Varicella (chickenpox): Qualitative research on new childhood vaccinations
Parents’ attitudes to vaccinations in general were discussed, in order to understand the context for the possible introduction of a new vaccination. Although all respondents agreed that vaccinations are, essentially, a good thing in helping to protect babies and children, a host of emotional concerns and fears also emerged around vaccinations.
These included the possible harm inflicted on their baby/child by the vaccine, worries about ‘overloading’ children’s immune systems by giving them too many vaccinations at too young an age and, finally, a set of concerns based on the perception that vaccinations go against the natural workings of the body. Naturally gained immunity was often thought to be more effective than that given by a (chemical) vaccination. There was also a widespread belief that, by vaccinating against more and more diseases, we are running the risk of so weakening our natural immunity that we will open the door to new conditions that we then won’t be in a position to ‘fight off’. Respondents were drawing an analogy here with hospital ‘superbugs’ and the over-use of antibiotics.
Most parents appeared to hold these fears and concerns at some level, but, because of their ultimate belief that vaccines offer protection against serious diseases and are therefore ‘worth it’, they worked to rationalise away and suppress such doubts and were content to let their children be vaccinated.
However the offer of a new vaccine, and/or any discussion surrounding it, could, potentially, have the effect of allowing these fears to emerge, with a possible (at least initial) knock-on effect on uptake. This is especially if parents feel in any way that the protection given by the new vaccination is against a less serious disease.
The research suggests that the introduction of a varicella vaccine is likely to be problematic for two main reasons:
- Parents did not take chickenpox seriously as a disease
- The proposed timing of the vaccination to coincide with the MMR vaccination
All parents were familiar with chickenpox. Their key associations, and the reasons why they didn’t take it seriously, were
- Being relieved when the child catches it – in fact, many parents talked about wanting their child to catch it
- Knowing it is far worse as an adult
- Experience of the disease as usually mild and harmless
- Ignorance of any serious consequences, in terms of what happens and who it affects
There was vague awareness of a connection with shingles, although parents were frequently unsure how the two diseases were related. Shingles was often known to be relatively serious/uncomfortable for adults.
Unfortunately, during the course of the research discussions, there was no significant movement in opinions among parents regarding the appeal of the varicella vaccine, due to a lack of convincing arguments for taking the disease seriously or strong positive benefits for the vaccine itself.
The suggested timing of the varicella vaccine, as coinciding with MMR, was regarded as problematic by many parents. Although the MMR controversy has certainly died down, and the overwhelming majority of parents that we spoke to were happy to take the ‘set menu’ of immunisations without questioning, MMR retains an aura of suspicion. Frequently parents weren’t sure why MMR was questionable, but were aware that there has been significant controversy in the past.
The possibility of adding varicella to the MMR set to create an MMRV vaccine appeared to stir up a host of latent concerns about the safety of the vaccine and the wisdom of administering a ‘cocktail’ to babies. Administering varicella as a separate vaccination but at the same time as MMR was preferred, although parents were reluctant for their child to receive 3 injections at 13 months, and there was still concern about the interaction of a separate new vaccine with MMR.
Overall then, whilst varicella could be seen as a recognisable member of the immunisation family (as it is a proper disease) it was not felt to be serious enough to merit inclusion. More worrying is its likely negative impact on the schedule if linked to MMR in any way, especially if seen as an unnecessary vaccine.
Healthcare professionals were much more aware of the seriousness of chickenpox, and, on the whole, welcomed the introduction of a varicella vaccine. They ‘correctly’ predicted that it will be harder to convince parents/the general public of the need for the vaccine, and they were also very worried about the impact on the schedule, and on MMR uptake, of introducing varicella to coincide with MMR.
In terms of communications, parents felt that a wide scale public campaign would be wasteful, as their preference was to hear about the new vaccine directly from their health visitor/GP, and to be given information about it via leaflets and posters.
On the other hand, the majority of the healthcare professionals that we spoke to were keen for a public campaign to announce and promote the new vaccine. They wanted some of the groundwork for informing parents about the varicella vaccine to have been done before they were put into the position of having to ‘sell’ the vaccine to parents, as many felt this was putting a large burden on them. Not all were confident, in the light of their experiences of dealing with the MMR debate, that they would be supplied with the necessary information/reassurance to pass on to parents.
To optimise the chances of this vaccine being accepted it will be necessary to project it as follows:
- Educate/ remind parents that chickenpox can have serious consequences for vulnerable groups e.g.
- Encephalitis, eye and body damage, Febrile Purpura
- Inform parents that 1 in 10 adults are still vulnerable to chickenpox
- Spell out the symptoms for badly affected children
- In eyes, mouth, scarring etc.
- Remind parents of general pain, discomfort and ‘social exclusion’ of infected children
- Possibly allude to carer ‘costs’ especially working Mothers
- Possibly allude to any benefits in protecting children against shingles later in life
- Give explicit reassurance about the safety of the vaccine, especially in the context of MMR
The varicella core driver is that, now that the parent knows how bad chickenpox can be for the child and (vulnerable) adults, it makes sense to avoid both the unpleasantness for their child and the risk to others.
Administering V as a separate vaccine seems likely to cause least impact on uptake of MMR, but we would suggest that acceptance of, and trust in, MMR remains very fragile and that it is still too soon to consider even this kind of change to the vaccination schedule.
There is a risk that a public campaign about the varicella vaccine will further stoke controversy over MMR. Parents, especially mothers, do not welcome being made to think about these issues, as this opens them up to their background doubts and fears which otherwise they try to suppress. Their preference is to be told what is best for their child, personally, by a healthcare professional that they know and trust. Our feeling is that parents would be more positively inclined towards the varicella vaccine, and more inclined to take it up, if they can hear about it initially in these circumstances.
That said, we do feel there is potentially a strong role for PR, in helping to educate parents about the possible risks of chickenpox, both to their child and to other vulnerable groups. Magazine or newspaper stories about people affected by the disease and discussion of the issues on parenting websites etc. are likely to have an impact on mothers’ perceptions of the seriousness of the disease and may encourage them to view a vaccination more favourably.
Qualitative research was commissioned to understand attitudes towards the potential new vaccine, including identifying any potential barriers to take-up, in order to help provide guidance for its introduction and to inform the development of communications around the new vaccine.
Specifically, the objectives of the research were to explore:
- The perceived need for, and interest in, the varicella vaccine
- How parents felt about the proposed methods and timings for administering the vaccine
- How the new vaccine was felt to sit within the current immunisation programme
- What were seen to be the benefits of, and barriers to, take-up
- The need and role for communications
The Department of Health is considering the introduction of a new vaccine against varicella (chickenpox) to its routine childhood immunisation programme.
The research highlighted that the introduction of a varicella vaccine is likely to be problematic because parents didn’t take chickenpox seriously as a disease, and the proposed timing to coincide with the MMR vaccination caused concerns
Proportional representation to local areas
The study included research with parents, and with healthcare professionals. Parents were consulted via a series of 5 discussion groups with mothers, and 2 discussion groups with fathers. Each of the groups comprised 5-6 respondents and lasted for 1 ½ hours. All the mothers had babies aged between 10 and 14 months, and the fathers had babies 0-14 months.
The sample covered the following demographic criteria:
- Split by first time vs. experienced mothers
- Split by socio-economic grade
- Split by age
- Fieldwork took place in Manchester, Birmingham and London
- Ethnic minorities were included as per local population
Any who would never allow their children to be vaccinated were excluded from the research.
3 paired depths with Health Visitors, and 3 single depths with Practice Nurses were also held.
The enquiry into varicella was conducted as part of a larger study which also looked at responses towards the introduction of a vaccination against rotavirus. In the course of the fathers’ groups and the depths with healthcare professionals, both vaccinations were discussed, but separate, dedicated groups were held with mothers for varicella and for rotavirus.
Mothers n=c.25, Fathers n=c.12, Healthcare professionals n=9
London/SE, Midlands, North
21st January and 9th February 2009.