as laws requiring motorists to have car insurance, drivers to stop at red traffic lights, or people not to murder one another. That is because some actions are recognized as crucial to saving lives, but they require the cooperation of many to be effective [14].
Common Misconceptions
Vaccine hesitancy is due to underestimating the severity of the diseases the vaccines prevent, particularly because these diseases and their effects have been out of the general population’s experience for a generation
This explanation for vaccine hesitancy is widely posited [1, 10]. Despite its popularity, the data do not support this explanation as the exclusive reason for vaccine hesitancy. In one survey of 376 parents, only 11% expressed concern that children are given vaccines for diseases they are unlikely to get, and 8% believed that vaccines are given for diseases that are not serious [1].
As far as diseases whose effects have been forgotten by the collective public memory, the vaccine with the weakest tie to this argument is influenza. Influenza kills an estimated 36,000 Americans per year and hospitalizes approximately 200,000 [10]. Even with these high rates, in a survey of 1,500 parents, respondents reported refusing the influenza vaccine most frequently [11]. The most common reason parents cited for refusal was that the vaccine was not necessary [11]. In another study that specifically outlined the dangers of influenza, no change was seen among participants in terms of their belief about the severity of the flu or their intention to vaccinate [23]. The study authors concluded that the dangers of the illness were already widely accepted, so providing further information was not effective in increasing intent to vaccinate [23]. This stands in contrast to MMR, which protects against less prevalent diseases. In this case, the same 1,500 parents surveyed reported hesitancy due to a concern of serious side effects from the vaccine rather than lack of concern about disease severity or likelihood [11].
The World Health Organization SAGE working group created the “Three C model” to explain the reasons parents show vaccine hesitancy [24]; complacency, convenience, and confidence [24]. Subsequent researchers examining the behavioral aspects of VHP added in a fourth—calculation—that involves the calculation of expected utility that parents conduct when deciding whether or not to vaccinate [25]. Calculation appears to have an overarching effect on hesitancy regardless of whether the parent is complacent, barred by inconvenience, or concerned. The process of calculating the cost versus benefit of engaging in any medical intervention lies at the heart of informed consent. Rather than assume ignorance on the part of parents, it is more prudent to determine which of the “Cs” are driving their hesitancy [25]. In our recommendations section, we outline the three unique Cs and suggested responses.
Parents who ask questions about vaccines do not trust their physicians
Approximately 30% of sampled doctors report dissatisfaction in their practice when parents express concerns around vaccines [9]. Among this group, 29% interpreted the parents’ questions as a lack of trust in their experience and respect for their judgment [9]. Yet patients consistently identify physicians as their most trusted source of vaccination information [9, 11, 26–28].
Initially hesitant parents who changed their minds about vaccinating their children reported largely doing so as a result of their trusted physician providing them with assurance as to the decision to vaccinate [9, 29]. This effect of physician influence held for both parents who wanted to delay vaccinations and those who initially refused vaccinations outright [9]. One study of 122 VHP participants found that approximately 87% reported their physician was their trustworthy source for information on vaccines [3]. When creating a measure to quantify parents’ levels of vaccine hesitancy, the developers had to remove the item about trusting one’s doctors because the responses they received on preliminary versions of the measure were too positively skewed to provide any meaningful input into the score [3].
Parents also identify friends (26%), family (25%), and the Internet (39%) as sources of reliable health information [3]. Aware that their patients also seek out other sources of information, physicians may misattribute these conversations or searches to a lack of trust in their opinion. While this may be true for certain patients, others consider researching vaccines as part of their role as health advocate for their children [3]. Rather than avoid the opinions of friends and family, physicians can directly ask their patients to share what their social group thinks. In this way, the physician validates the parents’ social support group and information-seeking behaviors. If friends and family have communicated any misinformation, the doctor can address it in the same manner as if the patient had arrived at that incorrect information on their own—nonjudgmentally and nondefensively.
With the Internet available to many parents at almost all hours of the day, it is not surprising that some will research vaccine information online. Evidence shows that many parents access this kind of information. In one survey of 376 parents, 60% reported searching the Internet for either “some” or “a lot” of vaccine information [1]. Fortunately, accurate information from reliable sources regarding vaccines is widely available to both parents and doctors. The AAP, CDC, and the Vaccine Education Center at the Children’s Hospital of Pennsylvania provide detailed information sheets specifically addressing common parental concerns regarding vaccination [3]. These organizations provide online information sheets and toolkits [3]. In their practices, however, few physicians make use of these resources [9]. Only 28% of physicians in one study were observed to distribute such information sheets to their patients [9]. Given that many parents report searching for this information, collaborating with patients in their searches guides them to more accurate sources. Embracing the new learning and advocacy styles of parents includes showing them reliable sources of information and teaching them to remain skeptical of ambiguous sources.
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