Vaccines and vaccine hesitancy has been my primary micro-beat since I began working as a full-time health/science journalist, so it’s been interesting to watch how coverage of the topic has evolved over the past decade.

For far too long, false balance was the biggest problem plaguing media coverage of vaccination, a trend that only slowly began fading after The Lancet retracted Andrew Wakefield’s fraudulent study.

By the time of the Disneyland measles outbreak in 2015, most journalists were finally avoiding the he-said-she-said “objective” reporting that creates false equivalence. The dominant media narrative had become the accurate one: that scientific evidence supports the safety and effectiveness of vaccines, and not vaccinating children endangers public health.

But a new problem emerged: demonizing vaccine-hesitant or vaccine-refusing parents. Anti-vaccine advocates — those publicly condemning vaccines, lobbying legislators to loosen immunization requirements and spreading misinformation and fear about vaccines — deserve to be marginalized. But they’re a tiny, tiny minority when it comes to the continuum of vaccine hesitancy.

Mocking and shaming parents who want to make the best health decisions for their children but feel anxious or frightened about vaccines doesn’t help public health goals of maintaining or increasing immunization rates. (While it’s not journalists’ role to further public health goals, it certainly isn’t our job to make them harder either.) Parents with genuine questions and concerns about vaccines who then feel shamed and castigated may slink away — not to vaccinate their kids but to avoid doctor visits altogether and ignore all the haughty “pro-vaccine” folks who might have helped them understand the information they need to make evidence-based decisions.

I tried to counter some of the vitriol and misconceptions about non-vaccinating parents with a series of articles debunking misconceptions about “anti-vaxxers” (parts one, two and three). The first misconception I addressed was the incorrect belief that any parent who doesn’t vaccinate is automatically an “anti-vaxxer.” And I relied on actual peer-reviewed research to address those misconceptions.

With measles outbreaks and vaccine hesitancy back in the spotlight, I’m seeing the same vitriol again, but now with more hot takes. It seems almost every person with an internet connection has opinions on why parents fear vaccines, why they don’t vaccinate, how to make them vaccinate, what we should do to force them to vaccinate, etc. But very few of these pundits, columnists and journalists pontificating on vaccine hesitancy seem to realize we don’t need opinions when we have actual data on the topic. Or, they latch onto one or two studies and cover those without context from the larger evidence base on the topic that’s essential to understanding those one or two studies.

Thousands of peer-reviewed studies focus on vaccine hesitancy and refusal at the micro and macro levels, from clinical, public health, psychological, sociological, economic and other perspectives. While a reporter on deadline certainly cannot read two dozen studies to catch up on that literature, it’s irresponsible to write about the topic without acknowledging that it exists or consulting the researchers who have studied it for years (as opposed to your friendly local doctor who has a single opinion on it).

One section of a new tip sheet on vaccine hesitancy includes a list of several studies on vaccine hesitancy that can be helpful primers or references. Most are free, some are paywalled, and all can help provide better context for an article on the topic. (These are, of course, the tip of the iceberg.)

Peer-reviewed studies on vaccine hesitancy

• “The rise (and fall?) of parental vaccine hesitancy” (2013)—“the evolution of the vaccine hesitancy movement and the individual, vaccine-specific and societal factors contributing to this phenomenon”
• “Factors associated with refusal of childhood vaccines among parents of school-aged children: a case-control study” (2005)—reasons parents don’t vaccinate.
• “Factors associated with suboptimal compliance to vaccinations in children in developed countries: a systematic review” (2008)—the huge diversity of characteristics associated with vaccine hesitancy (also showing that it cuts across nearly all demographics, religions and political ideologies)
• “Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007-2012” (2014)—identifies research on vaccine hesitancy and determinants of it
• “Vaccine hesitancy: Definition, scope and determinants” (2015)—discusses “factors influencing the behavioral decision to accept, delay or reject some or all vaccines”
• “Strategies for addressing vaccine hesitancy – A systematic review” (2015)—covers existing research on interventions and the complexity of addressing vaccine hesitancy
• “How to deal with vaccine hesitancy?” (2015)—covers the official recommendations to WHO on addressing vaccine hesitancy globally
• “Factors associated with refusal of childhood vaccines among parents of school-aged children: a case-control study” (2005)—looks at patterns of selective vaccination and reasons for not fully vaccinating children
• “Communicating with parents about vaccination: a framework for health professionals” (2012)—types of vaccine refusers/delayers/selectors
• “Prevalence of parental concerns about childhood vaccines: the experience of primary care physicians” (2011)—the burden on pediatricians when it comes to addressing parents’ questions and concerns
• “Confidence About Vaccines In The United States: Understanding Parents’ Perceptions” (2011)—what parents’ questions and concerns about vaccines are
• “Why do parents decide against immunization? The effect of health beliefs and health professionals” (2003)—the complexity involved in decision-making about vaccines
• “Sources and perceived credibility of vaccine-safety information for parents” (2011)—who parents trust for information about vaccines
• “Epidemiology of vaccine hesitancy in the United States” (2013)—an overview of vaccine hesitancy in the US from three major experts on the topic
• “How parents make decisions about their children’s vaccinations” (2013)—parents’ decision-making process about vaccines
• “The impact of social networks on parents’ vaccination decisions” (2013)—small study limited to a single county with low immunization coverage and high vaccine hesitancy
• “Geographic clusters in underimmunization and vaccine refusal” (2015) and “Geographic clustering of nonmedical exemptions to school immunization requirements and associations with geographic clustering of pertussis” (2008)—clustering of public school immunization exemptions
• “Parents’ Source of Vaccine Information and Impact on Vaccine Attitudes, Beliefs, and Nonmedical Exemptions” (2012)—as the title states
• “Vaccine Hesitancy: Where We Are and Where We Are Going” (2016)—existing strategies in use to address vaccine hesitancy

Tara Haelle (@TaraHaelle) is AHCJ's medical studies core topic leader, guiding journalists through the jargon-filled shorthand of science and research and enabling them to translate the evidence into accurate information.