Won't someone think of the (other person's) children?

When parents are deciding whether or not to vaccinate their kids, it's unclear whether the potential benefit or danger to others resulting from their decision is a motivating factor. That could be a gap in education that merits addressing by public health officials, according to a group of Indiana University pediatricians.

Much of the public discussion around vaccination concerns the benefits or risks to an individual child, the researchers wrote in a paper published in the journal Pediatrics.

"There appears to be some parental willingness to immunize children for the benefit of others, but its relative importance as a motivator is largely unknown," the authors wrote.

While vaccines for infectious diseases protect the person that gets them, they also have benefits for the public at large. When a large proportion of people in an area is protected against a contagious disease, that puts up a kind of firewall against it. Even if a person is unvaccinated - whether by choice, or because they are too young or weak - they can still be protected by this "herd immunity."

However, herd immunity only works if you have a substantial portion of the herd that's not susceptible to the disease. The more unvaccinated people there are in a population, the more opportunities there are for an infection chain to build.

Vaccination rates are dropping in certain areas of the US - and while some parents are adamantly anti-vaccine, fearing autism and other disorders, many parents are just uneasy, the authors wrote.

The authors of the Pediatrics paper reviewed 29 studies on parental decision-making regarding childhood immunization.

While only 1% to 6% of parents spontaneously cited "benefit to others" as a primary reason to vaccinate their children, around 30% to 60%, when asked, agreed that it is an important reason to vaccinate, the authors found.

That suggests that many parents are open to thinking about including public health concerns amongst the various factors they weigh when deciding when and how to vaccinate their children. It's a tricky balance though, as most studies show that pediatricians should avoid 'strong-arming' or guilting parents into putting their kids under the needle. 

"Qualitative studies are needed to explore how individual providers and public health initiatives can present the idea of childhood vaccination as a benefit to others, without suggesting that parents consider the welfare of others above that of their own child," the authors wrote.

In other words: how do you explain the importance of herd immunity to hesitant parents without coming across as a moralizing know-it-all? In delicate situations, the doctor's words and phrasing can mean all the difference.

SOURCE: Quadri-Sheriff et al. "The Role of Herd Immunity in Parents' Decision to Vaccinate Children: A Systematic Review." Pediatrics published online 27 August 2012.