Improve vaccine adherence by presenting immunization as default option

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the Clinical Advisor take:

Evolving both immunization laws and provider practices is necessary to balance patients’ individual choice and public health concerns, according to an editorial published in JAMA Pediatrics.

In immunization practice, clinicians are left to decide how far to stray from the standard of care when parents request a revised vaccination schedule for their children.

“Protecting individual choice and promoting public health are seemingly at odds. However, an impasse is not inevitable,” wrote Douglas J. Open, MD, MPH, of the Seattle Children’s Research Institute, and colleagues.

“Achieving a balance between these two competing values is a dynamic process that requires dynamic policy.”

Emerging data suggests clinicians adapt a communication strategy with parents that supports current vaccination policy: presentation of vaccination as default. Rather than soliciting parental vaccine preferences, clinicians should start the vaccine discussion at health visits with a statement regarding which vaccines the child is due for.

“Choice architecture leverages the propensity humans have to stick with a decision that is already made, especially among decisions perceived to be complex,” noted the editorial authors.

Although structuring vaccine conversations with patients as an opt-out, not opt-in, may increase tension between individual choice and public health, it better accommodates a provider’s obligations to the child’s and the public’s health.

“To achieve balance between individual choice and public health, we must not only continue to invest in research and programs that improve vaccine safety but also be prepared to engage in broad debate about what constitutes acceptable risks, costs, and outcomes,” concluded the researchers.

“It is no longer sufficient to rely on historical conceptions of risk to the public and the individual or a conventional understanding of choice.”

The resurgence of measles in California accentuates an important need to revisit vaccination policy and practice in the United States.

Improve vaccine adherence by presenting immunization as default option
Improve vaccine adherence by presenting immunization as default option

The tension between individual choice and public health is both long established and enduring. It also appears to be at a breaking point.

With Ebola still crisp in our collective consciousness, health-care professionals, public health practitioners, and the public have been captivated by a domestic measles outbreak and confounded by the variation on this timeless tension that it embodies: more parents are exercising their choice to refuse or delay vaccination for their child, yet continued widespread acceptance of vaccination is critical to maintain herd immunity and protect the community from diseases that still circulate.

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