Understanding Physician and Consumer Responses to Vaccination Policy

Problem Statement:

Vaccinations are an extremely effective tool in the prevention of multiple diseases, so much so that diseases such as measles, mumps, whooping cough, and chicken pox had been effectively wiped out in the United States. However, these diseases and others are resurging due to skepticism toward the benefits and concerns regarding the risks of vaccinating (time.com, 2014). Indeed, 26 states are not meeting the U.S. government target of vaccinating 95 percent of American children (cnn.com, 2015).

Marketing and Policy Implications:

While vaccination is typically associated with childhood, adults also receive vaccinations for adult-associated illnesses as well as to boost the effectiveness of previously administered vaccinations. The choice to vaccinate is made with input from the medical professionals who administer them. A myriad of demographic, structural, social, and behavioral factors impact people’s likelihood of accepting or refusing vaccinations for their children, themselves, or when considering medical professionals, their patients. A recent review by Thomson, Ronginson, and Vallée-Tourangeau (2016) identifies five primary drivers of vaccination behaviors; extant research has considered vaccine access, affordability, awareness, and acceptance, and has also explored the impact of activation, whereby consumers are nudged or otherwise incentivized to vaccinate. However, it is difficult to persuade people to vaccinate, particularly when their hesitancy is driven by firmly entrenched beliefs about the importance, risks, and ethics of vaccination (Dubé, et al. 2013). In this work, we seek to explore the relationship between physician and consumer responses to vaccination policy and, in doing so, to evaluate the legal, economic (insurance), and socio-cultural factors that affect responses to policy.

For physicians/providers who treat children, legal concerns, state/federal guidelines, and malpractice insurance regulations impact tolerance for treating patients whose parents have declined to vaccinate or who seek an alternative vaccination schedule. Increasingly, physicians are dismissing patients from practices for refusing to vaccinate children (O’Leary et al. 2015). In this track, we ask how the law (state/federal guidelines), health insurance regulations and reimbursement procedures, and malpractice insurance shape physician behavior related to treating patients who are vaccinated, treating patients who are not vaccinated, and dismissing patients who refuse vaccination.

We also seek to explore the impact of physician policy on consumer decisions to vaccinate. Indeed, numerous factors impact the decision to vaccinate. These factors can relate to individual differences in perceived morality, religion, political beliefs, education, and socio-economic status, just to name a few (Dubé, et al. 2013). We therefore will explore how each of these individual difference factors shape behaviors.

Additionally, we build on this work by exploring how the interactions between doctors and patients can impact vaccination behaviors; for instance, how the doctor presents vaccination options, the level of trust between the doctor and the patient, and default effects (i.e., whether a practice assumes patients want to vaccinate unless explicitly indicating otherwise). Additionally, policies to dismiss patients who do not vaccinate, and whether this information is known by patients, are also likely drivers of vaccine-related decisions.

While the aforementioned examples relate primarily to early childhood immunizations, teenagers and adults also receive immunizations. For instance, the CDC recommends that preteen girls and boys receive the HPV vaccine (CDC 2015). Additionally, adults are recommended to receive Tdap (tetanus, diphtheria, and pertussis) boosters every 10 years, a seasonal flu vaccine annually, and a shingles vaccine after the age of 65 (CDC 2016). The type of vaccine and the behaviors that lead to the disease may also impact related behaviors. For instance, diseases like whooping cough are typically acquired passively through casual contact, whereas a disease such as HPV results from engaging in risky activities (e.g., unprotected sex).

In sum, our proposed track seeks to address the relationship between physician and consumer responses to vaccination policy, and how factors such as information format, service provider policy, and qualities of the disease itself interact with policy to drive vaccine adoption or refusal decisions.

Tentative Timeline:

Preconference:

  • Session participants will identify topics most relevant to their research interests and backgrounds, undertake a literature review, and report to the team current practices (or lack thereof) in the legal, economic, and socio-cultural space. We will combine reviewed topics to outline a conceptual model before the conference.
  • We will identify concrete topics for empirical research grounded in the relationships identified above. Specifically, the team will discuss a study aimed at measuring physician attitudes and practices. A draft survey will be distributed winter 2017, with data collection efforts taking place in late winter/early spring 2017. Survey data will be distributed before the conference and we will review topics of interest in person. The physician data will be used to discuss a survey measuring consumer decision-making at the conference.
  • We plan to apply for grants to undertake the survey discussed in point 2. Specifically, CUNY has two grants that can be submitted in the fall, one with vulnerable populations and second is through the University for tenure-track Faculty. We plan to submit to both grants, and the team will help draft the grant proposals. If both grants are obtained, funds up to 10,500 USD can be allocated towards research.
  • Track chairs will invite selected academics who study vaccination law and who are nurse practitioners to further develop knowledge.

Conference Day 1:

Morning (9am-Noon): Discuss literature reviews undertaken before conference to begin outlining conceptual model of factors impacting physician and consumer decision making.

Afternoon (2-5pm): Discuss Physician Survey Data. Conduct additional analyses of data based on discussion.

Conference Day 2:

Morning (9am-Noon): After synthesizing knowledge from Day 1, participants will discuss possible designs for surveys designed to understand consumer decision making. We have two goals before participants disperse: to have outlined a conceptual model (to be submitted as a competitive paper to the TCR special issue) and to have the beginnings of an empirical paper outlined as well.

After conference:

We plan to apply to the TCR grants in the next funding cycle (Summer 2017). The team will also explore other funding opportunities such as the New York State Board of Health.

Chairs

References:

  1. CDC (2015), “HPV Vaccines: Vaccinating Your Preteen or Teen,” available at: http://www.cdc.gov/hpv/parents/vaccine.html.
  2. CDC (2016), “Adults Need Vaccines, Too,” available at: http://www.cdc.gov/features/adultimmunizations/.
  3. Dubé, Eve, Caronlien Laberge, Maryse Guay, Paul Bramadat, Réal Roy, and Julie Bettinger (2013), “Vaccine Hesitancy: An Overview,” Human Vaccines & Immunotherapeutics, 9(8), 1763-73.
  4. Levs, J. (2015), “The Unvaccinated, By the Numbers,” cnn.com, available at: http://www.cnn.com/2015/02/03/health/the-unvaccinated/.
  5. O’Leary, Sean T., Mandy A. Allison, Allison Fisher, Lori Crane, Brenda Beaty, Laura Hurley, Michaela Brtnikova, Andrea Jimenez-Zambrano, Shannon Stokley, and Allison Kempe (2015), “Characteristics of Physicians Who Dismiss Families for Refusing Vaccines,” Pediatrics, 136(6), 1103-11.
  6. Sifferlin, A. (2014), “Four Diseases Making a Comeback Thanks to Anti-Vaxxers,” time.com, available at: http://time.com/27308/4-diseases-making-a-comeback-thanks-to-anti-vaxxers/.
  7. Thomson, Angus, Karis Robinson, and Gaëlle Vallée-Tourangeau (2016), “The 5As: A Practical Taxonomy for the Determinants of Vaccine Uptake,” Vaccine, 34, 1018-24.