Vaccine Rejecting Parents’ Engagement With Expert Systems That Inform Vaccination Programs


In attempting to provide protection to individuals and communities, childhood immunization has benefits that far outweigh disease risks. However, some parents decide not to immunize their children with some or all vaccines for reasons including lack of trust in governments, health professionals, and vaccine manufacturers. This article employs a theoretical analysis of trust and distrust to explore how twenty-seven parents with a history of vaccine rejection in two Australian cities view the expert systems central to vaccination policy and practice. Our data show how perceptions of the profit motive generate distrust in the expert systems pertaining to vaccination. Our participants perceived that pharmaceutical companies had a pernicious influence over the systems driving vaccination: research, health professionals, and government. Accordingly, they saw vaccine recommendations in conflict with the interests of their child and “the system” underscored by malign intent, even if individual representatives of this system were not equally tainted. This perspective was common to parents who declined all vaccines and those who accepted some. We regard the differences between these parents—and indeed the differences between vaccine decliners and those whose Western medical epistemology informs reflexive trust—as arising from the internalization of countering views, which facilitates nuance.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.


  1. Australian Technical Advisory Group on Immunisation (ATAGI). 2015. The Australian immunisation handbook, 10th ed (2015 update). Canberra: Australian Government Department of Health.

  2. Andre, F., R. Booy, H. Bock, et al. 2008. Vaccination greatly reduces disease, disability, death and inequity worldwide. Bulletin of the World Health Organization 86(2): 140–146.

  3. Attwell, K., and M. Freeman. 2015. I Immunise: An evaluation of a values-based campaign to change attitudes and beliefs. Vaccine 33(46): 6235–6240.

  4. Austin, H., C. Campion-Smith, S. Thomas, and W. Ward. 2008. Parents’ difficulties with decisions about childhood immunisation. Community practitioner : The journal of the Community Practitioners’ & Health Visitors’ Association 81(10): 32–35.

  5. Beard, F.H., B.P. Hull, J. Leask, A. Dey, and P.B. McIntyre. 2016. Trends and patterns in vaccination objection, Australia, 2002–2013. Medical Journal of Australia 204(7): 275.

  6. Benin, A.L., D.J. Wisler-Scher, E. Colson, E.D. Shapiro, and E.S. Holmboe. 2006. Qualitative analysis of mothers’ decision-making about vaccines for infants: The importance of trust. Pediatrics 117(5): 1532–1541.

  7. Brown, K.F., J.S. Kroll, M.J. Hudson, et al. 2010. Factors underlying parental decisions about combination childhood vaccinations including MMR: A systematic review. Vaccine 28(26): 4235–4248.

  8. Brown, P.R. 2009. The phenomenology of trust: A Schutzian analysis of the social construction of knowledge by gynae-oncology patients. Health, Risk & Society 11(5): 391–407.

  9. Brown, P.R., and S.B. Meyer. 2015. Dependency, trust and choice? Examining agency and “forced options” within secondary-healthcare contexts. Current Sociology doi: 10.1177/0011392115590091.

  10. Brownlie, J., and A. Howson. 2005. “Leaps of faith” and MMR: An empirical study of trust. Sociology 39(2): 221–239.

  11. Casiday, R., T. Cresswell, D. Wilson, and C. Panter-Brick. 2006. A survey of UK parental attitudes to the MMR vaccine and trust in medical authority. Vaccine 24(2): 177–184.

  12. Cline, R.J.W., and K.M. Haynes. 2001. Consumer health information seeking on the Internet: the satate of the art. Health Education Research 16(6): 671–692.

  13. Crawford, R. 2004. Risk ritual and the management of control and anxiety in medical culture. Health, An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine 8(4): 505–528.

  14. Donovan, H., and H. Bedford. 2013. Talking with parents about immunisation. Primary Health Care 23(4): 16–20.

  15. Dube, E., M. Vivion, and N.E. MacDonald. 2015. Vaccine hesitancy, vaccine refusal and the anti-vaccine movement: influence, impact, and implications. Expert Review of Vaccines 14(1): 99–117.

  16. Gambetta, D. 1988. Trust: Making and breaking cooperative relations. Oxford, Cambridge: Basil Blackwell.

  17. Gaudino, J.A., and S. Robison. 2012. Risk factors associated with parents claiming personal-belief exemptions to school immunization requirements: Community and other influences on more skeptical parents in Oregon, 2006. Vaccine 30(6): 1132–1142.

  18. Giddens, A. 1990. The consequences of modernity. Cambridge: Polity Press.

  19. ———. 1991. Modernity and self-identity: Self and society in the late modern age. Stanford: Stanford University Press.

  20. ———. 1994. “Risk, trust, reflexivity.” In Reflexive modernization: Politics, tradition and aesthetics in the modern social order, edited by U. Beck, A. Giddens and S. Lash, 194–197. Cambridge: Polity Press.

  21. Govier, T. 1998. Dilemmas of trust. Montreal: McGill-Queen’s University Press.

  22. Greenhalgh, J., J. Howick, and N. Maskrey. 2014. Evidence based medicine: A movement in crisis? BMJ 348: g3725.

  23. Habermas, J. 1997. The theory of communicative action, Vol. 1. Cambridge: Polity Press.

  24. Hilton, S., M. Petticrew, and K. Hunt. 2006. “Combined vaccines are like a sudden onslaught to the body’s immune system”: Parental concerns about vaccine “overload” and “immune-vulnerability”. Vaccine 24(20): 4321–4327.

  25. Janko, M. 2012. Vaccination: a victim of its own success. American Medical Association Journal of Ethics 13(1): 3–4.

  26. Jolley, D., and K.M. Douglas. 2014. The effects of anti-vaccine conspiracy theories on vaccination intentions. PloS one 9(2): e89177.

  27. Larson, H.J., C. Jarrett, E. Eckersberger, D.M.D. Smith, and P. Paterson. 2014. Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007–2012. Vaccine 32(19): 2150–2159.

  28. Leach, M., and J. Fairhead. 2007. Vaccine anxieties: Global science, child health and society. London; Stirling, VA: Earthscan.

  29. Leask, J., and S. Chapman. 2002. “The cold hard facts” immunisation and vaccine preventable diseases in Australia's newsprint media 1993–1998. Social Science & Medicine 54(3): 445–457.

  30. Luhmann, N. 1979. Trust and power: Two works by Niklas Luhmann. Translated by Howard Davis, John Raffan and Kathryn Rooney. Brisbane: John Wiley and Sons.

  31. ———. 1995. Social systems, Writing science. Stanford, Calif.: Stanford University Press.

  32. MacDonald, N.E., and SAGE Working Group on Vaccine Hesitancy. 2015. Vaccine hesitancy: Definition, scope and determinants. Vaccine 33(34): 4161–4164.

  33. Meyer, S., P.R. Ward, J. Coveney, and W. Rogers. 2008. Trust in the health system: An analysis and extension of the social theories of Giddens and Luhmann. Health Sociology Review 17(2): 177–186.

  34. Mills, E., A.R. Jadad, C. Ross, and K. Wilson. 2005. Systematic review of qualitative studies exploring parental beliefs and attitudes toward childhood vaccination identifies common barriers to vaccination. Journal of Clinical Epidemiology 58(11): 1081–1088.

  35. Mollering, G. 2001. The nature of trust: From Georg Simmel to a theory of expectation, interpretation and suspension. Sociology 35(2): 403–420.

  36. ———. 2006. Trust: Reason, routine, reflexivity. Oxford: Elsevier.

  37. MuMullan, M. 2006. Patients using the Internet to obtain health information: How this affects the patient-health professional relationship. Patient Education and Counseling 63(1–2): 24–28.

  38. National Health Performance Authority. 2014. Healthy communities: Immunisation rates for children in 2012–2013. Sydney, NSW: National Health Performance Authority.

  39. Offit, P.A., and C.A. Moser. 2009. The problem with Dr. Bob’s alternative vaccine schedule. Pediatrics 123(1): e162–e169.

  40. Omer, S.B., K.S. Enger, L.H. Moulton, N.A. Halsey, S. Stokley, and D.A. Salmon. 2008. Geographic clustering of nonmedical exemptions to school immunization requirements and associations with geographic clustering of pertussis. American Journal of Epidemiology 168(12): 1389–1396.

  41. Parliament of Australia. 2015. Social services legislation amendment (No jab, no pay) bill Australia.

  42. Riessman, C.K. 2008. Narrative methods for the human sciences. Los Angeles, London, New Delhi, Singapore: Sage Publications.

  43. Rimer, B.K., P.A. Briss, P.K. Zeller, C.C.Y. Chan, and S.H. Woolf. 2004. Informed decision making: What is its role in cancer screening? Cancer 101(S5): 1214–1228.

  44. Scambler, G. 2001. Class, power and the durability of health inequalities. In Habermas, critical theory and health, edited by G. Scambler, 86–118. London: Routledge.

  45. Scambler, G., and N. Britten. 2001. System, lifeworld and doctor–patient interaction: Issues of trust in a changing world. In Habermas, critical theory and health, edited by G. Scambler, 45–67. London: Routledge.

  46. Smith, P.J., G.H. Sharon, E.K. Marcuse, et al. 2011. Parental delay or refusal of vaccine doses, childhood vaccination coverage at 24 months of age, and the health belief model. Public Health Reports (1974-) 126: 135–146.

  47. Sobo, E.J. 2015. Social cultivation of vaccine refusal and delay among Waldorf (Steiner) school parents. Medical Anthropology Quarterly 29(3): 381–399.

  48. ———. 2016. Theorizing (vaccine) refusal: Through the looking glass. Cultural Anthropology 31(3): 342–350.

  49. Sobo, E.J., A. Huhn, A. Sannwald, and L. Thurman. 2016. Information curation among vaccine cautious parents: Web 2.0, pinterest thinking, and pediatric vaccination choice. Medical Anthropology: Cross Cultural Studies in Health and Illness: 1–18.

  50. Sztompka, P. 1999. Trust: A sociological theory. Cambridge: Cambridge University Press.

  51. Ward, P.R., C. Coffey, and S. Meyer. 2015. Trust, choice and obligation: A qualitative study of enablers of colorectal cancer screening in South Australia. Sociology of Health & Illness 37(7): 988–1006.

  52. Ward, P.R., P. Rokkas, C. Cenko, et al. 2015. A qualitative study of patient (dis)trust in public and private hospitals: The importance of choice and pragmatic acceptance for trust considerations in South Australia. BMC Health Services Research 15(1): 297.

  53. Willis, K., J. Daly, M. Kealy, et al. 2007. The essential role of social theory in qualitative public health research. Australian and New Zealand Journal of Public Health 31(5): 438–443.

  54. Yaqub, O., S. Castle-Clarke, N. Sevdalis, and J. Chataway. 2014. Attitudes to vaccination: A critical review. Social Science & Medicine 112: 1–11.

  55. Zuzak, T.J., I. Zuzak-Siegrist, L. Rist, G. Staubli, and A.P. Simões-Wüst. 2008. Attitudes towards vaccination: Users of complementary and alternative medicine versus non-users. Swiss Medical Weekly 138(47–48): 713–718.

Download references

Author information

Correspondence to Katie Attwell.

Ethics declarations


The Fremantle data was gathered by Katie Attwell while working for the Immunisation Alliance of Western Australia, a not-for-profit immunization advocacy organization. The Alliance received funding from Sanofi Pasteur in the form of a $20,000 unrestricted grant to develop and evaluate the “I Immunise” campaign, which itself was funded by the Department of Health, Western Australia. Neither external organization contributed to the study design; data collection, analysis, interpretation, or writing, nor did they influence manuscript submission decisions. The data collection in South Australia was funded by the Flinders Medical Centre Foundation as a Seeding Grant, with no input into the decisions and processes outlined above. Julie Leask receives funding from the Australian Government Department of Health and the National Centre for Immunisation Research and Surveillance for research in addressing vaccine hesitancy. She is in receipt of an NHMRC Career Development Fellowship.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Attwell, K., Leask, J., Meyer, S.B. et al. Vaccine Rejecting Parents’ Engagement With Expert Systems That Inform Vaccination Programs. Bioethical Inquiry 14, 65–76 (2017) doi:10.1007/s11673-016-9756-7

Download citation


  • Vaccination
  • Vaccine hesitancy
  • Qualitative
  • Trust
  • Giddens
  • Modernity