Family Matters

How Social Networks Influence Parents’ Decision to Vaccinate

A small group of parent advocates is mobilizing "gentle propaganda" against vaccine naysayers

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At her son’s preschool near Seattle, Robin Haight is a foot soldier in the vaccine wars. She arranged for a pediatrician to speak about vaccines at the home of a school parent. She put up posters — she calls them “gentle propaganda” — that touted the importance of immunization in stopping the spread of disease. Her husband helped create a spreadsheet to track which children at the school are missing which vaccinations.

Some parents have said that Haight’s provaccination message has no place at preschool, that it’s disrespectful and patronizing, that the decision to vaccinate a child is nobody else’s business. One mother got so emotional that she broke out in hives. But Haight thinks a conversation is critical, and the latest research published in the journal Pediatrics backs her up.

“I’m just trying to let people know that if you don’t vaccinate your children, it might affect other children’s health,” says Haight. “It directly affects a community of young children. How do we not talk about this?”

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With so much confusing and even misleading information about vaccine safety available on the Internet, it’s no surprise that parents are influenced by their friends’ attitudes when it comes to immunizing their kids.

In the study, researchers surveyed 196 parents of children 18 months or younger in King County — Haight’s stomping ground — which has a vaccination rate that’s typically below the national average and has been gripped by a pertussis epidemic, along with areas in Vermont, Wisconsin and Minnesota. Among the parents in the study, 126 followed the nationally recommended childhood-vaccination schedule from the U.S. Centers for Disease Control and Prevention (CDC). The 70 other parents forged their own paths: 28 delayed vaccines, 37 partially vaccinated and five didn’t vaccinate at all.

At least 95% of parents in both groups indicated that they had consulted their “people network” for insight into making vaccination decisions. Parents reported they paid the most attention to their spouse or partner’s opinion. Pediatricians were next in line, followed by friends and relatives. (Interestingly, 10% of parents who followed CDC guidelines — the “conformers” — and 12% of parents who didn’t — the “nonconformers” — failed to list doctors among the top five people in their network.) Here’s why that’s important: 72% of nonconformers’ friends and relatives advised them to disregard CDC recommendations compared with just 13% of conformers’ friends and family members. In other words, says study author Emily Brunson, changing parents’ attitudes about vaccines may be a matter of influencing the people who are influencing parents in the first place.

(MORE: How Safe Are Vaccines?)

The significance of naysayers parents’ networks “blew any other variable out of the water,” says Brunson, who conducted the research as an anthropology graduate student at the University of Washington. “It was more important in terms of predicting what parents decide to do than any other factor, including parents’ own opinions.”

The effect was overwhelming, particularly for parents whose network mostly recommended not following immunization guidelines; they were more than 1,500 times more likely to not adhere to the CDC’s vaccination schedules for their children than other parents. Even parents whose networks were more compliant about following immunization schedules (comprising 26% to 50% of people who advised against the guidelines) were 31 times more likely to not vaccinate as recommended. “Parents’ people networks matter a ton,” says Brunson, now an assistant professor of anthropology at Texas State University. “Having those conversations with your sister, with your parent, with your friends matter a lot more than we thought.”

Parents who didn’t follow vaccination advice were also more likely to have extensive “source networks” — troves of books, websites and magazine articles they turned to for vaccine-related information. On average, 59% of nonconformers’ sources — many of which persist in promoting a widely debunked association between vaccines and autism — recommend ignoring CDC guidelines compared with 20% of conformers’ sources.

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Although the proportion of “zero dosers” — otherwise known as “antivaxers” — has stayed stable at less than 2%, the number of moms and dads who don’t trust that vaccines will do what experts say they will is growing. In the U.S., where parents haven’t seen firsthand the deadly consequences of vaccine-preventable diseases, pediatricians are frustrated about spending more and more time defending the importance of immunization. What used to be a staple of childhood health is now viewed with at least some skepticism by most parents, including the highly educated. They’re cherry-picking which vaccines they find acceptable or joining the ranks of the “delayers,” the 12% of parents who develop their own vaccine schedule, spacing out shots for years, which experts argue only extends the time their kids are susceptible to disease or capable of passing it on to others. A recent study showed that multiple vaccinations on a single day, which worried some parents, don’t pose a hazard to young children; in fact, older vaccines exposed toddlers to more antigens than newly formulated ones do. “There isn’t a lot of trust,” says pediatrician Wendy Sue Swanson, who was inspired by the growing number of hesitant parents to start blogging about vaccines as Seattle Mama Doc. “They’ve all heard the story that Jenny McCarthy told: the day her kid got the MMR shot, the light went out of his eyes.”

The findings highlight a potentially new strategy that public-health officials should consider when getting out the message that childhood immunizations are important for children’s health. It may be time, they say, to extend their reach beyond doctors and start paying attention to other people who influence parents’ vaccination decisions, namely friends and family whom moms and dads list as part of their “social network.” “If we want to improve vaccination rates, communication needs to be directed to the public at large,” says Brunson.

(MORE: Vaccine Safety: New Report Finds Few Adverse Events Linked to Immunizations)

That’s the objective of Immunity Community, the grassroots campaign that recruited Haight as a provaccine crusader. The program is testing the theory behind Brunson’s research, that parents can be instrumental in molding how other parents think about vaccines. At seven pilot sites in western Washington — two child-care centers, three preschools and two elementary schools — 13 “parent advocates” are being trained and supported to start a conversation about vaccination that has historically been dominated by vocal naysayers. When you’re following the status quo — in this case, adhering to the CDC’s recommended guidelines — you tend not to get fired up and speak out.

Later this month, some of the parents will host a health fair at a bowling alley featuring yoga, talks about fire safety and a spin-the-wheel trivia game about vaccine-preventable diseases. “This is about shifting a social norm and elevating the voice of the majority of parents who do immunize,” says Ginny Heller, the immunization program manager at WithinReach, the Washington state nonprofit behind Immunity Community.

(MORE: Multiple Vaccinations on Same Day Does Not Raise Autism Risk)

It’s a work in progress, with lots of cues and miscues. Emotions run high when parents believe others are examining their choices. One mother at Haight’s preschool threatened to withdraw her child; another said that hot topics such as vaccination and circumcision shouldn’t be discussed at school. “They feel they’re being judged,” says Haight.

But preliminary data on Immunity Community’s effectiveness look promising: last year, one Montessori-preschool pilot site raised its immunization rate from 60% to 80%. The CDC is keeping tabs on the results and could bring it to other states as a potential national model, albeit one rooted at the local level. “For people to be passionate and credible and persuasive about this, they have to be local community members,” says Kris Sheedy of the CDC’s immunization-services division. “We know that birds of a feather flock together, so it’s a good thing to make vaccinating parents more visible.”