Understanding vaccine hesitancy and under-immunization with childhood and human papilloma virus vaccines in Switzerland : a qualitative study

Extensive biomedical evidence documents the efficacy, minimal unwanted effects, and cost-effectiveness of vaccines recommended by numerous national immunization programs. Despite the public health successes of vaccines, people in high-income countries are expressing concerns about vaccine safety, efficacy or need, a phenomenon referred to as vaccine hesitancy. Existing literature points to differing influences on vaccine hesitancy and may include people’s personal, social, and local cultural networks, medical providers’ attitudes and communicative styles, and complementary and alternative approaches to medicine. Previous literature examining often-used variables in public health literature regarding vaccine hesitancy, such as socioeconomic status (SES) and educational attainment, shows inconsistent correlations between these variables and vaccination attitudes and practices, underscoring the necessity of examining vaccine hesitancy within specific, localized contexts and with attention paid to the decision-making processes. Further complicating the issue, certain parents have been questioning standard vaccination recommendations and instead opting for individualized vaccination schedules. Current scientific literature tends to focus primarily upon interactions between patients and biomedical healthcare providers and does not adequately examine complementary and alternative medical (CAM) provider approaches regarding vaccination perceptions and practices. Furthermore, little information exists on vaccine hesitancy in Switzerland. In order to fill these research gaps, this research focuses on seeking to better understand vaccine hesitancy related to 1) recommended childhood vaccines and 2) human papillomavirus (HPV) vaccines.
This research benefits from a guiding theoretical framework rooted in an agency-structure approach, which allows us to underscore the social processes behind vaccine decision-making, including the concepts of the coproduction of knowledge and health literacy. Coproduction of knowledge refers to the social processes by which social actors come to make and interpret meanings about the world in which they live. Health literacy refers to the socially situated practices through which people access, understand, appraise, and apply health knowledge in order to make health-related decisions.
This research employs qualitative methods in the German and French-speaking parts of Switzerland, including: 1) qualitative face-to-face interviews with parents and healthcare providers and 2) observations of medical consultations between parents and providers. The results from both linguistic regions are compared regarding vaccine knowledge and practices among Swiss parents and medical providers. Particular attention in this study is attributed to the coproduction of knowledge in interactions between complementary and alternative medical (CAM) providers, biomedical providers, and parents.