Vaccines: Practices and hesitancy among general physicians in France

At population level, vaccines contribute to reducing mortality associated with infectious diseases such as measles, diphtheria, tetanus, hepatitis B or bacterial meningitis. The community general physician, at the centre of this preventive strategy, remains the main source of information for families. In an article published in the journal Ebiomedecine, Pierre Verger (Inserm Unit 912, "Economics and Social Sciences Applied to Health and Analysis of Medical Information - SESSTIM") and his collaborators present and analyse the attitudes and practices of over 1,500 general physicians in France, in a context of distrust toward vaccines.

Vaccination is the most effective means of preventing, or even eliminating, many infectious diseases. However, in recent years, a growing number of unfavourable opinions regarding the latter has been observed among the general population in France.

Given the widespread scepticism, which is contributing to inadequate coverage for some vaccines, the general physician plays a major role in matters of prevention and information. The survey, conducted by Pierre Verger (Inserm Unit 912, "Economics and Social Sciences Applied to Health and Analysis of Medical Information - SESSTIM") between April and July 2014, has attempted to capture the practices of general physicians in different vaccination scenarios. The results obtained provide a better understanding of the factors in the reticence—or confidence—of physicians with respect to some vaccines.

Physicians' recommendations vary with the situation.

1st reassuring finding: Almost all physicians questioned (96%) are confident in their ability to explain the usefulness of vaccines to their patients. Nonetheless, this figure falls to 43% when it comes to speaking about the role of adjuvants, and justifying their use.

2nd finding: The recommendations of general physicians vary with the vaccination scenario: 83% often, or even automatically, recommend the measles, mumps and rubella (MMR) vaccine to adolescents and young adults, but only 57% advise vaccination against type C meningococcal infections for children and young people aged 2-24 years, although the latter is part of the vaccination schedule. "Their hesitation to vaccinate might also reinforce that of patients, and contribute to inadequate vaccine coverage, particularly for controversial vaccines," according to the authors of this article.

The majority of physicians, however, rather or quite trust the French Ministry of Health (8 in 10 physicians) or the health agencies (9 in 10 physicians) to provide them with reliable information as to the benefits and risks of vaccines.

Some uncertainties persist regarding the risks and usefulness of some vaccines

Some physicians express doubt concerning the risk of serious side-effects from certain vaccines, even when these doubts are refuted by the results of pharmacovigilance and epidemiological studies (e.g. regarding hepatitis B vaccine and the presence of adjuvants in some vaccines). Thus 6% of physicians questioned consider it likely, or even probable, that there is an association between papillomavirus vaccine and the occurrence of neurodegenerative diseases such as multiple sclerosis. Over a quarter of them (26%) also believe that some vaccines recommended by the public authorities are unnecessary, and 20% even believe that children are vaccinated against too many diseases.

The existence of such hesitation on the part of general physicians is directly associated with less regular recommendations for vaccination to their patients. Most of these doubts, like those of the general population, relate to vaccines that have been controversial in France (hepatitis B vaccine, human papillomavirus vaccine).

However, more surprisingly, a proportion of general physicians hesitate to recommend vaccines of proven safety and efficacy (meningococcal C and measles vaccines). For the moment, these hesitations affect only a minority of general physicians (again depending on the vaccine), but constitute an additional impediment to the maintenance of enough vaccine coverage in the population to protect it against infectious diseases that are still dangerous.

Although this study shows that general physicians trust the authorities, it also underscores their need for training and resources to help them respond to patients who are hesitant about undergoing vaccination.