Altern Ther Health Med. 2017 Jan;23(1):46-54.

Vaccination Attitudes and Practices of Integrative Medicine Physicians.

Buehning LJ, Peddecord KM.

PubMed link



Vaccination Attitudes and Practices of Integrative Medicine Physicians

Globally, there is increasing concern and negative public opinion regarding the safety of vaccines. With the growth of internet-based information and social networking, there has also been an increase in the accessibility and importance of anti-vaccine information.1-6 This information has resulted in a questioning of vaccination schedules and policies by many individuals.7


An overview of the attitudes of the public and of health care professionals regarding vaccination in Europe, has suggested that hesitant attitudes to vaccination are common and may have increased since the H1N1 influenza pandemic in 2009.8 The uncertainty about vaccine safety is common in patients who are seeking care from practitioners of integrative medicine (IM) and complementary and alternative medicine (CAM).9 In addition, these parents are also more likely to request nonmedical exemptions to school vaccination requirements for their children.8

Practitioners of IM and CAM are also more likely to question the vaccination policies proposed by the Centers for Disease Control and Prevention (CDC).9,10


There has been a rapid increase in the utilization of IM and CAM services in the United States. The Institute of Medicine (IOM) report on CAM11 showed that one-third of US adults were using some form of CAM, with total annual visits to CAM providers exceeding visits to primary care physicians. In addition, data from the 2007 National Health Interview Survey12 showed that 40% of adults and 12% of children had used CAM therapy in the 12 months before the survey.


This increase in the acceptance of IM has led to the expansion of the curricula of many medical schools to include alternative therapies. From 2000 to 2003, the National Center for Complementary and Integrative Health provided 5-year education grants to 14 schools of the health professions and to the American Medical Students Association Foundation.13 A 2004 study of medical students at the University of California Irvine showed that the students had high levels of positive attitudes toward and beliefs in CAM as well as self-reported CAM use.14 The Academic Consortium for Integrative Medicine and Health was created in 1999. This organization has a commitment to teaching, research, and clinical practice in IM.15 This organization presently consists of 57 academic medical centers and affiliated institutions throughout North America.


The primary specialty board for physicians practicing in the field of integrative and holistic medicine is the American Board of Integrative and Holistic Medicine (ABIHM).16 Founded in 1996; it officially changed its name to ABIHM in 2008. This organization has provided leadership, support, education, and certification for physicians practicing in the field of IM. It is a rapidly expanding organization and had certified nearly 3000 diplomats by 2014. This was a significant increase from the time of the initiation of this survey in 2013.17 Therefore; this organization was selected to perform a survey of these physicians’ attitudes and practices regarding vaccination. These results are summarized in the abstract of this paper.


In addition to the survey results summarized in the abstract, the survey included an open-ended question that asked, “Are there any other issues or concerns that you would like to communicate?” The comments received were generally supportive of immunizations, however they provided additional information regarding the vaccination concerns of some of these physicians. A few commenters voiced the opinion that they opposed all vaccinations and many expressed serious and specific concerns regarding the vaccination issues in this survey. These concerns included the large number of childhood vaccines that are recommended during the first 2 years of life and the requirement for vaccinations for diseases that are not highly communicable, such as neonatal hepatitis B. Some of the commenters who voiced strong support of immunizations preferred alternative schedules to the Advisory Council on Immunization Practices (ACIP) recommended childhood vaccination schedule.


Concerns also included the inadequacy of vaccine research on safety and the efficacy of post-marketing surveillance. The comments included some specific and emotional stories of patients and their family members, or of personal experiences of either being saved or injured by vaccines. One commenter wrote at length about the belief that the vaccine for measles, mumps, and rubella is causally associated with autism.


A number of commenters expressed disagreement with governmental mandates for vaccination, and some of those concerns appeared to be reflective of a general distrust in the government. In addition, several commenters openly criticized the vaccination industry and complained that the literature and research environment was highly controlled by the pharmaceutical industry. Compared to traditional practitioners IM practitioners were much more likely to express distrust of the medical establishment and of vaccination policies in general.


This survey showed a significant diversity of opinions, which likely reflects the growing complexity and scope of vaccination development, application and public health policy. IM physicians expressed significant concerns regarding the present vaccination program. Vaccine hesitancy and barriers to vaccination are issues that have become more visible and politicized in many countries.18 Vaccination hesitancy has been studied primarily among members of the general public; however, this current survey provided evidence that some physicians have similar concerns.


Information from other studies has identified barriers to vaccination. These include complacency and neglect, the avoidance of toxins, religious beliefs, and the interpretation of the risks and benefits of vaccination as compared to the risks of the disease.19 The primary concerns for patients are the safety of vaccines and a fear of side effects.7,20,21,22 Other important factors include a distrust of the government7,23 and of the scientific and medical establishments.24


Multiple media sources affect people’s opinions, and this has been studied in relation to vaccination hesitancy.20,21,35 Media advocacy has been shown to affect both public and political attention to vaccination issues and this can promote changes in attitudes and policy.26 An analysis of various media sources revealed that 31% of the reports contained negative content about vaccination.27

The polarization of the vaccination controversy has even led some authors to identify what they refer to as the anti-vaccination movement.28,29 An analysis of this movement has shown that the present issues regarding vaccinations are remarkably similar to those during the late 19th century.29


Vaccination policy has significant consequences in terms of law and ethics.30,31 School, day care, and employment mandates are increasing as the scope of vaccination expands. Most laws regarding vaccination were enacted in the 1960s and 1970s.30 In the United States, there is significant variation among the different states in regards to the types of exemptions, the extent of the application process, and the review mechanisms.32 States are not required to grant religious or philosophical exemptions, but frequently do so for political reasons.30


Parental concerns about mandates include the right to raise their children as they choose, to give informed consent, and to pursue freedom of religion or conscience.30 The rate of nonmedical vaccine exemptions is increasing at an accelerated rate.33,34


The results of the current study accentuate the importance of the concept of vaccination hesitancy in efforts to create effective public health policy. Multiple studies have shown that trust in their primary care provider is the most important factor for people in their vaccination decisions.3,18,20,25,35,36 Social networks also have an important effect on vaccination decisions.37


 As more patients seek care from IM and CAM providers, those providers will have a greater influence on vaccination decisions.18,20,23,26,37 From a public health perspective, it is important that influential professional organizations, such as the AIHM, take an active role in managing the controversies.


The current survey of the ABIHM’s physicians revealed significant concerns with the present public health vaccination policies and recommendations. Because the positive engagement of primary care physicians is essential to the success of any vaccination program, a greater understanding of the vaccine hesitancy of those physicians would be helpful. Creating dialogue and communication between public health leaders and the leaders of the IM community could prevent further polarization. With the expanding scope of vaccination, the issues are also likely to increase unless physicians’ concerns are adequately addressed.


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