Vaccine hesitancy among general practitioners: evaluation and comparison of their immunisation practice for themselves, their patients and their children

  • M. Killian
  • M. Detoc
  • P. Berthelot
  • R. Charles
  • A. Gagneux-Brunon
  • F. Lucht
  • C. Pulcini
  • S. Barbois
  • E. Botelho-Nevers
Original Article


To gain knowledge about vaccine hesitancy among general practitioners (GPs), we conducted a survey to compare their vaccination attitudes for themselves, their children and their patients. A questionnaire survey was sent to GPs working in private practice in the Rhône-Alpes region, France, between October 2013 and January 2014. GPs’ immunisation practices for diphtheria–tetanus–poliomyelitis (DTP), measles–mumps–rubella (MMR), pneumococcal, pertussis, hepatitis B (hepB), human papillomavirus (HPV), seasonal and H1N1 influenza and meningococcal C (menC) vaccines were considered. Divergence was defined by the presence of at least one different immunisation practice between their patients and their children. A total of 693 GPs answered the questionnaire. When considering all investigated vaccines, 45.7 % of divergence was found. Individually, divergence was highest for the newest and more controversial, i.e. HPV (11.8 %), hepB (13.1 %), menC (23.7 %) and pneumococcal (19.8 %) vaccines. Only 73.9 % of GPs declared that they recommended HPV vaccine for their daughters. After multivariate analysis, older age was associated with higher risk of divergence. According to the French 2012 recommendations, GPs were insufficiently immunised, with 88 % for DTP and 72 % for pertussis. GPs declared to recommend vaccination against DTP, pertussis and MMR for their patients and their children in more than 95 % of cases. The declared rates of recommendation were lower than 90 % for other vaccines. These results bring new insight about vaccine hesitancy. GPs have divergent immunisation attitudes toward their relatives and their patients, especially when considering the newest and most controversial vaccines, with HPV vaccine being the main focus of controversies.


Pertussis Vaccination Coverage Vaccine Coverage Immunisation Practice Pandemic H1N1 Influenza 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors thank the six medical councils (Loire, Ardèche, Drôme, Isère, Savoie and Haute-Savoie, France) involved in the study and URPS Rhône-Alpes for their help in the Web-based survey sending.

Compliance with ethical standards


No specific funding source was used for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study, formal consent is not required.

Supplementary material

10096_2016_2735_MOESM1_ESM.docx (40 kb)
ESM 1 (DOCX 40 kb)


  1. 1.
    Duclos P, Okwo-Bele J-M, Gacic-Dobo M, Cherian T (2009) Global immunization: status, progress, challenges and future. BMC Int Health Hum Rights 9(Suppl 1):S2. doi: 10.1186/1472-698X-9-S1-S2 CrossRefPubMedGoogle Scholar
  2. 2.
    Kata A (2010) A postmodern Pandora’s box: anti-vaccination misinformation on the internet. Vaccine 28:1709–1716. doi: 10.1016/j.vaccine.2009.12.022 CrossRefPubMedGoogle Scholar
  3. 3.
    Larson HJ, Cooper LZ, Eskola J, Katz SL, Ratzan S (2011) Addressing the vaccine confidence gap. Lancet 378:526–535. doi: 10.1016/S0140-6736(11)60678-8 CrossRefPubMedGoogle Scholar
  4. 4.
    MacDonald NE; SAGE Working Group on Vaccine Hesitancy (2015) Vaccine hesitancy: definition, scope and determinants. Vaccine 33:4161–4164. doi: 10.1016/j.vaccine.2015.04.036 CrossRefPubMedGoogle Scholar
  5. 5.
    Eskola J, Duclos P, Schuster M, MacDonald NE; SAGE Working Group on Vaccine Hesitancy (2015) How to deal with vaccine hesitancy? Vaccine 33:4215–4217. doi: 10.1016/j.vaccine.2015.04.043 CrossRefPubMedGoogle Scholar
  6. 6.
    Larson HJ, Jarrett C, Schulz WS, Chaudhuri M, Zhou Y, Dube E et al (2015) Measuring vaccine hesitancy: the development of a survey tool. Vaccine 33:4165–4175. doi: 10.1016/j.vaccine.2015.04.037 CrossRefPubMedGoogle Scholar
  7. 7.
    Falagas ME, Zarkadoulia E (2008) Factors associated with suboptimal compliance to vaccinations in children in developed countries: a systematic review. Curr Med Res Opin 24:1719–1741. doi: 10.1185/03007990802085692 CrossRefPubMedGoogle Scholar
  8. 8.
    Mikaeloff Y, Caridade G, Suissa S, Tardieu M (2009) Hepatitis B vaccine and the risk of CNS inflammatory demyelination in childhood. Neurology 72:873–880. doi: 10.1212/01.wnl.0000335762.42177.07 CrossRefPubMedGoogle Scholar
  9. 9.
    Denis F, Cohen R, Stahl J-P, Martinot A, Dury V, Le Danvic M et al (2014) Papillomavirus vaccination in France according to 2008 to 2012 Vaccinoscopie(®) data. Méd Mal Infect 44:18–24. doi: 10.1016/j.medmal.2013.11.001 CrossRefPubMedGoogle Scholar
  10. 10.
    Gherardi RK, Coquet M, Cherin P, Belec L, Moretto P, Dreyfus PA et al (2001) Macrophagic myofasciitis lesions assess long-term persistence of vaccine-derived aluminium hydroxide in muscle. Brain 124:1821–1831CrossRefPubMedGoogle Scholar
  11. 11.
    Freed GL, Clark SJ, Cowan AE, Coleman MS (2011) Primary care physician perspectives on providing adult vaccines. Vaccine 29:1850–1854. doi: 10.1016/j.vaccine.2010.12.097 CrossRefPubMedGoogle Scholar
  12. 12.
    Schwarzinger M, Verger P, Guerville M-A, Aubry C, Rolland S, Obadia Y et al (2010) Positive attitudes of French general practitioners towards A/H1N1 influenza-pandemic vaccination: a missed opportunity to increase vaccination uptakes in the general public? Vaccine 28:2743–2748. doi: 10.1016/j.vaccine.2010.01.027 CrossRefPubMedGoogle Scholar
  13. 13.
    Dubé E, Laberge C, Guay M, Bramadat P, Roy R, Bettinger J (2013) Vaccine hesitancy: an overview. Hum Vaccin Immunother 9:1763–1773. doi: 10.4161/hv.24657 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Bruno DM, Wilson TE, Gany F, Aragones A (2014) Identifying human papillomavirus vaccination practices among primary care providers of minority, low-income and immigrant patient populations. Vaccine 32:4149–4154. doi: 10.1016/j.vaccine.2014.05.058 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Bean SJ, Catania JA (2013) Vaccine perceptions among Oregon health care providers. Qual Health Res 23:1251–1266. doi: 10.1177/1049732313501891 CrossRefPubMedGoogle Scholar
  16. 16.
    Verger P, Fressard L, Collange F, Gautier A, Jestin C, Launay O et al (2015) Vaccine hesitancy among general practitioners and its determinants during controversies: a national cross-sectional survey in France. EBioMedicine 2:891–897. doi: 10.1016/j.ebiom.2015.06.018 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Eysenbach G (2004) Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res 6:e34. doi: 10.2196/jmir.6.3.e34 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Floret D (2012) Le Calendrier des vaccinations et les recommandations vaccinales 2012selon l’avis du Haut Conseil de la santé publique. Available online at: Accessed Dec 2015
  19. 19.
    Flicoteaux R, Pulcini C, Carrieri P, Schwarzinger M, Leport C, Verger P (2014) Correlates of general practitioners’ recommendations to patients regarding vaccination for the 2009–2010 pandemic influenza (A/H1N1) in France: implications for future vaccination campaigns. Vaccine 32:2281–2287. doi: 10.1016/j.vaccine.2014.02.074 CrossRefPubMedGoogle Scholar
  20. 20.
    Posfay-Barbe KM, Heininger U, Aebi C, Desgrandchamps D, Vaudaux B, Siegrist C-A (2005) How do physicians immunize their own children? Differences among pediatricians and nonpediatricians. Pediatrics 116:e623–e633. doi: 10.1542/peds.2005-0885 CrossRefPubMedGoogle Scholar
  21. 21.
    Fonteneau L, Urcun J-M, Guthmann J-P, Collet M, Neulat N, Bristol-Gauzy P et al (2013) Vaccination coverage in 6-year-old preschool children, France, 2005–2006. Arch Pédiatr 20:241–247. doi: 10.1016/j.arcped.2012.12.019 CrossRefPubMedGoogle Scholar
  22. 22.
    Antona D, Lévy-Bruhl D, Baudon C, Freymuth F, Lamy M, Maine C et al (2013) Measles elimination efforts and 2008–2011 outbreak, France. Emerg Infect Dis 19:357–364. doi: 10.3201/eid1903.121360 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Luthy KE, Beckstrand RL, Peterson NE (2009) Parental hesitation as a factor in delayed childhood immunization. J Pediatr Health Care 23:388–393. doi: 10.1016/j.pedhc.2008.09.006 CrossRefPubMedGoogle Scholar
  24. 24.
    Denis F, Cohen R, Martinot A, Stahl J-P, Lery T, Le Danvic M et al (2013) Evolution of hepatitis B vaccine coverage rates in France between 2008 and 2011. Méd Mal Infect 43:272–278. doi: 10.1016/j.medmal.2013.06.016 CrossRefPubMedGoogle Scholar
  25. 25.
    François M, Alla F, Rabaud C, Raphaël F (2011) Hepatitis B virus vaccination by French family physicians. Méd Mal Infect 41:518–525. doi: 10.1016/j.medmal.2011.07.002 CrossRefPubMedGoogle Scholar
  26. 26.
    Larson HJ, Heymann DL (2010) Public health response to influenza A(H1N1) as an opportunity to build public trust. JAMA 303:271–272. doi: 10.1001/jama.2009.2023 CrossRefPubMedGoogle Scholar
  27. 27.
    Semaille P, Gourbin C, Legrand D, Meyer A, Roland M, Paulus D et al (2006) Evaluation of the vaccine coverage of the general practitioners in the French Community. Rev Méd Brux 27:S292–S302PubMedGoogle Scholar
  28. 28.
    Massin S, Pulcini C, Launay O, Flicoteaux R, Sebbah R, Paraponaris A et al (2013) Opinions and practices from a panel of French general practitioner doctors regarding vaccination. Glob Health Promot 20:28–32. doi: 10.1177/1757975913483334 CrossRefPubMedGoogle Scholar
  29. 29.
    Martínez-Baz I, Díaz-González J, Guevara M, Toledo D, Zabala A, Domínguez A et al (2013) Attitudes, perceptions and factors associated with influenza vaccination among primary healthcare professionals in Navarre, 2011–2012. An Sist Sanit Navar 36:263–273CrossRefPubMedGoogle Scholar
  30. 30.
    Böhmer MM, Walter D, Ehrhardt J, Reiter S, Krause G, Wichmann O (2014) Seasonal and pandemic influenza vaccination: coverage and attitude among private physicians in Germany. Gesundheitswesen 76:44–47. doi: 10.1055/s-0033-1343431 PubMedGoogle Scholar
  31. 31.
    Gautier A (dir) (2011) Baromètre santé médecins généralistes 2009. Available online at: Accessed Dec 2015
  32. 32.
    Guichon JR, Mitchell I, Buffler P, Caplan A (2013) Citizen intervention in a religious ban on in-school HPV vaccine administration in Calgary, Canada. Prev Med 57:409–413. doi: 10.1016/j.ypmed.2013.06.005 CrossRefPubMedGoogle Scholar
  33. 33.
    Holman DM, Benard V, Roland KB, Watson M, Liddon N, Stokley S (2014) Barriers to human papillomavirus vaccination among US adolescents: a systematic review of the literature. JAMA Pediatr 168:76–82. doi: 10.1001/jamapediatrics.2013.2752 CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Larson HJ, Wilson R, Hanley S, Parys A, Paterson P (2014) Tracking the global spread of vaccine sentiments: the global response to Japan’s suspension of its HPV vaccine recommendation. Hum Vaccin Immunother 10:2543–2550. doi: 10.4161/21645515.2014.969618 CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Cohen R, Biscardi S, Levy C (2016) The multifaceted impact of pneumococcal conjugate vaccine implementation in children in France between 2001 to 2014. Hum Vaccin Immunother 12:277–284. doi: 10.1080/21645515.2015.1116654 CrossRefPubMedGoogle Scholar
  36. 36.
    Stahl J-P, Cohen R, Denis F, Gaudelus J, Lery T, Lepetit H et al (2013) Vaccination against meningococcus C. vaccinal coverage in the French target population. Méd Mal Infect 43:75–80. doi: 10.1016/j.medmal.2013.01.001 CrossRefPubMedGoogle Scholar
  37. 37.
    Offit PA, Quarles J, Gerber MA, Hackett CJ, Marcuse EK, Kollman TR et al (2002) Addressing parents’ concerns: do multiple vaccines overwhelm or weaken the infant’s immune system? Pediatrics 109:124–129. doi: 10.1542/peds.109.1.124 CrossRefPubMedGoogle Scholar
  38. 38.
    Pulcini C, Massin S, Launay O, Verger P (2013) Factors associated with vaccination for hepatitis B, pertussis, seasonal and pandemic influenza among French general practitioners: a 2010 survey. Vaccine 31:3943–3949. doi: 10.1016/j.vaccine.2013.06.039 CrossRefPubMedGoogle Scholar
  39. 39.
    Brien S, Kwong JC, Buckeridge DL (2012) The determinants of 2009 pandemic A/H1N1 influenza vaccination: a systematic review. Vaccine 30:1255–1264. doi: 10.1016/j.vaccine.2011.12.089 CrossRefPubMedGoogle Scholar
  40. 40.
    Llupià A, García-Basteiro AL, Mena G, Ríos J, Puig J, Bayas JM et al (2012) Vaccination behaviour influences self-report of influenza vaccination status: a cross-sectional study among health care workers. PLoS One 7:e39496. doi: 10.1371/journal.pone.0039496 CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Institut de Recherche et Documentation en Economie de la Santé (IRDES) (2013) Données de cadrage : Démographie et activité des professions de santé : Démographie des médecins. Available online at: Accessed Dec 2015
  42. 42.
    Conseil National de l’Ordre des Médecins (2014) Atlas de la démographie médicale 2014. Available online at: Accessed Dec 2015

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • M. Killian
    • 1
    • 2
    • 3
  • M. Detoc
    • 2
    • 3
  • P. Berthelot
    • 1
    • 2
    • 3
  • R. Charles
    • 4
  • A. Gagneux-Brunon
    • 1
    • 2
    • 3
  • F. Lucht
    • 1
    • 2
    • 3
  • C. Pulcini
    • 5
    • 6
  • S. Barbois
    • 1
  • E. Botelho-Nevers
    • 1
    • 2
    • 3
  1. 1.Infectious Diseases DepartmentUniversity Hospital of Saint-EtienneSaint-EtienneFrance
  2. 2.GIMAP EA 3064 (Groupe Immunité des Muqueuses et Agents Pathogènes)University of LyonSaint-EtienneFrance
  3. 3.Centre of Clinical Investigation Vaccinology (CIC) 1408 INSERMUniversity Hospital of Saint-EtienneSaint-EtienneFrance
  4. 4.General Practice DepartmentUniversity of LyonSaint-EtienneFrance
  5. 5.University of Lorraine, Paris Descartes University, EA 4360 APEMACNancyFrance
  6. 6.Infectious and Tropical Diseases DepartmentUniversity Hospital of NancyNancyFrance

Personalised recommendations