Commentary: Vaccine-hesitant parents’ reasons for choosing alternate protection methods in Turkey

This paper might appear to be perceived as niche and of limited general interest, until its implications become apparent given the ongoing COVID-19 pandemic. To be vaccine-hesitant might be a very big issue in the near future, if hopes for a vaccine for COVID-19 are realised. The authors have explored an issue that highlights the need for cultural sensitivity and respect. The plight of immigrants in Turkey is challenging, and their health needs appear from this paper to be even more of an issue.

Since the advent of vaccines, one would suspect that there have always been vaccine-hesitant parents. In recent years, the reduced incidence of once-common childhood diseases such as measles has led some parents to become vaccine-resistant or at least hesitant (Smith, 2017). But the vulnerable in our society, such as the immune-suppressed and older people, still require protection. Arguments about the need for vaccination rates to get to a level sufficient to provide herd immunity (Randolph and Barreiro, 2020) may not be sufficient to change parents from vaccine resistance. Other ‘fake news’ such as the infamous autism and vaccination research from the 1990s (Flaherty, 2011), continues to provide reasons for vaccine resistance, perhaps explained by a process known as ‘hysteresis’ (Chen and Fu, 2019). Again the capacity of public health units, and governments, to get messages out to debunk false information is an area that needs to develop, including the use of social media. This is especially so with the context of major international figures, such as President Trump, propounding health messages with little or no scientific evidence (Hernandez et al., 2020).

Conspiracy theories seem to abound with respect to COVID-19, and some of these might, at the least, be born of a lack of cultural sensitivity, or, at worst, of xenophobia (Huang and Liu, 2020). It is interesting to hypothesise about what would happen if China developed a viable vaccine for the virus. The conspiracy theorists would run amok. But more importantly, the take up of that vaccine could be impacted. And the result might be COVID-19 being around longer, more morbidity, and more mortality.

There has been discussion about some countries making immunisation for COVID-19 compulsory. Immunisations have never been compulsory, and signatories to the 1948 United Nations Declaration of Human Rights would find the lack of choice to be at odds with the principle. Given the need for speed to produce a viable vaccine, there are also dangers that the range and scope of safety processes will not have been as scrupulous, making the need for choice even more important. But these are also issues that are likely to make the vaccine-hesitant person even more hesitant.

The use of foetal tissue in the development of most vaccines in recent years (Olshansky and Hayflick, 2017) also means that there are potential issues based on religious belief. However, some compromise has been found in the past; for example, Roman Catholics have approved immunisations for Rubella, because of the potential for damage to the unborn child, and potential need for abortions as a result.

Readers of this journal do so on the basis of their education, profession and interest in research. This basis means that an understanding of evidence and science allows for a scrutiny of information, in short research and evidence literacy. Readers believe in science, but this paper highlights the need to be sensitive about other matters, such as religion. This paper emphasises how religion can be regarded as being as important as, if not more important than, science. Therefore, this awareness needs to be built into messages, rather than these being simply science-based.

This paper gives insight into the thinking and beliefs of immigrants to Turkey. It highlights the need for messaging about immunisations being culturally sensitive. It appears that ethnically diverse communities within various countries are suffering more from the impact of COVID-19 (Rothschild, 2020; ONS UK, 2020; CDC, 2020). The Melbourne understanding is that the communication was top-down, and not via the leaders in their community, and that this route might have been better received. Within this paper, these understandings are starting to be unpacked. The need for partnership with communities seems to be a key message to overcome vaccine resistance in a sensitive manner.

Biography

Steve Campbell is Professor of Clinical Redesign, Nursing, and Associate Head of Research at the School of Nursing at the University of Tasmania. He leads the School’s Patient Involvement Research Group, has multiple PhD students, and his most recent empirical research has been into reablement.

Elaine Crisp is Course Director of the Bachelor of Nursing at the School of Nursing, University of Tasmania. Her research interests include evidence-informed practice, health promotion and health literacy.