Navigating the (perceived) risk: an evidence-based typology of parental decision-making on childhood vaccines

Intensive parenting culture imposes upon parents the responsibility to invest all their cognitive and affective resources to protect their children’s health, making parenting a risky business that triggers anxiety and possible regret. In this context, decisions about childhood vaccinations assume a critical significance, implying, with vaccine acceptance and refusal, the posture that public health literature defines as vaccine hesitancy. Based upon and illustrated through qualitative analyses of data drawn from an international rapid team ethnography, this article presents a typology of parents’ stances towards childhood vaccines. The ‘surprising fact’ of refusing vaccines – deemed as one of the greatest public health successes – is tentatively framed in an evidence-based typology whose axes articulate two theoretical dimensions: the degree of trust in healthcare institutions and the generality of the cognitive assumptions parents adopt. The typology distinguishes six ’stances’, expressing different forms of vaccine acceptance and refusal. Each stance is dissected considering the assumptions on which it rests, the strategies used to face uncertainty and vulnerability through different forms of trusting, and its typical epistemic and psychological profile. Particular attention is devoted to parents’ lay risk metrics – namely, the contrasting probability principles through which they assess the risk of adverse events following immunisation – and to the epistemic orientations, paradigmatic or narrative that underpin them.