Vaccine hesitancy in the ‘religious’

MacDonald et al. highlight the importance of building strong physician–parent/patient relationships despite vaccine refusal (1). Certainly physicians should not dismiss such patients from their practices. But nondismissal with an ongoing sense of frustration at a family’s choice can still manifest in subtle ways and undermine the relationship. I am hopeful that if physicians can comprehend patient perspectives more readily and understand their rationales, this will help physicians to be more willing to continue caring for vaccine-hesitant families as opposed to doing so only out of fear of disciplinary repercussions. I offer one example here of hesitancy that led to positive outcomes.

In Canada, some vaccine-hesitant families come from religious, rural communities. While religion is an established risk factor for nonvaccination (2–4), it is important to consider not just religious belief but the social dynamics that lead certain religious persons to be vaccine hesitant. Religious people from rural areas often have limited interaction with medicine as there are few health professionals in the area, let alone research centers. Their exposure to science and medicine occurs largely through the popular media, where science and religion are frequently portrayed as obligatory opponents. Furthermore, the term ‘religious’ is often used pejoratively, and the beliefs of these families are often misrepresented to others. Media portrayals of religious extremism, irrationality, and ignorance alongside ardent antireligionists exacerbate the problem of distrust (5). Understandably, this dynamic in the media leaves many people feeling misrepresented and dismissed for being ‘religious’.

This changes how vaccines are perceived. Vaccines become a part of a hostile system. It is supported by the ‘scientists’, who are often viewed as arrogant and mistaken regarding what various religious beliefs entail. In this light, it is not surprising that vaccines are viewed with suspicion by some families. The empirical evidence is less important than the sense of derision that surrounds it. This is, of course, tragic because while the relationship between religion and science has certainly been complicated, religion has played a major role in the foundation of modern science and health care in both the technical and the altruistic sense (6–8). Many scientists are religious themselves (9).

If physicians were more aware of this underlying sense of ‘feeling criticized by the medical profession’, it would help them to see that some forms of vaccine hesitancy are quite understandable. This should mitigate the impulse to dismiss families because they are irrational or difficult. In my experience and that of others, patients in this subset are willing to discuss their hesitancies when they do not feel dismissed for being religious. Many are surprised but reassured at some of the aforementioned points regarding science and religion, and they no longer feel that they are forced to choose between the two. Some have reconsidered their hesitancy altogether. Through strong relationships and a discerning mind, physicians can change care of questioning families from a duty to an opportunity for reconciliation and promotion of child health.

Potential Conflicts of Interest: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.