Risk, responsibility and negative responses: a qualitative study of parental trust in childhood vaccinations

Childhood vaccination programmes have benefits that far outweigh risks, in public health terms. However, some parents decide not to immunise their children. This paper explores the ways in which such parents talk about the perceived risks and benefits incurred by vaccinating (or not vaccinating) their children. Between 2013 and 2016, we undertook 29 in-depth interviews with non-vaccinating and/or ‘vaccine hesitant’ parents in Fremantle, Western Australia and Adelaide, South Australia. Our analysis of the interviews identified particular constructions of risk and responsibility. All interviews were transcribed and analysed using both inductive and deductive processes. Our analysis mirrors the chronological process through which parents navigate risk. We start with the concept of ‘responsibilisation’, which underpins parental engagement with decision-making and praxis. We then explore how responsiblisation takes the form of detailed and time-consuming ‘research’. Parents then attempt to navigate multiple and conflicting ‘risks’: the risk of vaccine-preventable diseases, risks associated with vaccination and risks associated with their own perceived lack of understanding. After engaging with risk, parents justify the decision and accept the associated ‘responsibility’. Parents use this sense of responsibility to navigate through the ‘responses’ of others, which we conceptualise as the risk of unwelcome consequences. In conclusion, parents have a reflexive understanding of the physical, psychological and socio-economic risks they incur as a consequence of their choice to either partially vaccinate, delay vaccination or reject vaccination for their children. They construct these risks with reference to particular discourses, engagement with expert opinion and lifestyle choices emblematic of late modernity. The risks they are willing to accept and the subsequent responsibility and blame they assume when choosing to abstain, or partially abstain, from vaccinating their children are, to the parents, coherent with their interpretation of best parenting practice.