Pediatric primary care immunization policies in New York State

Introduction: Practice immunization policies may reflect how their physicians and nurses approach vaccine hesitant parents. This study utilized New York State primary care practices’ websites to locate immunization policies for pediatric patients and collect practice-level data. Methods: For this cross-sectional study, we extracted website data in February/March of 2019. We first conducted a qualitative content analysis using the policy text and developed definitions of practice policy types (i.e., formal, informal, or no policy). Two authors independently reviewed and coded the text, and employed consensus meetings and feedback from the third author to finalize the content analysis. We then examined associations between practice-level characteristics and immunization policy presence through categorical data analysis. Results: Of the 254 practice websites identified, 36 referred to formal immunization policies that may include consequences (e.g., dismissal) for refusing to vaccinate or not fully vaccinating, and 64 referred to informal policy statements supporting immunization. Most (89%) policies included appeals to scientific and/or professional authority. Almost all (92%) contained language tailored to potential reasons for parents’ vaccine hesitancy. Our categorical analyses indicate that majority-pediatrician practices are associated with the presence of either formal or informal immunization policies (p < 0.001). Our results also suggest regional variation in the presence of such policies across New York state, although statistical significance is not achieved. Conclusions: Vaccine hesitancy in the pediatric population has become a global concern due to infectious disease outbreaks, most recently the COVID-19 pandemic. Future studies may examine whether practice-level policies are effective in improving local immunization rates.