To counter vaccine hesitancy, you likely first need to understand what it means.
“Vaccine hesitancy refers to delay in acceptance or refusal of vaccines despite availability of vaccination services. Vaccine hesitancy is complex and context specific varying across time, place and vaccines. It includes factors such as complacency, convenience and confidence.”
SAGE Vaccine Hesitancy Working Group
So it means someone who is anti-vaccine, right?
“Although many may characterize all individuals who eschew vaccines as “anti-vaccine” or “vaccine deniers,” in reality there is a broad spectrum of individuals who choose not to have themselves or their children vaccinated.”
Tara C Smith on Vaccine Rejection and Hesitancy: A Review and Call to Action
Many of the folks who are vaccine hesitant aren’t truly anti-vaccine. They are likely being misled by anti-vaccine myths and propaganda, but at least they aren’t the ones spreading it across Facebook or on their own blogs and anti-vaccine websites.
How To Counter Vaccine Hesitancy
How do you counter vaccine hesitancy?
“It’s unfair for anyone to expect me [or any parent] to take the word of the pharmaceutical companies who have much to gain from and industry worth billions without question – and then have to dismiss any concerns of my own.”
“Well, if you’re going to inform yourself about vaccines, I think anybody who’s truly informed will realize that getting a vaccine is much better than not getting one. If you’re choosing not to vaccinate your child, it’s because you’re getting, frankly, bad information about vaccines.”
Paul Offit, MD
You also make sure that parents, teachers, nurses, doctors, pharmacists, reporters, and everyone else gets good information about vaccines.
What actually happens when a pediatrician has a vaccine policy that requires parents to vaccinate their kids or face dismissal from the practice?
Not surprisingly, there are a lot of myths about the controversial issue of pediatricians dismissing families who don’t vaccinate their kids.
1 ) It is a myth that the American Academy of Pediatrics has a policy encouraging pediatricians to dismiss families who don’t vaccinate their kids.
There is no such policy.
Instead, in 2016, about 400 leaders from AAP chapters, committees, councils, and sections voted on a resolution at the 2016 AAP Annual Leadership Forum (ALF) to support pediatricians who dismissed families who didn’t vaccinate their kids.
RESOLVED, that the Academy support, in their policy statements and clinical guidelines about immunizations, pediatricians who decide to discharge patients after a reasonable, finite amount of time working with parents who refuse to immunize their children according to the recommended schedule or who fail to abide by an agreed-upon, recommended catch-up schedule, and be it further RESOLVED, that the Academy continue to support pediatricians who continue to provide health care to children of parents who refuse to immunize their children.
Resolution #80.81SB Supporting Pediatricians Who Discharge Families Who Refuse to Immunize
The resolution also voiced support for pediatricians who didn’t dismiss these patients.
2) It is a myth that pediatricians dismissing families who don’t vaccinate their kids is a new thing.
Although it is getting a lot more attention now, since that 2016 resolution and a report on Countering Vaccine Hesitancy that soon followed, dismissing or firing families who don’t vaccinate their kids is not new.
A 2005 AAP report, Responding to Parental Refusals of Immunization of Children, discusses the issue.
“In general, pediatricians should avoid discharging patients from their practices solely because a parent refuses to immunize his or her child. However, when a substantial level of distrust develops, significant differences in the philosophy of care emerge, or poor quality of communication persists, the pediatrician may encourage the family to find another physician or practice.”
Responding to Parental Refusals of Immunization of Children
And a study, Dismissing the Family Who Refuses Vaccines, also published in 2005, made it clear that many pediatricians “would discontinue care for families refusing some or all vaccines.”
3) It is a myth that dismissing families who don’t vaccinate their kids is an evidence based policy.
There is nothing beyond anecdotal evidence that families, when faced with the decision of getting vaccinated or getting dismissed from an office, will choose to get vaccinated.
Again, the latest resolution supporting the idea of dismissing families came because it was voted on and became an official Annual Leadership Forum resolution. In general, only the top 10 ALF resolutions are acted upon urgently by the AAP.
At the time, many pediatricians felt constrained by the previous statements from the AAP that discouraged dismissing these families.
4) It is a myth that pediatricians dismiss families who don’t vaccinate their kids because they don’t want to be bothered talking about vaccine safety.
Although few pediatricians would want to talk to a parent who is arguing that vaccines are poison, aren’t necessary, and never work, fortunately, most vaccine-hesitant parents don’t actually talk like that. They are usually on the fence or simply scared because of all of the anti-vaccine propaganda they are exposed to and need a little extra time to understand that vaccines are safe and necessary.
And most pediatricians give them that extra time and do talk to them about their concerns. Despite the perception from some of the headlines you might see, families typically don’t get fired after one visit because they refused one or more vaccines.
5) Pediatricians who don’t dismiss unvaccinated families are supporting the use of alternative vaccine schedules.
While this is certainly true for some providers who actually advertise that they are “vaccine-friendly” and encourage parents to follow a non-standard, parent-selected, delayed protection vaccine schedule, most others understand that there is no evidence to support these alternative schedules and they are simply tolerated until the child can get caught-up with all of his vaccines.
6) It is illegal to dismiss a family who doesn’t want to vaccinate their kids.
While some pediatricians think that it is a bit of an ethical dilemma, the legal issues are very clear.
Physicians can’t simply abandon a patient so that they go without care, but they are typically free to end the physician-patient relationship after giving them formal, written notification, and continuing to provide care (at least in emergency situations) for a reasonable amount of time, giving the family time to find a new physician.
Of course, state and federal civil rights laws protect families from being terminated because of sex, color, creed, race, religion, disability, ethnic origin, national origin, or sexual orientation.
7) It is a myth that dismissing families who don’t vaccinate their kids will protect those families who do vaccinate and protect their kids.
This is often the main reason that pediatricians use to justify dismissing families who don’t vaccinate their kids. After all, it isn’t fair to the families who come to your office, those who do get vaccinated and protected, if someone who is intentionally not vaccinated gets measles and exposes them all, right?
There seem to be several problems with this idea though:
relatively few exposures during outbreaks actually occur in a pediatrician’s office. Looking at most recent measles outbreaks, for example, exposures were more likely to occur while traveling out of the country, in an urgent care center, emergency room, somewhere in the community, or in their own home.
infants who get pertussis are usually exposed by a family member
while measles is very contagious and the virus can linger in an exam room for hours, other vaccine-preventable diseases are far less contagious. Mumps, for example, typically requires prolonged, close contact, which is why you are unlikely to get mumps at your pediatrician’s office.
when dismissed by their pediatrician, there is a concern that families might cluster together in the offices of a vaccine-friendly doctor or holistic pediatrician, making it more likely for outbreaks to erupt in their community if any of them get sick
And that’s the key point. Just because families get dismissed from a pediatrician’s office, it doesn’t mean that they leave the community. Your patients might still see them at daycare, school, at the grocery store, or walking down their street.
With RSV, strep, cold viruses, and everything else that kids have in the average pediatrician’s office, it is best to take steps to reduce the chances that kids are exposed to all of them. How do you do that? Don’t have a waiting room full of kids that are exposing each other to germs!
8) Most families don’t vaccinate their kids because they don’t trust their pediatrician.
“In today’s world, smallpox has been eradicated due to a successful vaccination program and vaccines have effectively controlled many other significant causes of morbidity and mortality. Consequently, fear has shifted from many vaccine-preventable diseases to fear of the vaccines.”
Marian Siddiqui et al on the Epidemiology of vaccine hesitancy in the United States
“With all the challenges acknowledged, the single most important factor in getting parents to accept vaccines remains the one-on-one contact with an informed, caring, and concerned pediatrician.”
“…nearly half of parents who were initially vaccine hesitant ultimately accepted vaccines after practitioners provided a rationale for vaccine administration.”
“Developing a trusting relationship with parents is key to influencing parental decision-making around vaccines.”
“Pediatricians should keep in mind that many, if not most, vaccine-hesitant parents are not opposed to vaccinating their children; rather, they are seeking guidance about the issues involved, beginning with the complexity of the schedule and the number of vaccines proposed.”
“Because most parents agree to vaccinate their children, this dialogue, which can be started as early as the prenatal interview visit if possible, should be an ongoing process.”