Series: What do health care professionals have to say? *Taylor Holroyd: the Ph.D. Candidate*

Social media has made it easy for people to voice their political views and issues with trust in the government. Federal agencies like the Centers for Disease Control and Prevention (CDC) come up a lot with those questioning vaccines, so I wonder:

Have vaccination rates been falling due to lost trust in public health agencies?

To find out, I turned to Taylor Holroyd, a Ph.D. candidate in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. 

In Taylor’s dissertation, she is looking at trust in public health authorities, school immunization law, and how vaccine knowledge, attitudes, and beliefs can all impact vaccine decision-making and, subsequently, vaccine coverage.

She’s particularly interested, among many other aspects of vaccinations, in looking at how and whether people trust public health authorities, such as the CDC, US Department of Health and Human Services (HHS), US Food and Drug Administration (FDA), and state and local public health authorities. 

Taylor wants to know whether people trust public health authorities differently than they trust healthcare providers or other parts of the government, and how that trust impacts whether they follow vaccine recommendations.

Widespread vaccination has been a huge public health success, but this success has been threatened to some extent by increasing vaccine hesitancy both in the US and in other countries.


Although Taylor reports that trust in the government has been decreasing in general over time, her research indicates that people do generally trust public health agencies. 

Our research has shown that effective, accessible, and appropriate communication is really important in determining whether a population is going to trust government agencies, including public health agencies. If people trust public health agencies, and we have found that they do, then they’re more likely to follow public health recommendations, including vaccine recommendations. Trust in public health authorities is definitely important for vaccine decision-making since lots of people get their information from sources like the CDC.


When it comes to local, state, national, and global health authorities, Taylor doesn’t see many differences in trust. However, in health emergencies, people tend to turn to national or global agencies, as they believe they will have more and better information than state or local authorities if the crisis isn’t happening in their area. 

Trust doesn’t stop at public health authorities. Taylor has found that in general, people still listen to their doctors. 

There’s a recent global report by the Wellcome Trust that shows over 70% of people still trust doctors and nurses as an accurate source of health information.” The same report indicated that 80% of people see vaccines as safe and effective.


She notes that even though people generally still trust their healthcare providers, the relationships between them have changed over time.

People go to the doctor expecting it to be a conversation, like shared decision-making.


Taylor has found that when doctors let parents know that the vaccines are happening versus asking parents if they want vaccines, it could approve vaccine rates.  

There’s a whole area of research that looks at the approach that doctors take when they are talking to parents about vaccines. If the doctor approaches it in a presumptive sense saying, ‘today we are going to be doing some shots,’ they get a different reaction from parents than if it’s more participatory, such as saying, ‘what do you want to do about shots today?’


Although the presumptive approach may work best vaccine rate-wise, should the healthcare provider take the participatory approach, the open conversations between doctors and parents could be an excellent opportunity for doctors to answer parents’ questions about their vaccine concerns.

There’s a spectrum of vaccine hesitancy. 

It’s normal and common for parents have concerns. Just because a parent has concerns doesn’t mean that they don’t trust their doctor or that they won’t get their child vaccinated. Only a segment of the population chooses not to vaccinate…There’s a perception that the size of this group has been growing over time, but it hasn’t really–-the vast majority of people still fully vaccinate themselves and their children. Social media has played into that perception and enabled people to spread misinformation about vaccines.


Healthcare professionals could make improvements to help regain the trust of parents who are vaccine-hesitant or resistant to vaccines.

Taylor says that the medical school curriculum could increase the amount of time spent on vaccine education, as well as teaching how to communicate with parents to encourage them to vaccinate effectively. 

Wary parents need to know that they should be asking their healthcare professionals questions to alleviate their concerns.

For people who hold vaccine concerns, having an accurate understanding of how vaccines work is a really important step to accepting vaccination.


Public health authorities also need to provide more apparent and concise information to the public. 

We did an interesting study where we interviewed a diverse range of people from different socioeconomic backgrounds to figure out what makes up trust in agencies like the CDC. 

We found a couple of characteristics were important, like constructs of trust in public health authorities:

*If people view public health agencies like the CDC as competent, altruistic, and innovative
*If they think that these agencies have integrity
*If they think that the people working for those agencies have a strong work ethic and are committed to evidence-based science
*If there’s a consensus between different public health agencies in reporting their findings

All those things contribute to people trusting public health agencies.


According to Taylor, people of different socioeconomic backgrounds have similar levels of trust in public health agencies.

Her findings also show that some people of a lower socioeconomic standing report that they have a hard time understanding some of the information put out by officials, therefore it’s essential to offer more straightforward and understandable materials.

Transparency and quick reporting are crucial to people trusting government agencies.  

Our findings have also shown that public health authorities’ timely reporting of information, particularly in public health emergencies, such as an infectious disease outbreak, is crucial for people finding public health authorities to be trustworthy and transparent.

People want complete and clear information from public health authorities and clear recommendations, specifically recommendations that can be useful to them for disease prevention.


When it comes down to it, Taylor’s research shows that most people have trust in health officials, follow the recommendations, and are making rational decisions when it comes to vaccinations.

It’s normal for parents to question things when it comes to their children, and it’s great that we have health officials so willing to step up and offer answers.

Education is pivotal to getting parents to understand that getting the vaccine is much safer than getting the vaccine-preventable disease.

Vaccination is one of the most effective and cost-effective health interventions of all time. I think that people understanding that it’s much better and safer for their kids to get vaccinated than not can help contribute to trust and rational decision making. 


Here’s the takeaway.

Most people still fully vaccinate their children, but it’s crucial that we maintain that level of trust and that level of vaccine coverage in order to ensure that populations are protected against vaccine-preventable disease in the long term.

To parents who have concerns, it’s definitely good to ask questions, but it’s important to seek out the best resources like your health care providers and agencies like the CDC that put a lot of information and create good resources for parents.


Public health agencies have no reason not to be transparent. It’s important to use the resources provided by these authorities, as well as to make sure that you are getting your questions answered by your doctor.


Craig: The Pharmacist

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