Vaccinations have long been a routine part of practice in late summer and early fall for pediatricians and family physicians.
Back to school brings enrollment vaccination requirements and sports physicals, as well as the opportunity to bring young patients up to date on recommended vaccinations. For years, childhood vaccinations have been largely unremarkable and uncontroversial—but not this year.
Questions over whether children should be vaccinated against COVID-19, the danger posed by the fast-spreading delta variant, reluctant and sometimes hostile parents, and the involvement of political bodies from local school boards to state legislatures promise to make this a fall like no other.
Anyone who doubts this has only to look at what happened recently in Tennessee. Under pressure from Republican state legislators, the state health department has banned all child vaccination outreach efforts — not just COVID-19 programs — and fired the state’s top vaccination official.
Think about that for a moment. In Tennessee, anti-immunization hysteria over COVID-19 could lead to fewer vaccinations for rotavirus, hepatitis A, influenza, and other diseases.
Currently, the Pfizer and Moderna vaccines are approved for 12- to 17-year-olds and clinical trials are underway, testing mRNA vaccines for kids between the ages of 6 months to 11 years. The first request for emergency authorization should arrive at the FDA in September or October.
The need is real. Children represented 14.2 percent of all U.S. COVID cases in July, up from 2 percent in April 2020, according to the American Academy of Pediatrics. More than 4 million children in the U.S. have contracted COVID-19 and more than 340 have died. Another 4,200 developed MIS-C, a potentially fatal inflammatory syndrome that occurs after COVID infection.
It is incumbent on physicians to do everything in their power to make sure eligible children are vaccinated. But doctors shouldn’t address this crisis on a piecemeal basis or wait until fall to act.
The first step is for physicians to compile a registry of their pediatric patients eligible to receive the COVID-19 vaccination. Then, using surveys, emailed questionnaires, and text outreach programs, they should determine which children have been fully or partially vaccinated and which have not.
The next step is to contact the parents of youngsters who are unvaccinated or partly vaccinated and attempt to convince them that their children need to be vaccinated, whether by their own doctor or at another site.
There are several digital tools that can make this outreach more efficient and less labor-intensive for office staff than mailing postcards or making phone calls. Automated texts and emails allow multiple and repeated points of contact and can direct parents to online sites with the most relevant information on why children should be vaccinated.
While opposition to the vaccine may be hardening, pediatricians and family physicians enjoy an advantage the CDC and Dr. Fauci may not: namely, they are liked and trusted by patients. In general, parents look to personal physicians for guidance and usually follow their advice on health care for their children. Doctors can use that trust to convince skeptical parents of the benefits of getting their children vaccinated.
Even the medical office setting can be an advantage. Unlike a bustling pharmacy or a crowded mass vaccination site, a doctor’s office offers a low-key, familiar environment, one in which a parent might be more open to counseling.
Of course, that trusting relationship will not suffice in all cases. Some parents who wouldn’t balk at MMR or DTaP vaccinations will oppose COVID-19 shots for a variety of reasons: doubts about the reality of the virus and how much danger it poses to children or child transmission to vulnerable adults, political ideologies, and religion can figure into that opposition.
The initial outreach to parents is likely to show the greatest results. Some parents will need only a reminder or some gentle persuasion to agree to vaccination. Others will be convinced by restrictions that schools place on unvaccinated students. However, as the numbers of vaccinated patients grow, the parental holdouts may be unreceptive to the vaccine and determined not to comply.
Unfortunately, there is no universal, foolproof method for persuading parents to have their children vaccinated. However, there are some best practices to follow:
- Don’t overwhelm the parents with information or demand that they permit the vaccination. Chances are they’re already feeling pressured or beleaguered, and they will not react well to a hard sell from their physician.
- Listen to their concerns. Ask them exactly what they are worried about, and don’t dismiss their fears. Respond to their questions with simple, dispassionate, and factual answers.
- If they are still reluctant, ask if you can revisit the topic with them again in another month or so. Realize that this process might take some time.
- Offer to have them speak to parents who have had their children vaccinated.
- Have some well-written materials available or a website they can go to for reliable information on this topic.
In the near term, physicians in general and pediatricians, in particular, should update their vaccine registry monthly to stay current and to concentrate efforts on the COVID-19 vaccine holdouts. These same physicians will realize that they’re not going to succeed in every case because there are limits to their powers of persuasion. Don’t be discouraged! Instead, physicians and nurses will treasure every victory because they are doing incredibly important work at a historical time.
Rich Parker is an internal medicine physician.
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