How to answer difficult vaccine questions from parents

recent blog comes to the conclusion that non-vaccinating parents believe their pediatrician “would have to be staggeringly incompetent, negligent or malicious to keep administering (vaccines).”  Using this as the premise, this pediatrician goes on to say that these patients should be dismissed from our practices.

First off, these parents don’t think we’re the enemy.  The reason they bring their kids to see us is they trust us, they respect us and, most importantly, they want to do what’s right for their children. But when you search the Internet to find vaccine information and most of it is either boringly technical or rabidly anti-science, it’s hard to know where to turn.  ”Vaccines still prevent measles” is a boring story.  “Celebrity/talk show host/presidential candidate says vaccines cause horrible side effects” is misleading but gets hits.

Second, dismissing patients for making bad decisions is just plain wrong.  I have had plenty of families who have refused to try to quit smoking even when their child has spent days in an ICU with asthma.  Others stare at me in disbelief when I suggest that eliminating soda and chips will help their child lose weight and prevent imminent type 2 diabetes. But I don’t discharge them from my practice; I keep working with them. And the same thing must happen with vaccines refusers if we hope to make any progress at all.

The most successful technique is providing evidence-based reasons to vaccinate.  We need to reassure families that vaccines are safe and effective.  Our training and research tells us they are, but families don’t have our training.

We also need to emphasize that immunizing is what most families do.  Not immunizing is a big story and a big debate on the Internet, but in my practice, over 90 per cent of families fully vaccinated their children and know how important it is to protect them from these diseases.

Sharing stories of how and why people vaccinate is important. I used to have just my own story and those of my patients to use, but now there are myriad resources. Voices for VaccinesNurses Who Vaccinate, Parents for Vaccines, Shot By ShotMoms Who Vaccinate, and dozens of Twitter feeds and blogs have started sharing stories as well.

The conversation with our patients who think they are not going to vaccinate needs to continue.  It can be frustrating, maddening even, but in the end it is very important and often satisfying.  We are not trained to do this well in medical school or residency.  I find that I need to make time, sit down, breathe deeply, and speak calmly, remembering that we all want what is best for the child.

After years of trial and error, I’ve adopted ways to engage in conversations with parents and patients that can help address fear and misinformation regarding vaccines.

Here are some of the ways I have started these conversations.

Parent: “So I keep hearing about the bad things vaccines do …”

Response: “Where did you hear them?

Parent: “Most of the things I’m hearing about tend to be from celebrities or on unreferenced opinion websites, and when I compare them to what scientific sources say, I get a very different picture.”

Response: ”Why don’t you give me some of your sources and I’ll give you mine and we can compare?”

Parent: ”I’m worried about autism.”

Response: “Of course you are.  I’m worried about autism, too. But the whole vaccines-autism connection has actually been a huge waste of energy and money that could have been better spent elsewhere.  It was a scare based on faked science.There are some great studies of ties between pesticides and autism, there are others showing connections between genetic disorders and autism.  But if we were going to look at what has been studied that doesn’t cause autism…vaccines have been proven not to be associated more than just about anything else.”

Parent: “I’m worried about additives.”

Response: “Me too. What additives are you worried about?  Some people are worried about thimerosal, but that has been removed from the equation. I know that some Internet sites talk about all sorts of ingredients that are in vaccines in microscopic amounts. And it’s great that these are being looked at, but the reality is science has shown us no adverse effects from additives in vaccines.”

Parent: ”I want to try an alternative vaccine schedule that I read about.”

Response: “While it may be better than nothing, an alternative schedule leaves kids open to infection.  Will you choose to leave them vulnerable to one form or meningitis but not another?  Are you going to risk the possibility of an outbreak of something we hadn’t planned for?  And, what about the trauma it will cause to ‘space out vaccines’ with a visit every few weeks for a shot compared to giving them together?”

Other conversations are to take advantage of opportunities to discuss vaccines.

Parent: “He fell into the side of the house and cut his face.”

Response: “I know you haven’t vaccinated before and have had some misgivings.  But now we’re faced with a difficult situation.  He really needs a tetanus shot to protect him.  As part of this shot, he’ll be getting the pertussis vaccine too, but since there have been a few pertussis outbreaks recently, I’m sure you can see why he needs that too. Let’s give it to him today.”

Parent: “I’ve been reading about this measles outbreak and I’m scared.”

Response: “I’m scared too and worried for your child. You’ve chosen not to vaccinate your child, and he is definitely at risk for measles now. There really is nothing else out there that is going to protect him.  It takes about two weeks to be protected, so let’s start today.”

Some of the best conversations I have had have really focused on why we vaccinate at all.

Even the most basic information to a doctor may be new information to a family.  I can’t count the number of terrified parents I’ve had in my office, thinking their children might have measles, not knowing that is part of what the MMR vaccine protects against.

Parent: “We breastfeed, eat organic and stay really active. We don’t need vaccines.”

Response: “Those are all great things.  They have all been shown to protect against many diseases, but none of them have been shown to protect against pneumococcus or rotavirus or any of the other diseases we vaccinate against. You’re already doing so much, let’s take that extra step and do the vaccines.”

Parent: “Do you really think he needs these vaccines?”

Response: “Yes, I do.  I have a son. I worry about his health, his development, what he eats, who he plays with.  I probably over-research everything.  And I vaccinated him. I also vaccinate myself to protect my health and my patients.”

Parent: ”But my kids are healthy.”

Response: “Yes, they are. And vaccines will keep them that way. Also, we need to think about other people.  Let’s say your child gets chicken pox. You’d keep him away from other people so they don’t get sick, but did you know the illness can be most contagious in the first few days as the rash shows up? In those few days, you could infect someone’s new baby or a person with cancer or a defective immune system. And while your kids might get away with a few scars from the pox, that other person could get really, really sick.”

Parent: “But nobody really gets these diseases any more.”

Response: “It sure seems that way some days.  But then we get an article about a measles outbreak, or a pertussis epidemic, and it reminds us that these diseases are under control, not gone. Personally, I can’t wait for the day for more of these diseases to be eliminated so we can stop vaccinating against them.”

Even with these conversations, there will be families who are in special circumstances.  I am still direct and use evidence-based arguments to vaccinate.

I had one parent who had multiple children with autism and others with chronic medical conditions. She was dismissed from another pediatrician’s practice for wanting to defer a round of vaccines. Our conversation went like this:

Parent: “I know vaccines didn’t cause my kids’ autism, but I notice that they regress for a while after shots. They also regress when they’re sick, so I’d like to do their shots slowly and when they’re not sick.

Response: “I haven’t seen anything in the literature about this sort of response to vaccines. I recommend that you fully vaccinate them now to protect them from these serious illnesses that could have severe consequences for the rest of the family. But I haven’t walked in your shoes. Tell me what you want to do.” (In this case, the kids were vaccinated, but late.  They did have some regression after some shots, but none after others. They also regressed periodically when they didn’t have shots.)

Another came to me with a chemistry degree and studies about immunoglobulin levels being protective after just a few shots.  We had to have a discussion about how long these levels stay high and how boosters provide lasting protection.  I pulled studies on one vs. two chicken pox shots. I discussed the impact of boosters on waning immunity levels.  And eventually the children were all immunized correctly.

Results will vary. Conversations will vary. But, as physicians, we have a duty to guide our patients to better health instead of shoving them out the door.

Andrew Cronyn is a pediatrician who blogs at Parents for Vaccinations.

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