Vax Northwest: Partnering Across Sectors to Promote Immunization as a Social Norm

By Todd Faubion, Immunization Manager, WithinReach

Todd_FaubionIn 2008, Washington State held a very dubious title. We had the highest kindergarten vaccination exemption rate in the country at 7.5 percent —5 times the national average! Immunization leadership in Washington realized that this rate represented a shift in the landscape—away from immunization as a community priority. People had begun fearing vaccines themselves, not the diseases they prevent. Our usual vaccine promotion strategies were not working, but we also recognized that there was no evidence base from which to create a new plan. Therefore, we needed to think differently, gather information, and research the challenge.

Gone are the days (if they ever existed) where parents simply received and followed a doctor’s advice. Parent investment in health decisions, as well as the lack of a perceived threat from vaccine-preventable diseases, means that our strategies for advising parents need to evolve, too—and overwhelming families with science will not help convince parents to vaccinate.

In response to the need to develop new strategies, Drs. Ed Marcuse and Kyle Yasuda led the effort to create Vax Northwest,  a public-private partnership focused solely on vaccine hesitancy in Washington State. These pediatricians realized that we needed not only new research and evaluated strategies, but also that new alliances would be crucial to our success. Recognizing that health promotion needs many minds at the table, they brought together various sectors to form an oversight committee for the partnership. Eight years later, Vax Northwest is still composed of that same leadership and remains dedicated to promoting vaccine confidence. Those partners are BestStart Washington, Group Health, Seattle Children’s Hospital, the Washington State Department of Health, and WithinReach.

So, what did our process actually look like? Starting in 2008, we did three years of needs assessment and pilot work to determine the best leverage points around vaccine hesitancy. Two crucial areas of influence emerged: working with providers on how best to converse with hesitant parents and working within existing parent social networks to increase the positive chatter about vaccines. Each leverage point became an intervention that was robustly evaluated by the Group Health Research Institute, and today the results have advanced our nation’s collective knowledge about vaccine hesitancy.

What is perhaps most notable about Vax Northwest is our structure, which embraces the Public Health 3.0 principle of connecting all sectors in promoting health and recognizing that health emerges at the intersection of multiple forces (policy, the business environment, leadership, etc.) By bringing together a cross-sector group of stakeholders, we are able to offer expertise in preventive medicine, infectious disease, public health, social marketing, health behavior, evaluation, and resource development. This structure and expertise gives us credibility in many sectors, and we have emerged as a leader in the field, most recently as the hosts for an international vaccine hesitancy learning opportunity through the International Association of Immunization Managers. Vax Northwest was also featured in local and national media. Most importantly, our structure allows us to draw from a broad range of talents to deftly respond to the challenges we identify, which has principally involved thinking about new ways to communicate information. To learn more about how we do our work, please check out our website,

If you have any questions, or would like to learn more, please reach out to!