nurse drawing up vaccine 2101 x 1400

Instead of wagging their fingers at parents reluctant to vaccinate their children, Vax Northwest, a unique public-private partnership in Washington state that includes Kaiser Permanente Washington Health Research Institute (KPWHRI), the Group Health Foundation, WithinReach, Seattle Children’s Hospital, BestStart Washington, and the Washington State Department of Health, formed an “Immunity Community.” They knew from earlier studies that parents who interact with other parents in a social network trust the opinions of their peers and generally support vaccination if their peers do.


Advocating for vaccination…peer-to-peer

The Immunity Community was made up of parents who understand and value childhood vaccination. These parents were mobilized into their communities to serve as advocates and to have positive conversations—in person and through social media—with other parents at their kids’ childcare centers, preschools, and schools.

To assess the effectiveness of the intervention, researchers at KPWHRI surveyed parents in two communities in Washington state before and three years after the implementation of the program. The results of their study were published in the journal Health Promotion Practice on April 11, 2017. They document significant improvements in vaccine-related attitudes:

  • Parents concerned about others not vaccinating their children rose from 81% to 89%.
  • Those who called themselves “vaccine hesitant” fell from 23% to 14%.
  • Fewer parents thought children receive vaccines at too young an age.
  • More parents were confident that vaccinating their children is a good decision.
  • More parents knew the vaccination rates at their children’s childcare or school.

Further, study principal investigator Clarissa Hsu, PhD, at KPWHRI’s Center for Community Health and Evaluation noted that,

“Our evaluation found that the Immunity Community program was successful at empowering parents to communicate positive messages about vaccines in a way that was not confrontational.”

This is a far cry from the demanding, cajoling, belittling, berating, and other heavy-handed approaches health professionals and the media (including ourselves) have used in the past and that led to (no surprise here) parents concerned and confused about the fake news and pseudoscience that surrounds childhood vaccination just digging in their heels.

As Dr. Hsu states,

“Strong negative rhetoric about vaccines can circulate widely on social media. And some parents feel hesitant about early childhood vaccines and may delay or refuse some or all vaccines, which may put others in their community at risk.”

This project was designed to “counterbalance prevalent anti-vaccine messages that do not reflect the fact that most (at least four in five) people vaccinate their kids and are supportive of vaccines.


Why this study is important

Addressing vaccine hesitancy among parents is important because vaccines work best when a high proportion of people in a community are immunized against a contagious disease. This phenomenon, known as “community immunity” (also called “herd immunity”), is based on the fact that the viruses that cause many of the common preventable childhood illnesses, such as influenza, measles, mumps, and rotavirus, require a pool of susceptible individuals in order to spread from person-to-person. When a critical portion of the community, somewhere in the range of 80-90%, is immune to the virus—either because of vaccination or because they have had the infection in the past—large outbreaks are not possible. Everyone in the community benefits, including those who are unable to receive vaccines, such as infants, pregnant women, and immunocompromised individuals.

The researchers reported some limitations to the study, including that it had no control group. Rather, information from parents was compared before and after the intervention. This is considered a weaker study design than one in which participants are randomized to an intervention vs. a non-intervention (or control) group. In addition, it was not possible to determine with certainty that the observed improvement in attitudes about immunization were actually due to the Community Immunity intervention and not to other factors, such as outbreaks of vaccine-preventable disease or changes in state laws around school exemption policies, that could have led to increased vaccination during the intervention period.

Not all participating sites are required to report their immunization rates to the Washington Department of Health. But the Immunity Community worked with the Organization of Parent Education Programs to improve the processes for tracking immunization rates and disease outbreaks for the children who attend cooperative preschools across the state of Washington. This policy change could affect thousands of families, according to Schoeppe.


Applauding innovation

The Immunity Community program is innovative,” said study author Jennie Schoeppe, MPH, MS, also affiliated with KPWHRI’s Center for Community Health and Evaluation. “We are unaware of any other intervention that has used volunteer parent advocates to effect change in their communities.

This study is part of broader efforts by Kaiser Permanente and the Group Health Foundation to promote immunization as the most effective way to protect children from many infectious diseases, including ones that can cause serious disease and even death. The Group Health Foundation’s Childhood Immunization Initiative seeks to promote immunization and also funded the first randomized trial to test an intervention aimed at decreasing hesitancy about early childhood vaccines by working directly with doctors. Pediatrics published those results in 2015.

Kudos to Vax Northwest and Kaiser Permanente’s Washington Health Research Institute for designing such an innovative intervention and then testing whether or not it worked. Being able to break away from traditional approaches with mediocre results and try something new is the hallmark of a learning organization. We could use a whole lot more of this in healthcare.


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