LAUSR

What an unusual series of encounters with Byron Bay ‘Gav’ and his amusingly inconsistent vaccination views. This story does highlight some of the key findings from our recent research with a group of non-vaccinating parents in the Byron Shire. The Byron Shire in Northern NSW has about 30 000 residents with a well-established community emphasis on natural health and lifestyle, and a national reputation for lower than average childhood vaccination rates. In 2015–2017 we spoke with 32 parents living in the Byron Shire who had chosen not to vaccinate their children, to understand more about their reasons for this choice. Recent studies with similar aims have also been conducted in well-defined geographical areas near Adelaide and Perth and more recently through nationally targeted recruitment. We have learned that parents who make this decision come to it in vastly different ways, that they are in general reasonable, conscientious parents and quite often they review their decision surprisingly frequently. Perhaps Gav has reached his views through online conspiratorial reading. However, studies in Australia and internationally convincingly refute the concept that passively reading anti-vaccination messages online or otherwise is the sole cause of vaccine refusal. More commonly parents reported such things as an event which caused them to doubt the safety or efficacy of vaccines, mistrust for the institutions who provide and promote vaccination and misalignment with their inherent belief systems and parenting values. Despite the path parents take in reaching their decision not to vaccinate, what we have learned is that a nuanced, personalised conversation with non-vaccinating parents is more fruitful than a one-size-fits-all approach. Health professionals’ recommendations, when accessible and non-judgemental, have often been highly valued in our studies. They can approach this by asking about parents’ stories, making every effort to understand the reasons behind their decision and acknowledging their experiences and concerns. Parents expect health professionals to make a clear, unambiguous recommendation to vaccinate according to the immunisation schedule and appreciate being provided with information addressing their specific questions regarding the safety, efficacy or necessity of recommended vaccines. In regards to managing casual conversations in a Byron café, perhaps we need a further research project, for which I (approaching the end of a part-time doctorate) will not be volunteering! There are some great resources for both health professionals and parents including those on the Sharing Knowledge About Immunisation (SKAI) website (https://www.talkingaboutimmunisation.org.au/ and http://providers.talkingaboutimmunisation.org.au/) which has a suite of excellent evidence-based resources to guide effective, respectful conversations with parents about vaccination. Gav’s story also provides a reminder of the importance of collecting accurate vaccination data. Currently we know the percentages of vaccination coverage throughout Australia; however, since the introduction of No Jab No Pay legislation in 2016, Australia does not record the number of conscientious objections as distinct from incomplete vaccination for other reasons. Just as a vet cannot know how many dogs are vaccinated as a percentage of the whole population, only those who present to their practice, Australia no longer has a truly accurate measure of intentional childhood vaccination refusal. One last thing to consider: living in the Byron Shire for over 20 years, I have witnessed a significant cultural change in the past couple of years. As houses are listed for sale, they are snapped up by city dwellers at increasingly impressive prices. This is visibly changing the culture and norms of the area. Perhaps it is timely for us to consider changing our narrative to avoid ongoing ‘anti-vax’ stereotyping of the Byron Shire, steering clear of the risk thatwemay normalise or even glamorise vaccination rejection as ‘part of the Byron lifestyle’.