Why do people not vaccinate?By Hal WillabyPublished in The Conversation March 27th 2014The National Health Performance Authority’s report on childhood vaccination coverage released this morning shows immunisation rates have slightly increased in 2011–2012. But there are still some areas where coverage is below the national target.The good news is that Australia has one of the highest vaccination rates in the world with over 90% of children fully immunised by age five. But there are areas where only 80% of five-year-olds are protected against preventable contagious disease.So why are some children not immunised? There are two broad influences on timely uptake of routine childhood vaccines – access and acceptance.Access is partly a structural problem, linked to barriers such as a lack of transport, limited clinic opening times, homeboundedness and, beyond that, to poverty and social exclusion. Generally speaking, we can address access problems by minimising these barriers.The other factor impacting vaccine uptake is acceptance. This is the psychological orientation to vaccines influencing uptake; it’s about attitudes, beliefs and concerns regarding vaccines, parenting, medicine generally, and a host of related matters. An individual’s vaccine acceptance is the result of a certain composition of these, like a metaphorical DNA.The public tends to hear a lot more about acceptance factors than they do about access. It’s an easy formula for mass media to pit vaccination opponents against proponents, and parade examples of non-vaccinating parents. It excites emotion, leading to high click rates in online articles and crowded comments pages.Nevertheless, the attention given to such parents is out of proportion to their actual numbers, and the likelihood of changing their minds. Vaccine refusers are a very small proportion in Australia – about 2% of parents make a values-based choice to forego all vaccines for their children.A more interesting group is the 12% of parents who are at least somewhat supportive of vaccination, but fear both vaccination and non-vaccination could have negative outcomes for their child. About half of that 12% vaccinate fully, and the other half may delay or avoid certain vaccines but will have others.Any action taken at the community level starts with acknowledging that parents want the best for their children regardless of their access to and acceptance of vaccines. When otherwise well-intentioned messages criticise what these parents view as healthy skepticism, the result can be a further distancing from timely uptake.Based on the information in the article, suggest three broad strategies for increasing vaccination rates amongst Australian children.