The Impact of the Emotions that Frame Mothers' Decision-making about the Vaccination of Toddlers

Human beings bring a broad range of additional emotional information into the decision-making process. In the context of vaccination, the lay public often make decisions on the basis of strong emotions, impacted by information on the internet, anti-vaccination campaigns, misleading information, and negative media stories about vaccine risks. The so-called "framing effect" suggests a key role for an emotional system in mediating decision biases; the negative frame effect has found to be more persuasive than the positive one. This study analysed the impact of emotion on parental decisions to reject vaccination in Slovakia.

Conducted from January to May 2018, the quantitative research was based on a standardised questionnaire adopted from the Slovak public health institution RÚVZ SR, which was modified to analyse the attitudes of 875 mothers of 2-year-old children toward childhood vaccination.

Among the results:

• The results showed 4 types of mothers' attitudes to vaccination: (i) unconditionally accepts vaccination with fewer risk concerns; (ii) hesitates - mostly accepts, but has great concerns; (iii) selectively vaccinates; (iv) totally refuses the public vaccination programme, with negative attitudes about the risks.
• Younger mothers up to 35 years-old are more willing to risk not vaccinating and have a higher negative attitude about vaccinating.
• Being less willing to vaccinate a child is linked with: safety concerns (relationship observed in 24%, p = 0.0226), lack of perceptions of vaccine effectiveness and importance (17%; p = 0.0583), belief that vaccine causes autism (7%, p = 0.1151), own and others' experiences of vaccines (26%, p = 0.0257) and vaccine adverse events (22%, p = 0.0341), belief in anti-vaccination campaigns with the emotional basis and arguments (23%, p = 0.0325), belief in the danger of immune overload (8%, p > 0.05), thinking about vaccination as a business (5%, p = 0.148), and belief that children receive too many shots (3%, p = 0.2174).
• Those who are easily influenced prefer the negative frame. They are more likely to see the side effects of vaccinations rather than positive aspects (e.g., children with permanent damage after measles, mumps, and rubella (MMR) vaccine, p = 0.011). People with a positive frame and with strong convictions are less likely to refuse the vaccination due to symptoms of diseases (p = 0.026) and non-vaccination risks (p = 0.034).
• Mothers in this study indicated that when they start searching for information, it is hard to find reliable information and to make a choice from all the information they have found.
• The mothers spoke about violations of their human rights by making the Slovak vaccination programme obligatory. They call for a change and freedom of choice (31.5%). If the vaccination decision is on the basis of free will, many Slovaks would definitely not vaccinate.
• 39.5% of the sample think the vaccination programme should remain compulsory to prevent and reduce diseases, save lives, and build collective immunity.
• There are also neutral attitudes present in some mothers' opinions: Vaccination is not for everybody (11.4%), and vaccination brings positive and negative aspects in itself (17.6%).

Thus, in this study, the refusal of vaccination was found to reflect multiple factors, including family background, perceptions about healthy lifestyle and aspects of the natural immune system of children, awareness of risks of the diseases, perceived disadvantages of vaccines, vaccines' adverse effects compared to efficacy, and negative experience with vaccination in the family or social environment.

"Despite the enormous success of the vaccination program in Slovakia and the decreasing number of people infected with dangerous diseases or preventable diseases, the thinking surrounding the importance of vaccination has changed from a tool that encourages collective immunity to a compulsory tool of the state to support the pharmaceutical business. There are increasing numbers of parents who refuse to vaccinate their children. Fear of potentially deadly diseases has been replaced by the fear of real and, more often, imaginary side effects of vaccination. This is only encouraged by the emotional feelings of parents and emotional arguments against vaccination..."

The researcher suggests continuing public education and increasing awareness about vaccination side effects; for example, publishing the risks of non-vaccination and the consequences of fatal diseases (negative framing) is more effective in increasing the willingness to get vaccinated than promoting the positive aspects of vaccines and its safety. In addition, vaccine refusal can be addressed by respectfully listening to parental concerns and discussing the risks of non-vaccination.