There are a few main reasons why people forgo vaccines for their kids or for themselves. But by understanding their reasoning, scientists hope to raise the vaccination rate. (Photo: Getty Images)

Health care providers have been trying for years to get more people to vaccinate their kids — and the results have been mixed.

But a new paper published in the journal Policy Insights From the Behavioral and Brain Sciences argues that vaccination rates will improve once physicians and experts target their approach to a person’s reason for not using vaccines.

The paper breaks nonvaccinators into four categories, based on their reasoning:

Complacence: Complacent people don’t care about immunization and tend to exist where vaccine-preventable diseases aren’t viewed as a threat. As a result, they think they don’t need to vaccinate. Complacent people simply aren’t in the habit of vaccinating and don’t vaccinate as a result.

Convenience: This group finds the vaccination process inconvenient in terms of time, affordability, willingness to pay, and proximity to a place that offers vaccinations. While most people in this group agree that vaccination is important, other personal issues seem more important or urgent.

Confidence: People who are distrustful of vaccines because they have incorrect knowledge about them fall into this camp. This group typically is strongly against vaccination and may be affiliated with the antivaccination movement.

Calculation: This group doesn’t have a strong preexisting attitude toward vaccination and extensively researches the pros and cons of the practice. When they read conflicting information, they may become confused and don’t do anything as a result.

Lead study author Cornelia Betsch, a researcher at Germany’s University of Erfurt, tells Yahoo Health that she hopes the categories will help make a difference in increasing vaccine rates.

“The reasons why people do not vaccinate are not created equal,” she says. “Categorizing … highlights that there are different types and psychological profiles that need different kinds of care.”

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For people who have lost their confidence in vaccines, for example, there will be a very different need for intervention compared to those who are generally in favor of vaccination but are buried in everyday routines and practical barriers, she says.

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Internist Lawrence Dell, MD, co-founder of Lakes Urgent Care in Michigan, tells Yahoo Health that the categories could be “very helpful” in urging patients to get vaccinated. “By categorizing, we can actually answer concerns or promote improved compliance and increase vaccination among the different groups,” he says.

According to a recent estimate by the Centers for Disease Control and Prevention, more children are being vaccinated in the U.S. than previously thought. The CDC says the current vaccination rates will prevent 322 million illnesses, 21 million hospitalizations, and 732,000 deaths of children born between 1994 and 2013.

But only 71 percent of children received the recommended combined vaccination series (four doses of DTaP; three doses of polio; at least one dose of measles, mumps, and rubella; three to four doses of Haemophilus influenzae Type B; at least three doses of hepatitis B; one dose of chickenpox; and four doses of pneumococcus) which experts say isn’t great.

Betsch says it’s important that doctors understand where their patients are coming from and tailor their approach to vaccination as a result.

Related: What California’s Strict New Vaccination Law Means for the Rest of the Country

For example, patients who struggle with convenience can benefit from being regularly reminded to vaccinate their children. But those who aren’t confident in vaccines may be prompted to take action after a good, informative talk with their doctor.



For complacent patients, Betsch says it may be helpful to hear a story about the disease they’re not vaccinating against to understand how serious it is. And those who calculate may benefit from hearing about the importance of herd immunity, which is the phenomenon that occurs when a large portion of a community is immunized against a contagious disease. (As a result of herd immunity, most people in the community are protected against the disease because there is little chance of an outbreak occurring.)

Dell says he’s seen patients who don’t want to vaccinate their children, but only discovered after talking with them that they had concerns about mercury levels in vaccines (which prompted him to answer questions and help dispel fears). “By addressing these concerns individually, we may see an improvement,” he says.

Betsch says she hopes categorization can help boost vaccination rates, decrease preventable illnesses, and save lives. “Not all people who do not vaccinate have lost confidence in vaccines and the system that delivers them,” says Betsch. “We want to emphasize that there may be a lot of potentially successful interventions to increase coverage without forcing people to vaccinate.”

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