Having disagreements about getting kids vaccinated and protected are not rare these days.
“Many parents have questions about their children’s vaccines, and answering their questions can help parents feel confident in choosing to immunize their child according to the CDC’s recommended immunization schedule.”
They understand that terminating the physician-patient relationship over vaccines truly is a last resort for “when a substantial level of distrust develops, significant differences in the philosophy of care emerge, or poor quality of communication persists.”
Whether you find yourself on opposite sides about immunizations with a friend, your spouse, an ex, or your pediatrician, agree to get educated about vaccines using these recommended and reliable sources of information and then talk about it some more.
In addition to seeing future immunization workshops and conferences that you might be interested in attending, here are many archived workshop videos, presentations, slides, and posters that you can watch and read online:
National Immunization Conference – sponsored by the CDC and HHS, the NIC has been bringing together a wide variety of local, state, federal, and private-sector immunization partners to explore science, policy, education, and planning issues related to immunization in general and vaccine-preventable disease for over 48 years.
Current Issues in Immunization NetConference (CIINC) – scheduled 4 to 5 times per year, these live, 1-hour presentations combine an online visual presentation with simultaneous audio via telephone conference call and a live question and answer session.
Got Your Shots? Immunization Conference – this 2016 Minn DOH immunization conference had presentations on social media, social norming, incorporating new best practices, how to give a strong vaccine recommendation, and why we vaccinate
UNSW Immunisation advocacy workshop – a 2015 workshop that focused on increasing immunization rates for existing vaccines using media advocacy, grass roots citizen advocacy, and government and political processes.
Have you been to an immunization conference this year?
What to Know About Immunization Workshops and Conferences
Immunization conferences are a great way to learn about childhood and adolescent immunizations, vaccine preventable diseases, implementing appropriate immunization communication strategies, and addressing vaccine hesitancy.
“Our systematic review did not reveal any convincing evidence on effective interventions to address parental vaccine hesitancy and refusal. We found a large number of studies that evaluated interventions for increasing immunization coverage rates such as the use of reminder/recall systems, parent, community-wide, and provider-based education and incentives as well as the effect of government and school immunization policies.
However, very few intervention studies measured outcomes linked to vaccine refusal such as vaccination rates in refusing parents, intent to vaccinate, or change in attitudes toward vaccines.
Most of the studies included in the analysis were observational studies that were either under-powered or provided indirect evidence.”
Sadaf et al on A systematic review of interventions for reducing parental vaccine refusal and vaccine hesitancy
It’s that we don’t really know how to talk about vaccines to vaccine hesitant parents, at least not in a way that we know will consistently get them to vaccinate and protect their kids.
Understanding Studies About Vaccine Hesitancy
Sure, a lot of studies have been done about talking to vaccine hesitant parents.
We have all seen the headlines:
Study: You Can’t Change an Anti-Vaxxer’s Mind
Pro-vaccine messages can boost belief in MMR myths, study shows
UWA study shows attacking alternative medicines is not the answer to get parents to vaccinate kids
Training Doctors To Talk About Vaccines Fails To Sway Parents
Does that mean that you shouldn’t try to talk to vaccine hesitant parents?
Of course not.
“How providers initiate and pursue vaccine recommendations is associated with parental vaccine acceptance.”
Opel et al on The Architecture of Provider-Parent Vaccine Discussions at Health Supervision Visits
Just understand that these headlines are usually about small studies, which if they were about treating a child with asthma or strep throat, likely wouldn’t change how you do things.
In one study that concluded that “physician-targeted communication intervention did not reduce maternal vaccine hesitancy or improve physician self-efficacy,” the physicians got a total of 45 minutes of training!
So they shouldn’t have so much influence about how you might talk to parents about vaccines that you throw up your hands at the thought of talking to a vaccine hesitant parent and won’t even think about learning how to use the CASE method, why presumptive language might work, or about vaccination-focused motivational interviewing techniques.
The bottom line is that no matter what the headlines say, we just haven’t found the best way to talk to vaccine-hesitant parents and help them overcome their cognitive biases. And until more studies are done, none of the existing studies about anti-vaccine myth-busting should likely overly influence how you do things.
“Physicians should aim for both parental satisfaction and a positive decision to vaccinate. Researchers must continue to develop conceptually clear, evidence-informed, and practically implementable approaches to parental vaccine hesitancy, and agencies need to commit to supporting the evidence base. Billions of dollars fund the research and development of vaccines to ensure their efficacy and safety. There needs to be a proportional commitment to the “R&D” of vaccine acceptance because vaccines are only effective if people willingly take them up.”
Leask et al on Physician Communication With Vaccine-Hesitant Parents: The Start, Not the End, of the Story
If you spend any time talking to vaccine hesitant parents, especially those who are on the fence, you quickly learn that many are eager to get good information about vaccines and all want to do what is best for their kids.
“…while the drivers of vaccine hesitancy are well documented, effective intervention strategies for addressing the issue are sorely lacking. Here, we argue that this may be because existing strategies have been guided more by intuition than by insights from psychology and by the erroneous assumption that humans act rationally.”
Rossen et al on Going with the Grain of Cognition: Applying Insights from Psychology to Build Support for Childhood Vaccination
If a parent is concerned about glyphosate, you might not sound too convincing telling them not to worry if you don’t even know what glyphosate is.
What to Know About Vaccine Hesitancy Studies
While we learn better ways to talk about vaccines, so that vaccine-hesitant parents can more easily understand that vaccines are safe and necessary, don’t dismiss current strategies because of small studies and attention grabbing headlines.
If you are talking about vaccines, this probably isn’t that kind of cherry picking though.
What Is Cherry Picking?
Have you ever been to a cherry orchard?
“Pick only the cherries that are fully red (or whatever color they are supposed to be when ripe!). Part the leaves with your hands to look for hidden cherries ready for harvest.”
Cherry Picking Tips and Facts
Cherries don’t continue to ripen off the tree, so you want to pick them at exactly the right time. Not too early and not too late.
So when you go cherry picking, you are looking for the perfect cherries.
That’s what folks do when they go cherry picking for just the right information to fit their beliefs, but ignore any and all other information that might prove them wrong.
“Whatever one might think about Andrew Wakefield, he was just one man: the MMR autism scare has been driven for a decade now by a media that over-emphasises marginal views, misrepresenting and cherry picking research data to suit its cause. As the Observer scandal makes clear, there is no sign that this will stop.”
It is not uncommon to hear about parents having ‘panic attacks’ over the idea of vaccinating their kids.
“…many parents are inundated with horror stories of vaccine dangers, all designed to eat away at them emotionally while the medical and scientific communities have mounted their characteristic response by sharing the facts, the data, and all of the reliable peer-reviewed and well-cited research to show that vaccines are safe and effective.”
Federman on Understanding Vaccines: A Public Imperative
“…recognizes the importance of examples—testimonials and stories—that are the lifeblood of vaccine-hesitant beliefs.”
Nathan Rodriguez on Vaccine-Hesitant Justifications
Vaccine injury stories aren’t new though.
These types of anecdotal stories were very popular when folks used to think that the DPT vaccine was causing a lot of side effects. It wasn’t though. And it was soon proven that the DPT vaccine didn’t cause SIDS, encephalitis, non-febrile seizures, and many other things it was supposed to have caused.
“Anecdotes – about a new miracle cure, a drug that is not being made available on the NHS, or the side effects of treatment, or some environmental hazard – sell product. Data, on the other hand, which take us towards the truth about these things, are less popular. Anecdotes, however many times they are multiplied, do not point the way to reliable knowledge. As the aphorism says, “The plural of anecdote is not data”.”
Raymond Tallis on Anecdotes, data and the curse of the media case study.
That anecdotes “sell” better than data may be one reason why you see them so often on anti-vaccine websites. Another is that they simply don’t have any good data to use as evidence!
Are Vaccine Injury Stories True?
Vaccines are not 100% safe, so there is no doubt that some vaccine injury stories are true.
There is also no doubt that what many people perceive to be vaccine injuries have actually been proven to not be caused by vaccines, from allergies and eczema to autism and MS.
“In the absence of a specific etiology for ASDs, and a tendency among parents of children with a disability to feel a strong sense of guilt, it is not surprising that parents attempt to form their own explanations for the disorder in order to cope with the diagnosis.”
Mercer et al on Parental perspectives on the causes of an autism spectrum disorder in their children
Also keep in mind that in addition to the many so-called vaccine induced diseases, there are many historical vaccine injury stories that have been shown to be untrue:
Johnnie Kinnear supposedly began having seizures 7 hours after getting a DPT vaccine, when he was 14-months-old, but medical records actually shown that his seizures started 5 months after he received his vaccines
Dravet syndrome now explains many severe seizures associated with vaccinations
And at least one of Wakefield’s own followers – a mother who claimed that the MMR vaccine caused her son’s autism, was “dismissed as a manipulative liar” by a court in the UK.
Vaccine Injury Stories are Dangerous
Do vaccine injury stories have a purpose? They might help a parent cope with a diagnosis in the short term, but vaccine injury stories are dangerous in so many ways.
We have seen how they create anxiety for many parents, which can scare them away from vaccinating and protecting their kids from life-threatening vaccine-preventable diseases.
What else can they do?
They can certainly build up mistrust towards pediatricians and other health professionals. That is one way that the anti-vaccine movement continues to hurt autistic families. They also can lead parents to think that their “vaccine injured” child is “damaged” in some way.
And they push parents towards dangerous, unproven, unnecessary, and expensive alternative treatments. It shouldn’t be a surprise that many of the sites and forums that push vaccine injury stories also promote a lot of dangerous advice.
“Vaccines protect the health of children and adults and save lives. They prevent life – threatening diseases, including forms of cancer. Vaccines have been part of the fabric of our society for decades and are one of the most significant medical innovations of our time.”
More than 350 medical, professional and advocacy organizations in a 2017 letter to President Trump
It is the hundreds of thousands of experts at every major health organization around the world!
American Academy of Pediatrics
The American Academy of Pediatrics, an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists, has long advocated for the health and safety of our children.
“Vaccines are safe. Vaccines are effective. Vaccines save lives.
Claims that vaccines are linked to autism, or are unsafe when administered according to the recommended schedule, have been disproven by a robust body of medical literature. Delaying vaccines only leaves a child at risk of disease. Vaccines keep communities healthy, and protect some of the most vulnerable in our society, including the elderly, and children who are too young to be vaccinated or have compromised immune systems.”
Fernando Stein, MD, FAAP, President and Karen Remley, MD, MBA, MPH, FAAP, CEO/Executive Vice President, American Academy of Pediatrics
Vaccine friendly pediatricians who are pushing non-standard, parent-selected, delayed protection vaccine schedules are leaving kids at risk for vaccine-preventable diseases.
“Pediatricians who routinely recommend limiting the numbers of vaccines administered at a single visit such that vaccines are administered late are providing care that deviates from the standard evidence-based schedule recommended by these bodies.”
AAP on Countering Vaccine Hesitancy
Vaccines are necessary.
“Because rare medically recognized contraindications for specific individuals to receive specific vaccines exist, legitimate medical exemptions to immunization requirements are important to observe. However, nonmedical exemptions to immunization requirements are problematic because of medical, public health, and ethical reasons and create unnecessary risk to both individual people and communities.”
AAP on Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance
Society of Pediatric Nurses
“Immunizations are safe and effective in promoting health and preventing disease.”
SPN Position Statement on Immunizations
National Association of Pediatric Nurse Practitioners
Established in 1973, with more than 8,500 members, the National Association of Pediatric Nurse Practitioners (NAPNAP) is the professional association for pediatric nurse practitioners (PNPs) and all pediatric-focused advanced practice registered nurses (APRNs).
“NAPNAP supports the prioritization of immunization education for parents, guardians and other caregivers of infants, children, and adolescents. This education must include the most current scientific evidence related to vaccine safety, risk, benefits and current resources available to ensure that parents and caregivers receive adequate information about immunizations. This includes, when necessary, relaying the risk of not immunizing their child and potential devastation that can occur when a child is infected with a vaccine-preventable disease. It is incumbent that a PNP also be aware of misinformation in the public domain and provides the correct information to the public as well as the health care community.”
NAPNAP Position Statement on Immunizations
American College of Preventive Medicine
“Vaccine-preventable diseases were a major cause of mortality and morbidity in the United States in the 20th century. With the advent of immunizations, there have been dramatic rates of decline in these diseases. Clinical studies have shown vaccines to be efficacious and cost effective. ”
ACPM on Childhood Immunizations
American College of Obstetricians and Gynecologists
Founded in 1951, the American College of Obstetricians and Gynecologists (The College) represents more than 58,000 members.
“Health care providers and patients should be aware that the reassuring safety data for use of the aforementioned vaccines in pregnancy are compelling, and there is no link to vaccine administration and miscarriage. An added benefit to immunizing during pregnancy is the potential for disease prevention in newborns by way of passive antibody transfer to the fetus. Hence, offering pregnant patients influenza and Tdap vaccines is an avenue to protect newborn infants at a critically vulnerable time and before neonates can be vaccinated.”
ACOG on Immunization for Pregnant Women
American Public Health Association
The American Public Health Association was founded in 1872, the APHA represents over 25,000 public health professionals.
“And further noting that the Institute of Medicine has recently released a report10 describing the U.S. immunization system as “a national treasure that is too often taken for granted” and calling for substantial increases in federal and state allocation of funds to support immunization infrastructure; therefore
Reaffirms its support for immunization as one of the most cost-effective means of preventing infectious diseases;”
APHA on The Need for Continued and Strengthened Support for Immunization Programs
American Medical Association
The American Medical Association, which was founded in 1847, has just over 240,000 members.
“The AMA fully supports the overwhelming body of evidence and rigorous scientific process used by the Advisory Committee on Immunization Practices which demonstrate vaccines are among the most effective and safest interventions to both prevent individual illness and protect the health of the public.”
William E. Kobler, MD, member of the AMA Board of Trustees.
Immune Deficiency Foundation
“The development of immunizations for common bacterial and viral infections has represented a major advance in the battle against microbial organisms that constantly threaten the welfare of humankind and particularly the pediatric population. However, the alarming increase in nonimmunized persons could lead to a return of the epidemics seen in the past.
…critical need for maintenance of herd immunity in the population at large. It is particularly important for family members of patients with defective T and B lymphocyte–mediated immunity to receive all of the available standard immunizations (excluding live poliovirus).”
Medical Advisory Committee of the Immune Deficiency Foundation on Recommendations for live viral and bacterial vaccines in immunodeficient patients and their close contacts
American Nurses Association
The American Nurses Association (ANA), founded in 1896, represents “the interests of the nation’s 3.6 million registered nurses.”
“To protect the health of the public, all individuals should be immunized against vaccine-preventable diseases according to the best and most current evidence outlined by the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP). All health care personnel (HCP), including registered nurses (RNs), should be vaccinated according to current recommendations for immunization of HCP by the CDC and Association for Professionals in Infection Control and Epidemiology (APIC).
As stated in the Code of Ethics for Nurses (ANA, 2015, p. 19), RNs have an ethical responsibility to “model the same health maintenance and health promotion measures that they teach and research…,” which includes immunization against vaccine-preventable diseases.”
ANA Position Statement on Immunizations
Autism Science Foundation
“Multiple studies have been completed which investigated the measles, mumps and rubella vaccination in relation to autism. Researchers have also studied thimerosal, a mercury-based preservative, to see if it had any relation to autism. The results of studies are very clear; the data show no relationship between vaccines and autism.”
The American Association of Immunologists (AAI) is the largest professional association of immunologists in the world, representing more than 7,600 basic and clinical immunologists.
“Recent outbreaks have brought increased attention to vaccine- preventable diseases and have highlighted the need for robust and timely immunization to reduce preventable sicknesses and deaths. AAI strongly urges full adherence to recommended vaccination schedules and views vaccines as efficacious for individuals and crucial to public health.
Research has repeatedly confirmed that vaccinations are safe and highly effective for all healthy children and adults, and any suggestions to the contrary have been discredited. Ongoing vaccine research continually reaffirms its safety and efficacy, including the number of vaccines administered at any one time and the recommended vaccination schedule.”
The American Association of Immunologists Statement on Vaccines
American Osteopathic Association
“The American Osteopathic Association supports the Centers for Disease Control and Prevention in its efforts to achieve a high compliance rate among infants, children and adults by encouraging osteopathic physicians to immunize patients of all ages when appropriate ; supports the HHS National Vaccine Implementation Plan; and encourages third- party payers to reimburse for vaccines and their administration.”
AOA on Immunizations
National Association of School Nurses
#TodaysSchoolNurse is “grounded in ethical and evidence-based practice, are the leaders who bridge health care and education, provide care coordination, advocate for quality student-centered care, and collaborate to design systems that allow individuals and communities to develop their full potential.”
“It is the position of the National Association of School Nurses (NASN) that immunizations are essential to primary prevention of disease from infancy through adulthood.
The school nurse is well-poised to create awareness and influence action to increase the uptake of mandated and recommended immunizations. The school nurse should use evidence-based immunization strategies, such as school-located vaccination clinics, reminders about vaccine schedules, state immunization information systems (IIS), strong vaccination recommendations, and vaccine education for students, staff, and families.”
NASN Immunizations Policy Statement
American Academy of Family Practice
“With the exception of policies which allow for refusal due to a documented allergy or medical contraindication, the AAFP does not support immunization exemption policies.”
AAFP Immunization Policy Statement
American Academy of Allergy, Asthma & Immunology
The American Academy of Allergy, Asthma & Immunology (AAAAI) is a professional organization with over 7,000 members, including allergists/ immunologists, in the United States and 73 other countries.
“Immunization is perhaps the greatest public health achievement of all time, having significantly reduced the morbidity and mortality of many infectious diseases. Routine immunization of children, adolescents, and adults provides substantial protection from a large number of infectious diseases…
Patients who have experienced adverse reactions to vaccines might unnecessarily be advised to avoid subsequent immunization, which could have important adverse personal and population health consequences. Although there are some adverse reactions to vaccines that constitute absolute contraindications to administration of future doses, most such reactions do not preclude subsequent immunization. Patients who have experienced an apparent allergic or other serious adverse reaction after receiving a vaccine warrant evaluation by an allergist/immunologist. Also, patients with preexisting health conditions that might predispose to adverse reactions to vaccines could benefit from such an evaluation. In most cases, a risk-benefit analysis will favor subsequent immunization.”
AAAAI Practice Paramater on Adverse Reactions to Vaccines
CJ First Candle
“There seems to be a common misconception that vaccines are somehow associated with SIDS deaths. This is not true! Experts warn that the risk of leaving your baby unprotected is 1,000 times greater than any increased risk for SIDS. Because infants receive many immunizations during the critical development period from two to six months of age, and 90 percent of SIDS deaths occur within this time frame, it is only logical that many SIDS victims have recently received vaccines. This does not mean that the immunization had anything to do with the infant’s subsequent sudden and unexpected death. The cause and effect of immunizations and SIDS has been comprehensively studied for more than two decades. In fact, in countries where immunization schedules are different from those in the United States, the peak incidence of SIDS is still between two to four months.”
CJ First Candle on Immunizations
Infectious Disease Society of America
Founded in 1963, the Infectious Diseases Society of America (IDSA), with over 9,000 members, represents physicians, scientists and other health care professionals who specialize in infectious diseases.
“The Infectious Diseases Society of America (IDSA) recognizes the great benefits that vaccines provide for the public health. Substantial scientific evidence demonstrates vaccines’ enormous value in protecting individuals and populations from serious and life-threatening infections. Scientific evidence also demonstrates the overall safety of vaccines. Communities are most effectively protected when all are immunized.
Studies demonstrate that the easier it is to receive an exemption, the higher the rate of exemptions in a particular state. As the number of exemptions increases, the risk of vaccine – preventable disease increases. Therefore, states must make every effort to minimize the number of its citizens exempted from immunization mandates. Such exemptions make the state legislatures who grant them, as well as the individuals who receive them, responsible for placing the remaining state population at greater risk of acquiring potentially fatal infections.”
IDSA Policy Statement on State Immunization Mandates
The Arc of the United States
“Prior to widespread immunization in the United States, infectious diseases killed or disabled thousands of children each year. The near elimination of intellectual disability due to measles encephalitis, congenital rubella syndrome, and Haemophilus influenzae type b meningitis or Hib can be contributed to vaccines.”
The Arc Facts About Childhood Immunizations
American College Health Association
“The American College Health Association (ACHA) strongly supports the use of vaccines to protect the health of our individual students and our campus communities. In recognition of the vital role that vaccine coverage plays in community immunity (herd immunity), ACHA discourages use of nonmedical exemptions to required vaccines.”
ACHA on Immunization Recommendations for College Students
What to Know About Expert Statements on Vaccines
Over the years, hundreds of organizations representing millions of families, health care providers, researchers, patients, and consumers, have repeatedly expressed their unequivocal support for vaccines, because they understand that vaccines work and that they are safe and necessary.
One strategy that might work includes asking open ended questions about why the parent is hesitant to vaccinate their kids. Next, while responding to a few of their biggest concerns, be sure to affirm what the parent is saying and use reflective listening.
You are really worried that your child might get sick after their vaccines.
It sounds like you think kids get too many shots.
Now, address a few of those concerns.
Pediatricians often feel like they don’t have enough time to have long discussions about vaccines, when they also need to talk about many other important topics at each visit, including nutrition, development, and safety, etc. The vaccine talk doesn’t have to be extensive though. Just get it started and come back to it again at the next visit.
It is not enough to simply tell your vaccine hesitant parents to read a book, visit a website, or offer them some handouts though. It is important that pediatricians also talk to parents about vaccines.
Study after study show that pediatricians are the most influential, most convincing, and most used source of information about vaccines for many parents.
“How providers initiate and pursue vaccine recommendations is associated with parental vaccine acceptance.”
Opel et al on The Architecture of Provider-Parent Vaccine Discussions at Health Supervision Visits
Include stories and anecdotes about kids who have gotten sick and parents who regret not vaccinating their kids.
Become familiar with the anti-vaccine talking points that may be scaring your patients away from getting vaccinated on time. Why is this important? If they are concerned about glyphosate, you might not sound too convincing telling them not to worry if you don’t even know what glyphosate is.
Try the CASE Method for talking about vaccine concerns.
Are your kids fully vaccinated? Talk about that too.
There is much more to all of this than simply letting parents follow non-standard, parent-selected, delayed protection vaccine schedules and arguing with them about getting caught up.
What to Know About Talking to Vaccine Hesitant Parents
Learning new ways to talk to vaccine hesitant parents, including the use of vaccination-focused motivational interviewing techniques, presumptive language, and high-quality recommendations, might help pediatricians have more success and get less frustrated.