Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA; Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
Department of Epidemiology, Faculty of Medicine, McGill University, Montreal, QC, Canada.
Vaccine. 2020 Mar 4;38(11):2620-2625. doi: 10.1016/j.vaccine.2020.01.035. Epub 2020 Feb 11.
Increases in vaccine hesitancy and vaccine-preventable disease outbreaks have focused attention on state laws governing school-entry vaccine mandates and the allowable exemptions (medical and nonmedical) from those mandates. There is substantial variation in the type of exemptions available in each state, and states with more rigorous or burdensome exemption requirements generally have lower exemption rates. States have little evidence, however, about how vaccine-hesitant parents respond to different requirements. Despite recent efforts to formulate "model legislation" templates for states to follow, policy evidence about optimal exemption regimes is limited to observational studies in states that have changed exemption laws. We conducted two online experiments to explore how parental attitudes and intentions responded to different school-entry vaccine mandate exemption requirements. We randomly assigned online participants to one of four hypothetical vaccine exemption application scenarios: parental signature only, a checklist of vaccines for which an exemption is requested, a lengthy (10-30+ min) video-based vaccine education module, and a requirement to write a statement justifying the exemption. Among parents with high vaccine hesitancy, a required vaccine education module led to significant decreases in vaccine hesitancy, while checklist and justification requirements increased vaccine hesitancy slightly. Among parents with low vaccine hesitancy, we observed a potential backfire effect when parents were required to write a justification statement. Our findings warrant replication in a larger, fully-powered trial to accelerate knowledge about how parents across the vaccine hesitancy spectrum respond to exemption regimes.
疫苗犹豫情绪的增加和可预防疾病的爆发，使人们对各州管理入学疫苗授权的法律以及对这些授权的可允许豁免（医疗和非医疗）的关注焦点。每个州可用的豁免类型存在很大差异，豁免要求更严格或更繁琐的州，其豁免率通常较低。然而，各州几乎没有证据表明对疫苗持犹豫态度的父母对不同的要求有何反应。尽管最近努力制定了各州可遵循的“示范立法”模板，但关于最佳豁免制度的政策证据仅限于豁免法律发生变化的各州的观察性研究。我们进行了两项在线实验，以探究父母的态度和意图对不同的入学疫苗授权豁免要求的反应。我们将在线参与者随机分配到四个假设的疫苗豁免申请场景之一：仅需父母签名、请求豁免的疫苗清单、长达 10-30 多分钟的基于视频的疫苗教育模块，以及要求写一份豁免声明的要求。在疫苗犹豫程度较高的父母中，需要进行疫苗教育模块，这会导致疫苗犹豫情绪显著下降，而清单和理由要求则略微增加了疫苗犹豫情绪。在疫苗犹豫程度较低的父母中，当父母被要求写一份理由声明时，我们观察到了一种潜在的适得其反的效应。我们的研究结果需要在更大、更有力的试验中进行复制，以加速了解疫苗犹豫程度不同的父母对豁免制度的反应。
