Are you tired of reading about outbreaks that might put your family at risk, either because they are too young to be vaccinated, fully vaccinated, or because they have a true medical condition that keeps them from being vaccinated?
Make sure vaccines are easily available to everyone in your community.
Know that some parents are just scared to vaccinate their kids because of all of the anti-vaccine misinformation they see online, so need a little help to make the right choice about vaccines.
Analogies and metaphors are a good way to explain things, including that vaccines are safe and necessary.
As the CDC explains, we are sunk if we stop vaccinating.
Here are some of my favorite vaccine analogies and metaphors.
Getting vaccinated is like:
applying sunscreen before going to the beach
applying insect repellent before going camping in the woods
making sure that your kids are wearing a seat belt or sitting in an age-appropriate car seat or booster seat when you get in the car
installing anti-virus software on your new computer
When do you put on your seat belt? When you get in the car, before you get in an accident. Just like a vaccine. You get it before you get sick. Yes, some vaccines do work after you have been exposed to an illness, but they don’t work after you are already sick.
There is a problem with these metaphors though; they don’t include the risks to other people.
These do:
taking driver’s ed and getting your license before driving
taking swimming lessons before going in the water without a life jacket
putting your gun in a locked safe
putting a fence around your backyard so that no one in your neighborhood can drown in your pool
making sure folks don’t text and drive
That’s right.
Vaccination equals protection.
And not just protection for the person getting vaccinated. Being unvaccinated puts others at risk too, as you might start an outbreak.
Getting your kids vaccinated is like taking them to swimming lessons instead of just throwing them in the lake. Either way they can learn to swim and have protection/immunity from drowning. But one method (throwing them in the lake) is much more dangerous than the other.
“Vaccines are a like a wanted poster, they just show your body what the bad guys look like, so when faced with them for real you are ready, prepared, and able to stop them before they cause harm.”
Can vaccines overwhelm the immune system?
Are there analogies that explain the idea of free-riders – folks who intentionally don’t vaccinate their kids and attempt to hide in the herd?
“If all my child’s friends are vaccinated, won’t he be protected by herd immunity? Why should I put my child at risk for vaccine reactions if all the other children around him are already immune?
This is like riding in a carpool where everyone contributes each month to pay for gas, repairs and parking. One morning, a new neighbor shows up and says, “I think I’ll ride along with you. But I’m not going to pay, since you’re going downtown anyway and you have an empty seat.” If enough people choose to take a free ride on other children’s immunity, herd immunity will soon disappear.”
Why is herd immunity so important?
And to explain the idea of what some folks consider vaccine injuries.
“I have found that it sometimes helps to give parents an analogy. I ask them the following: If they were to put gas in their car and then later got a flat tire, would that mean putting gas in the car had caused the flat tire? No. The two events were just a coincidence.”
Since that bridge isn’t 100% safe (I Googled that some bridges have collapsed), I’m going to let my kids swim across this river with fast moving water.
Have you heard the bridge analogy?
There are also versions with crocodiles in the water…
In case it’s not clear, in this analogy, walking across the bridge is like getting vaccinated. Swimming across the river is like intentionally not vaccinating your kids.
There are plenty of other good analogies that help to explain the importance of vaccines.
“Clusters of unvaccinated people are like patches of dry grass that, with a single match, can start a wildfire that will burn not only dry material, but sometimes wet as well. The match could be a student who returns from a trip abroad with measles or a train commuter with whooping cough.”
Saad Omer
It’s also important to remember that anyone, even those who are well prepared, can get burned in a wildfire. That’s why the analogy works so well.
“Vaccinating one’s children is like paying taxes. We all have a moral and a legal duty to pay taxes because we have a moral and a legal duty to contribute to the upkeep of our society and to its public goods (e.g., a good public health system, national defence, etc.).”
Vaccine Refusal Is Like Tax Evasion
Why are we concerned about those who are unvaccinated if our own children are fully vaccinated?
“Think of camping as an analogy. If everyone at a campground properly stores their food, bears won’t be enticed to come around. If even one person leaves their food unprotected, it invites bears in to investigate all the campsites for opportunities to eat.”
How does choosing not to immunize affect the community?
“Being intentionally unvaccinated against highly contagious diseases is, to carry Holmes’ analogy a bit further, like walking down a street randomly swinging your fists without warning. You may not hit an innocent bystander, but you’ve substantially increased the chances that you will.
One might usefully analogize the risk of disease to a crapshoot. A person’s chance of being infected is, as Dr. Singer acknowledges, a matter of luck. But is it really OK for the unvaccinated to load the dice to increase the odds against other people? If so, by how much?”
Ronald Bailey on Vaccines and the Responsibility To Not Put Others at Risk
Of course, there are plenty of bad vaccine analogies and metaphors that anti-vaccine folks push:
“genes load the gun but the vaccines pull the trigger”
vaccine manufacturers are like tobacco manufacturers
I won’t set my child on fire to keep yours warm (this doesn’t work as a vaccine analogy, mostly because there is no benefit to setting your child on fire. Would an anti-vaxxer let their child start a campfire to keep their friends from dying in the cold?)
getting a vaccine is like eating a handful of M&Ms out of a big bowl when you know that a few have been poisoned
getting a child vaccinated is like giving 1,000 kids 1,000 cupcakes, telling them to pick one and eat it, knowing that one of the cupcakes is poisoned (it’s maybe like letting a child with a severe peanut allergy choose a cupcake, knowing that there is a one in a million chance that the cupcake he chooses has been made with peanuts…)
I want safer cars, but that doesn’t make me anti-car
You understand why the anti-car one is a bad analogy, right? Folks who want safer cars generally still drive and ride in cars!
Have you heard any good or bad analogies or mataphors about vaccines?
What do kids do when their parents are anti-vaccine?
Most teens do know what’s in a vaccine and they want to get vaccinated and protected.
Whether or not they know it, they hide in the herd, at least until they understand what’s going on.
And then they often make a choice to either continue with their parents beliefs and remain unprotected or they get caught up.
Can Minors Consent to Getting Vaccinated?
Since getting vaccinated is a medical procedure, in most cases, you are still going to need the consent of a parent, guardian, or other adult family member if you are still a minor, which leaves out simply going out and getting caught up.
“State law is generally the controlling authority for whether parental consent is required or minors may consent for their own health care, including vaccination.”
Abigail English, JD on the Legal Basis of Consent for Health Care and Vaccination for Adolescents
Are you still a minor?
“In most states, age 18 is the age of majority and thus, before treating a patient under the age of 18, consent must be obtained from the patient’s parent or legal guardian.”
Ann McNary, JD on Consent to Treatment of Minors
When it comes to immunizations and health care, in addition to what state you live in, that likely depends on whether or not you are an emancipated minor (court order), married minor, pregnant minor, or minor parent (situational emancipation). It also can depend on the type of health care you are seeking, like if a minor is seeking birth control or treatment for an STD.
“States Parties shall assure to the child who is capable of forming his or her own views the right to express those views freely in all matters affecting the child, the views of the child being given due weight in accordance with the age and maturity of the child.”
Convention on the Rights of the Child
Are you a mature minor? In some states, you can also give consent for medical procedures, including getting vaccinated, if you are a mature minor – someone who is old enough to understand and appreciate the consequences of a medical procedure.
In Washington, for example, minors may get immunizations without their parents consent after their health care provider evaluates the minor’s “age, intelligence, maturity, training, experience, economic independence or lack thereof, general conduct as an adult and freedom from the control of parents.”
asking someone, like your pediatrician, to be an advocate and talk to your parents with you
petitioning the court for emancipation ( you may get a whole lot more than the ability to get consent to get vaccinated though…)
waiting until you are old enough to consent to get vaccinated without your parent’s permission
While waiting is likely the easiest option, since that leaves you at risk for getting a vaccine-preventable disease, you should probably think about talking to your parents.
Does it sometimes seem like anti-vaccine folks are speaking a foreign language?
It definitely seems like they misunderstand and misuse a lot of scientific terms, like evidence, research, and toxin, doesn’t it?
Anti-Vaccine Glossary
The first step to understanding someone who is truly anti-vaccine and unnecessarily puts their kids at risk for vaccine-preventable diseases, might be to understand how they misunderstand most things about vaccines…
anything and everything bad that happens to you in the days, weeks, months, and years after you get vaccinated or in the days, weeks, months, and years before you were born because of the vaccines your parents or grandparents received
Or they might have a friend, family member, or other immunization advocate that helps them be more skeptical of the information and advice that is scaring them away from vaccines.
Remember. The great majority of parents vaccinate their kids. And those that don’t, do often change their minds.
If you ever wander into a holistic parenting group or a vaccine group that claims to offer “both sides” to educate folks about vaccines, you will, or at least you should, quickly notice that all of the posts and replies sound eerily alike.
This toddler might end up with tetanus because of bad advice in this anti-vaccine group.
If a parent asks about a tetanus shot for their child’s wound in one of these groups, no one will suggest that they rush to their pediatrician and get it.
The only disagreements you might see are whether they should treat the wound with colloidal silver, black salve, garlic, urine, activated charcoal, tea tree oil, raw honey, essential oils, or some other non-evidence based therapy.
Anti-Vaccine Censorship
It is no accident that folks get uniform advice against vaccines in these so-called vaccine “education” groups.
As often happens on anti-vaccine sites, my comment about tetanus shots was quickly deleted and I was banned from posting further messages.
Anyone who goes against the “vaccines are dangerous” mantra of these groups typically has their comments quickly deleted and gets banned from the group.
Why?
“Echo chambers abound for many other conditions which are not medically recognised, from chronic Lyme disease to electromagnetic hypersensitivity. But perhaps most worrisome is the advance of anti-vaccine narratives across the web. The explosion of dubious sources has allowed them to propagate wildly, undeterred by debunking in the popular press. We might take the current drastic fall in HPV vaccine uptake in Ireland, driven by anti-vaccine groups like REGRET, despite its life-saving efficacy. While organisations including the Health Service Executive have valiantly tried to counter these myths, these claims are perpetuated across social media with little to stop them.”
Echo chambers are dangerous – we must try to break free of our online bubbles
After all, it is easier to feel confident in your decisions when you think that everyone else is doing the same thing. Of course they aren’t though. The great majority of people vaccinate and protect their kids.
It is only in these echo chambers of anti-vaccine misinformation that anyone would think that it would be okay to not get an unvaccinated toddler proper treatment for a cut, to skip a rabies shot after exposure to a rabid bat, or to not get travel vaccines before visiting high risk areas of the world.
That’s the power of confirmation bias.
And whether or not you realize it, confirmation bias is likely one of the reasons that you aren’t vaccinating and protecting your kids.
That’s why you need to step out of these echo chambers if you want to understand that vaccines are safe and necessary.
What to Know About Anti-Vaccine Censorhip
Anti-vaccine groups routinely censor, ban, and block messages from people who correct misinformation about vaccines and vaccine-preventable diseases.
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.
A typical vaccine policy gives a parent plenty of time to get their child caught up on vaccines before they might be dismissed from the office.
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.
While this is likely true for some, those families who want to see a pediatrician and don’t refuse any other treatments, like their newborn’s vitamin K shot and eye ointment, likely do 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
More and more these day, if you ask them, they will likely tell you that they don’t know. It would be much easier if they were afraid of something specific, like the myth that a baby’s immune system is too immature to handle any vaccines, that there are hidden ingredients in vaccines, or that vaccines are somehow associated with autism.
“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.”
AAP on Countering Vaccine Hesitancy
Whatever their vaccine policy, pediatricians should all work to counter vaccine misinformation and propaganda, so that our families get vaccinated and protected and our communities are safe.
And we definitely new more ways to help everyone learn to think critically, be more skeptical about the things they see and read, and overcome their biases.
What to Know About Pediatricians Who Discharge Families Who Refuse to Immunize Their Kids
Whether they have a vaccine policy that dismisses families who don’t vaccinate their kids or they continue seeing them, pediatricians want to do what is best for their kids.
More on Pediatricians Who Discharge Families Who Refuse to Immunize Their Kids
