By Chris Adams

Why do people hesitate – or outright refuse – to do something that their doctors almost uniformly say is in their best interests?

That’s the quandary behind “vaccine hesitancy,” which childhood immunization expert Dr. Kristen Feemster detailed for National Press Foundation fellows. Feemster, of the Philadelphia Department of Public Health, Children’s Hospital of Philadelphia and the University of Pennsylvania, said there are a range of reasons why people opt out of getting immunized – or  having their children immunized.

Some of it is religious, as some religious communities refuse vaccines due to their interpretation of religious teachings. Some is due to concerns – widely debunked by a range of scientific bodies – that there is a connection between measles, mumps and rubella vaccinations and autism.

“Hesitancy is not new – there was hesitancy from when the smallpox vaccine was first introduced,” she said. There were antivaccination leagues in the United Kingdom and the U.S. more than 100 years ago – precursors to today’s anti-vaccination movement.

Feemster said hesitancy can include those who have concerns about vaccinations to those who refuse them. But sometimes the reasons people don’t get vaccinated are far simpler.

“Confidence, complacency and convenience – those are the three primary domains,” she said. “Sometimes, it’s not about safety concerns. It could also be prioritizing other concerns over vaccines, or thinking it’s too hard to get to the clinic.”

She talked through her strategies for communicating to doctors what they should say to patients who might be hesitant, as well as those who simply can’t be bothered to get their shots.

Providers can be hesitant as well, at least on some vaccines. The move to vaccinate girls and boys as young as 11 or 12 for the sexually transmitted human papilloma virus has been met with mixed success, due to concerns it would acknowledge or excuse sexual activity at a young age.