Why Parents Say No to Having Their Children Vaccinated against Measles: A Systematic Review of the Social Determinants of Parental Perceptions on MMR Vaccine Hesitancy

Abstract

Ongoing outbreaks of measles threaten its elimination status in the United States. Its resurgence points to lower parental vaccine confidence and local pockets of unvaccinated and undervaccinated individuals. The geographic clustering of hesitancy to MMR indicates the presence of social drivers that shape parental perceptions and decisions on immunization. Through a qualitative systematic review of published literature (n = 115 articles; 7 databases), we determined major themes regarding parental reasons for MMR vaccine hesitancy, social context of MMR vaccine hesitancy, and trustworthy vaccine information sources. Fear of autism was the most cited reason for MMR hesitancy. The social drivers of vaccine hesitancy included primary care/healthcare, education, economy, and government/policy factors. Social factors, such as income and education, exerted a bidirectional influence, which facilitated or hindered vaccine compliance depending on how the social determinant was experienced. Fear of autism was the most cited reason for MMR hesitancy. Vaccine hesitancy to MMR and other childhood vaccines clustered in middle- to high-income areas among mothers with a college-level education or higher who preferred internet/social media narratives over physician-based vaccine information. They had low parental trust, low perceived disease susceptibility, and were skeptical of vaccine safety and benefits. Combating MMR vaccine misinformation and hesitancy requires intersectoral and multifaceted approaches at various socioecological levels to address the social drivers of vaccine behavior.

Pervasive Parental Hesitancy and Resistance towards Measles Rubella Vaccination in Jordan

“…In this study, a thorough investigation of the determinants of parental MR vaccine acceptance using the validated PACV tool highlighted several critical factors, similar to the recent systematic reviews on parental attitudes towards measles vaccination [18,19]. Among these factors, confidence in vaccine safety and efficacy emerged as a key element influencing the likelihood of parental MR vaccine acceptance [58,59].…”

“…One of the key aspects of confidence in vaccine safety is related to parental concerns about the number of doses their child receives [19]. Additionally, some participating parents in this study (48%) expressed a preference for natural immunity over MR vaccination, believing it to be a safer option.…”

“…One of the major reasons behind suboptimal measles vaccine coverage is parental vaccine hesitancy [17,18]. Factors driving parental measles vaccination hesitancy was recently systematically reviewed by Novilla et al and included parental concerns and philosophical, moral, and religious objections [19].…”

Differences in COVID-19 vaccine hesitancy and trusted sources of information among a large sample of Chicagoans

“…5 A 2011 study found that most parents interviewed were cautious about a new biomedical intervention and, rather than refusing altogether, preferred to "wait and see." 6 Studies of in uenza 7,8 , hepatitis 9 , and childhood vaccinations such as measles, mumps, and rubella (MMR) 10,11 and chickenpox 12 have found similar vaccine hesitancy across populations.…”

Is Vaccination Approaching a Dangerous Tipping Point?

“…Regrettably, pediatric vaccine hesitancy now has been responsible for several measles outbreaks in the US, including a recent one in central Ohio involving local acquired cases in 85 children, 36 of whom (42%) had to be hospitalized for complications . It is sobering to note that vaccine hesitancy to childhood vaccines, such as the measles, mumps, and rubella vaccine, has been found to cluster in middle- to high-income areas among parents with at least a college degree who preferred social media narratives over evidence-based vaccine information delivered by clinicians . Anyone doubting the benefits of vaccination need only look to low-income parts of the world where measles vaccination is inaccessible, and many thousands of children continue to die each year due to preventable disease.…”