Record: Jeremiah D. McCoy, Julia E. Painter, and Kathryn H. Jacobsen, “Perceptions of Vaccination Within A Christian Homeschooling Community in Pennsylvania” in Vaccine 37(2019): 5770-5776. [Abstract here]
Summary: George Mason University graduate Jeremiah McCoy is the Health Policy Analyst at Better Medicare Alliance. Former Assistant Professor in Global and Community Health at George Mason University, Dr. Julia Painter is a Senior Epidemiologist at the Fairfax County Health Department. Her research interests include the intersection of behavioral science and epidemiology; behavioral vaccinology; and child, adolescent, and school health. Dr. Kathryn Jacobsen, also from George Mason University, specializes in global health epidemiology. Her primary research interests are epidemiology, global health, infectious disease epidemiology, and global burden of disease.
The three authors here offer a qualitative study of Pennsylvania homeschoolers’ attitudes toward vaccination.
They begin with a solid literature review of basic homeschooling trends and demographics, followed by a quick look at previous studies on vaccination, of which there have been very few. Most states, they note, do not require homeschoolers to vaccinate, and homeschooling families on average visit their family physician (if they even have one) less often than do families whose children attend schools that require vaccination (or at least documentation from a physician citing religious or other objections leading to exemption).
Given these preliminary findings of previous research, McCoy and colleagues wanted to learn more about homeschooling families’ attitudes toward vaccination. To do so they conducted four 30-40 minute focus group discussions (2 to 5 adults per group) in late 2017 with a purposive sample of 14 white Christian homeschooling parents (13 mothers and 1 father) in Pennsylvania. Semi-structured interviews sought to elicit participants’ attitudes and beliefs about vaccination. Sessions were recorded and later coded by two of the researchers independently, and both researchers agreed that the data aligned with the venerable Health Belief Model, which predicts that people are more likely to engage in healthy behaviors when they
- believe the action will help them,
- feel empowered to choose, and
- have an external stimulant to help encourage the behavior.
The results are interpreted according to those three factors, but first the researchers note that the participants had a wide range of vaccine practices. Four parents fully vaccinated according to medical guidelines, and two did so but delayed some of the vaccines to space them out more. Four partially vaccinated, and four more rejected all vaccines. Among the four who did not vaccinate, two had vaccinated their older children but did not vaccinate their younger ones. After explaining all of this the authors move to the three Health Belief factors:
- Most of the parents in this survey believed that their homeschooling practice shielded their children from the chance of exposure to vaccine-preventable diseases. They also tended to downplay the severity of some of the diseases some of the vaccines treat, believing that it is part of God’s plan for children to develop their immune systems by being exposed to pathogens like chicken pox. On the other hand, parents understood the idea of herd immunity, and those who chose to vaccinate largely did so out of concern not for their own children but for the broader society. Parents were also largely skeptical about the claims made for vaccines by companies and the government, believing that the advice reflected the pecuniary motives of the sponsors rather than a legitimate concern about public health. Finally, the parents worried about potential side-effects of vaccines, especially the newer ones for which we do not have longitudinal data and the increased number of vaccines given so close together. Interestingly, though all of these beliefs were expressed by all of the subjects, dramatically different personal choices about whether or not to vaccinate children resulted.
- All of the parents in the sample were adamant that these decisions should be freely made by parents, not mandated by bureaucrats or medical experts. These parents felt empowered by the extensive research they had done into this issue, believing that the alternative information they had found on the internet or resources like the anti-vax The Vaccine Book gave them an insight into the issue that medical professionals often lacked. Some said that when they were young and ignorant parents they did what the doctor said, but as they gained knowledge they felt more free to disregard the doctor’s opinions.
- The external stimulant was usually the physician’s recommendation, but it could also be peers and family members. Parents with a more collegial relationship with their family doctor were typically more willing to have their children vaccinated despite their own reservations about the practice. For parents with less collegial relationships, this issue could become a contentious one, as they openly defied their physician’s advice. On the other side, given the conservative subculture within which these subjects all lived, those who did vaccinate sometimes felt pressure from friends and family not to do so. Whatever decision a parent made was likely to cause tension in one part of her or his life or another.
In their discussion the authors note a couple more things. Contrary to the beliefs of many homeschoolers, participation in the homeschooling community actually exposes their unvaccinated children to higher than average risk, especially in homeschooling communities with high numbers of unvaccinated children attending churches that do a lot of mission work in developing countries. Anecdotal outbreaks of diseases in the homeschooling community that are almost unknown in the broader country add credence to this assertion. They also note that the skepticism voiced by homeschooling parents differed only in degree, not in kind, from that expressed by many parents who send their children to school, noting that anti-vaccination sentiment is growing around the world.
Appraisal: We have published reviews of other vaccination-related articles in the past, and the findings here are consistent with what has gone before. For example, McDonald, et al., in a study of 24 California homeschoolers, found exactly what this article found: that actual practice varies widely among homeschoolers and that homeschoolers’ views here are complex. The vaccination issue has gained in urgency as New York, California, Washington State, and Maine, all moved to restrict religious or ideological exemptions to vaccination in the past year after a massive spike in measles in 2019. Many news outlets have associated these new restrictions with increases in homeschooling. The current Covid-19 situation potentially will move public opinion a bit more back toward the belief that public health takes priority over individual choice on such matters, meaning that more states could follow and limit exemptions for children attending public (and perhaps even private) school. It will be for future research to determine the degree to which these anecdotal news accounts of anti-vax parents turning to homeschooling capture a long-term trend or just rhetorical flourishes borne out of frustration over changes in the law. It will also be interesting to see if the world’s experience with a new virus, and eventually with a new vaccine against it, will motivate at least some homeschoolers to reevaluate their anti-vaccination stance.
Milton Gaither, Messiah College