Changing Minds Starts With “Why?": Ways to Address Common Concerns with Immunization
Families choose to avoid certain vaccines for various reasons. Sometimes, they refuse all of them. Many pediatricians choose not to see families that don’t vaccinate their children. I’m one of a handful of pediatricians who will see these families in Licking County. Vaccine hesitancy was recently listed as one of 10 threats to global health by the World Health Organization. Trust between a physician and their patient + family is paramount to countering it. Changing minds starts with “why?” “Why are you choosing to forego vaccinations?” “What concerns you about vaccines?”
1.) No Reason: Sometimes, families can’t or won’t articulate exactly what their concerns are. In situations like this, it’s important to stick to a short, positive statement like “I recommend the entire vaccine schedule. Vaccines are safe and effective. Vaccinating is one of the best things you can do for your child.” The statement I personally make is, “If vaccines weren’t safe and effective, I wouldn’t recommend them. I didn’t become a pediatrician to harm your child.” At this point, don’t spend too much time prying as you may cause the family to “dig in.” It’s up to you to build a relationship with the patient’s family. Check in regarding vaccination at future appointments. As they grow to trust you, you may change their mind.
2.) Autism: Vaccines don’t cause autism spectrum disorder. We know this. Recently, a meta-analysis involving over one million children reaffirmed it. However, for a parent not versed in evaluating research, waving a study in their face may not be the best strategy. We know autism spectrum disorder is present from birth. And, we can be assured that toddlers who screen negative for it at their 18 and 24 month well child checkups probably don’t have it. At this point, I reassure families on the fence that now would be a good time to start vaccinating.
3.) The Immune System: Parents sometimes report concern about the overall number of shots and if their baby’s immune system can handle it. The number of injections received over the course of the recommended CDC schedule seems like a lot. I tell parents “while the number of pokes seems like a lot, the number of proteins and preservatives in the vaccines is much lower than a few decades ago. Your child is getting similar protection with fewer things going into their body.” In terms of number of shots, a child could likely get 10,000 vaccines at once and develop an immune memory response to each. The most we give in my office at once is 6 (and that only happens at one well child check.)
4.) HPV: I haven’t had any parent refuse HPV because they thought it would lead to promiscuity. That thought is out there though. It’s been debunked. Most parents have a hard time saying why they’re refusing it, falling into “no reason” above. Only about half of teens are getting it. I’ve had it refused enough that I’ve developed a specific response: “HPV is the ‘human papilloma virus.’ It causes warts on the body, both in private areas and on fingers + toes. Most people think it’s only spread by intimate contact but one touch spreads it; it’s highly contagious. It isn’t uncommon for a baby to develop genital warts because they had their diaper changed by a family member with a wart on their fingers. In fact, nearly all adults in America have been exposed to it. Your child will likely be exposed too. It’s up to you to decide whether or not you want to protect them from the deadly cervical and head + neck cancers that could result.” Again, I always emphasize I would never recommend anything that wasn’t safe or effective to my patients.
5.) The Flu Shot Causes the Flu: This old wives tale seems to cut across all demographics: I heard it in my residency clinic which was in an urban setting and I hear it in my current somewhat-rural setting. It’s uttered by both families of kids with private insurance and Medicaid. The flu shot can’t cause the flu. “The virus in the shot is completely killed, dead, inactivated. It’s safe to give it to children with immune system problems like leukemia. Having your child get their flu shot decreases their chance of dying from flu by 65%; that’s more than half.” The sad truth is, people will continue parroting this myth. And, children will continue to die every season from influenza, the vast majority not vaccinated against it.
I think the genesis for this myth comes from a known side effect of the vaccine: achiness. I’ve experienced it myself. I’ve also experience true influenza. They aren’t the same. Frankly, I haven’t heard any other population whine and complain about how they feel after the flu shot like adults do. Kids don’t seem to get the achiness like the grownups complain about. Or, as I’ve come to appreciate in my career, children are more resilient than adults and it’s one of the reasons I chose Pediatrics. (Sorry grownups, you whine too much.)
In Summary… for some patients and their families, vaccination can be quite contentious. However, for the majority of parents, what you as their physician recommends matters. Building a trusting relationship with your patients and their families is key; demonstrate you’re worthy of that trust. Ask why a family or patient is declining an immunization. Show empathy, then directly address their concern. Continue to build the patient-doctor relationship. Check in. Over time, you can help convince your patients and their families to protect themselves and their loved ones.
Sean Gallagher, MD FAAP is a Pediatrician in Newark, Ohio. You can reach him on Twitter @TheKidKidDoc. He’s also (fairly) active on his blog at WeThePeds.com.