College students who had vaccine waivers often share parental misconceptions

Young adults who received waivers for childhood vaccinations tend to share their parents’ perceptions on vaccine safety and resist updated immunizations even in their college years, according to a new report.

The study, published in Frontiers in Public Health, investigated the demographics of college students who were not up-to-date on vaccinations and what was preventing them from becoming updated.

Emmanuel D. Jadhav, DrPh, MHA, assistant professor at Ferris State University College of Health Professions, Big Rapids, Michigan, and lead author of the study, says children whose parents refuse vaccination at a young age are not likely to get caught up with immunizations at a later age for a variety of reasons, including shared misconceptions about vaccines and a lack of access.

“The objectives of our study were to characterize the sociodemographic characteristics of young adults with and without vaccination waivers and identify their perceived benefits, barriers, and influencers of vaccination,” Jadhav says. “One of the key findings of the study is that, even among college-going students, a little over one-third of young adults who had a vaccination waiver were not up-to-date on their vaccinations, and think that vaccinations can cause autism.”

Vaccine coverage among young adults during the 2016-2017 season was only 33.6%, according to the report-well under the national goal of 70%. University clinics are dealing with an uptick of vaccine-preventable diseases as a result, the study notes, and these diseases pose an increased risk to both vaccinated and unvaccinated individuals.

“As those who were under- or unvaccinated as children now enter college, especially those college programs that do not require an updated vaccination status, they pose an increased risk of disease susceptibility by living and interacting in close quarters, leading to the emergence and reemergence of serious infectious disease outbreaks,” the study adds.

Many unvaccinated individuals on college campuses received a vaccination waiver in their youth at the request of their parents. The study notes that some higher-education institutions require updated immunizations for entry, but these requirements vary by state and institution.

More than 1000 university students were polled for the study, and roughly 9% had a vaccine waiver in their youth. Of those students who had vaccine waivers, 72% were female, 43% were aged 18 to 21 years, and 31% were students in the College of Health Professions. In the backgrounds of these students, 30% had parents whose highest level of education was a bachelor’s degree, and 72% had not had any changes in insurance coverage in the previous 3 years that would have negatively impacted their access to vaccines.

Researchers were surprised to find that a third of the students polled who were not up-to-date with vaccinations held a strong belief that vaccines cause autism, and did not plan to receive updated immunizations.

“This could be explained as a reflection of the identified barriers that include out-of-pocket cost associated with the catch-up schedule or the fear associated with the risk of adverse experience with vaccination schedules,” the report notes. “Likewise, the proportion of those that are not sure if they think the resurgence in vaccine-preventable diseases is related to decline in vaccination rates may be related to the transfer of commonly held negative perceptions associated with vaccine effectiveness.”

The researchers found that there was still a big misperception among young adults who had received vaccination waivers in their youth that vaccines cause autism, although some did identify the benefit of disease control. The greatest barrier to vaccinations in the young adult population, according to their report, was the out-of-pocket costs associated with vaccination.

“Interestingly, the comparison of groups with limited access and with or without being counseled by a primary care provider suggests an opportunity for campus clinics to educate students on vaccination benefits and subsequently address the concern of our study that adults who were under- or unvaccinated as children are now entering college in a communal environment,” the study notes. “The finding that 65% of students that had a vaccination waiver reported as being up-to-date on their current vaccination further reinforces the power of health education but may also be a reflection of the high number of respondents from the College of Health Professions that run programs that require them to be up-to-date on vaccinations.”

Study participants acknowledged the role of vaccines in preventing disease, although participants who had waivers in their youth ranked this benefit lower than those who were fully vaccinated. Students with waivers in their youth also placed greater emphasis on adverse effects of vaccines, with a heavy reliance on the opinions of their parents. Other studies have confirmed that students follow the examples of their parents in terms of their perception of vaccines, and this report suggests that the optimal time to persuade students to receive up-to-date vaccinations is when they first begin to understand the importance of vaccination but don’t know where to start in terms of being updated.

“The challenge for campus vaccination programs for students is to reign in negative intergenerational perceptions to vaccination and develop strategic, targeted messaging that informs, educates, and encourages students to confront the perception of adverse effects associated with vaccinations,” the report says.

Jadhav hopes the report will help clinicians make a greater effort to offer vaccination counseling to parents before signing off on request for vaccination waivers. His research did not investigate what types of education might be best in these efforts, but the study reveals that vaccine administration programs, such as university campus clinics, might be best suited to address immunization concerns in young adults.

“Our study suggests that making vaccinations convenient, affordable, and accessible is vital for a university community,” the report states. “For students who are uncertain about whether to get vaccinated, proper educational materials that dispel myths and misconceptions and further the understanding of the risks and benefits of vaccination should be distributed to target these individuals. Potentially, greater availability of such information among a university community would diminish barriers and assist students in reaching an affirmative decision to participate in a future vaccination campaign.”