DO PARENTS CONSIDER BENEFITS TO OTHERS WHEN DECIDING WHETHER TO IMMUNIZE THEIR CHILD?

Purpose: In a well-vaccinated population, herd immunity is an important benefit of childhood immunization.  However, it is unknown if this concept influences parents’ decisions to immunize their children. We sought to determine if the concept of “benefit to others” had been found in the existing literature to influence parents’ or guardians’ motivation for childhood immunization. 

Method: We systematically searched Medline for articles on parental/guardian decision-making regarding child immunization.  Two authors selected titles and abstracts to identify relevant articles to review in full.  Three authors analyzed articles chosen for full review.  Disagreement was resolved through discussion.  Articles were included for analysis if they were original studies, elicited responses from parents/guardians of children <18 years old, and in any way addressed willingness to vaccinate children for the benefit of others.  Non-English articles were excluded. 

Result: The search yielded 5865 titles.  Of these, 86 articles were identified for full review.  Seven additional articles were found among the references cited by these articles.  Eighteen studies met inclusion criteria.  Eight of the included studies were qualitative in nature.  Another eight studies assessed benefit to others as one among many factors involved in parents’ decision to immunize their child.  In the eight non-qualitative studies, anywhere from 1% to 60% of parents listed benefit to others as a reason to have their child immunized.  Lastly, we found two studies where the importance of benefit to others was ranked relative to other motivating factors.  In the first of these studies, benefit to others was reported as the primary motivating factor for childhood immunization by only 6% of respondents (Kilmartin et al., 1998).  In the other study, it was ranked by 37% of respondents as the second most important factor, after preventing disease in one’s own child (Wu et al., 2008).  

Conclusion: In studies on parental decision-making regarding childhood immunization, benefit to others is rarely assessed as a motivating factor.  There appears to be some parental willingness to immunize children for the benefit of others, but its relative importance as a motivator of vaccine uptake is largely unknown.  Further work is needed to explore this concept as a possible motivational tool for increasing childhood immunization uptake.