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Vaccination: why do parents hesitate? It’s complicated.

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One out of three Quebecers hesitate to have their children vaccinated. People are quick to mock these parents, yet some are highly educated. Why are they doubtful? Let’s explore the roots of vaccine hesitancy, not to be confused with the anti-vaccination movement.  

When talking about anti-vaxxers, the most preposterous theories often capture attention. According to one such allegation, microchips will be “hidden” in an eventual COVID-19 vaccine.  

But much more down-to-earth stories grab people who have reservations about vaccines.  

For example, a 6-month-old baby dies in intensive care from pneumococcal meningitis. The mother had nothing against vaccines. She didn’t know about the disease and had forgotten to have her child vaccinated.  

Here’s another story. Every year, hundreds of children die from sudden infant death syndrome, with no apparent explanation. But some parents report their baby had just received one or more vaccinations within 24 hours before death.  


Playing with legitimate fear 

Raising doubt through fear. That’s a strategy commonly employed by anti-vaxxers. They use it to push a third kind of story. In very rare cases, it’s happened that an allergic reaction to a vaccine causes death. This troubling fact will only be mentioned with extreme caution by the health authorities. Instead they rightly publicize the fact that vaccines prevent millions of deaths a year, as well as suffering that can leave after-effects. The benefit-risk balance clearly tilts in favour of vaccination. But conspiracy theories give this a sinister interpretation. Because the authorities are uncomfortable discussing the risks, they must be hiding “the truth”. This sows the seeds of vaccine hesitancy – the parent’s fear of being the exceptional unlucky case.  

If they want to communicate effectively against the anti-vaxxers, public health institutions have a lot of catching up to do. As recent studies showed, the anti-vaccination movements are more active on social media and prefer more personalized exchanges. This gives them a better chance of making arguments tailored to shake the confidence of hesitant people. They can use elements of truth to build false narratives. 

For example, in the case of the second story we mentioned, sudden infant death syndrome is a real phenomenon, but its causes are still unknown. The problem is that the riskiest time for babies is around 2 to 4 months old. This coincides with the age for the first vaccinations. For parents looking for a reason for their baby’s death, the coincidence may seem suspicious. That’s even if it’s been proved that the vaccines aren’t involved

“If I choose to have my child vaccinated and something happens, this is an active choice that will make me feel guilty,” Eve Dubé reminds us. Dubé, a researcher at Université Laval and the Institut national de santé publique du Québec, served for two years on the World Health Organization’s Vaccine Hesitancy Working Group. “When vaccination works, nothing happens. We’ll never have confirmation that our child avoided a disease thanks to the vaccine,” she adds. It’s precisely because vaccines are so effective that people are no longer afraid of serious diseases, Dubé points out. So they forget why vaccines are necessary.  


A respectful approach 

How can doctors initiate a dialogue with these hesitant people? Start by listening to the position, answers Arnaud Gagneur. He’s a pediatrician and Professor at the Faculty of Medicine and Health Sciences of the Université de Sherbrooke. He also knows the issue up close and personal: the child who died in the first story was his patient. 

Trying to prevent such situations from recurring, Dr. Gagneur set up what would become the EMMIE Program. (EMMIE is the French acronym for Motivational Conversation in Maternity for Immunization of Children). This involves meeting the parents in the hours or days after childbirth. The subject of vaccines is addressed without a preconceived position or lessons in morality. The principle was first tested in the Eastern Townships a few years ago. Then it was applied throughout the province. The objective is to cover all maternities by 2021. 

Even without this intervention, out of the one third of Quebecers who express doubts about vaccines, most parents end up agreeing to vaccinate their child. However, some do it late or only accept certain vaccines. About 80% of Québec two-year-olds are up to date with their vaccination coverage. 

The EMMIE Program has done more than guide a number of undecideds. It estimates it has improved vaccination calendar compliance by parents accepting the vaccine. In addition, the hesitancy felt by parents who participated in the program is down by 30% to 40%. Increased adherence to complete vaccination coverage between 0 and 2 years is estimated at 9%. 

According to Dr. Gagneur, the EMMIE Program’s respectful approach is the secret of this success. Parents are trusted for their ability to judge. “Separating the discussion from the act of vaccination allows a freer dialogue. Parents don’t get the impression that someone is waiting with a syringe hidden behind his back. Ultimately, the vaccination counsellor won’t know if the child will be vaccinated after the meeting. And the parents will have two months to think about it” before the first recommended vaccination date on the calendar.  

Dr. Gagneur specifies that past studies had shown that hesitant parents said they needed more information to make their decision. But when it was provided, it didn’t affect the vaccination rate.  

The EMMIE Program suggests instead that what’s important is the way this information is given and the time this is done. “Parents who hesitate really have the impression they’re being judged” when they express their fears. “It’s essential to treat them with respect, Arnaud Gagneur insists. 


Québec variant 

Compulsory vaccination, like in France, isn’t the way to go, according to Eve Dubé. “The anti-vaccination movement becomes more aggressive when compulsory vaccination is implemented. This isn’t the case in Québec.” That would partly explain why no organized group specifically opposed to vaccinations has emerged there. But Eve Dubé notes that some networks, like those advocating “natural” or “holistic” health integrate anti-vaccination elements into their arguments. 

Such anti-vaccinations are spreading in Québec throughout real and virtual exchanges. “This provides a sort of bias. If the information comes from a trusted person, we won’t direct our searches to prove this person is wrong,” Dubé explains. 

It’s possible that the EMMIE Program is making a positive contribution to private discussions, even if this doesn’t figure in its objectives. “We have no data to prove it,” Arnaud Gagneur specifies, ”but my impression is that the parents met will be less susceptible to share disinformation afterwards,” 


Agence Science-Presse and Québec Science are joining forces to explore the underpinnings of health-related  conspiracy theories. This is a first report. This article was originally published on the website of L'Agence Science-Presse (French only).


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