Childhood vaccination in the twenty-first century: Parental concerns and challenges for physicians

Vaccination is one of the most important methods of prevention of infectious disease, saving millions of lives worldwide and protecting people from potentially debilitating complications. It is therefore hailed as one of the greatest advances of science-based medicine of all times. Although repeatedly proven safe and effective, vaccination has been questioned and resented throughout its long history. Vaccine hesitancy and refusal are once again on the rise in this century, due to a complex interplay of numerous factors and circumstances. A decline in childhood vaccination rates has already resulted in resurgence of hitherto eliminated vaccinepreventable diseases in many countries, and is now perceived as a major public health threat. This decline is closely related to increasing spread of misinformation regarding vaccine safety and effectiveness, coupled with a growing anti-vaccine activism. This, among other issues, underscores the need to improve communication between healthcare workers and parents, as well as devise a more comprehensive approach to boosting vaccine confidence, where scientists, physicians, media and the general public all have important roles to play. In this paper, we discuss the phenomenology and causal structure of vaccine hesitancy and refusal, and briefly review some widespread vaccine-related questions of everyday practical importance.