Vaccine decision making in a vaccine-hesitant community: Marin County, California

Communities with low vaccination rates are more vulnerable to outbreaks of vaccine preventable diseases. In Marin County the rate of kindergarten parents seeking Personal Belief Exemptions (PBEs,)  non-medical exemptions from required school immunizations is nearly four times the California average and increased from 3 .7% in 2002 to 7.8% in 2012;. In 2014, California implemented legislation requiring parental conversations with medical professionals before receiving PBEs.  This Marin Childhood Vaccination Survey explored local vaccine decision-making to equip providers and the community for the conversations required under the new law. Survey topics included exemption status, vaccine information sources, and vaccine behaviors and beliefs.  In late 2013, immunization coordinators of 40 public and private schools distributed the survey to kindergarten parents.  Of 493 respondents, 85% (417) had fully-vaccinated children and 8% (39) had PBEs.   More parents with PBEs received vaccine information from complementary and alternative providers (54%) compared to parents without PBEs (4%).   Fewer parents with PBEs received vaccine information from healthcare providers (87%) compared to parents without PBEs (99%). Of kindergartners with PBEs, 84% had at least one of the school entry vaccines, 64% were up to date with DTaP while 6% had met the hepatitis B requirements.  Parents with PBEs believed that children get too many vaccines at the same time (100% agreed) or that vaccines contain unsafe toxins (62%).  Parents also reported distrust in the healthcare system and low perceived risk of certain vaccine-preventable diseases.  Addressing vaccine concerns revealed in this study can improve communication between providers and vaccine-hesitant parents.