Tag: vaccine hesitant

How Can I Get Vaccinated If My Parents Are Anti-Vaccine?

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.
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.”

Fourteen other states, including Alabama, Alaska, Arkansas, Delaware, Idaho, Illinois, Kansas, Louisiana, Maine, Massachusetts, Montana, Nevada, Oregon, Pennsylvania, South Carolina, Tennessee, and West Virginia have laws that allow mature minors to consent to general medical treatment either in all or a range of restricted circumstances.

How Can I Get Vaccinated If My Parents Are Anti-Vaccine?

Believe it or not, this question comes up a lot more than you can ever imagine.

If you are old enough to consent to getting vaccinated on your own, then you are all set and can start to get caught up on your immunizations.

If not, then your options are more limited, but might include:

  • talking to your parents about your concerns
  • 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.

Why don’t they want you to get vaccinated? Do they have specific concerns about side effects? Do they have a religious objection?

Vaccines are safe and necessary. Hopefully you can help your parents understand that and they will allow you to get caught up on all of your vaccines.

More on Getting Vaccinated If Your Parents Are Anti-Vaccine

8 Myths About Pediatricians Who Fire Families Who Don’t Vaccinate Their Kids

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.
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.

Pediatricians who don’t dismiss families who don’t vaccinate their kids often feel that it is better to keep working to help them understand that vaccines are safe and necessary, so that they eventually do get vaccinated and protected.

What about the extra risk in their own offices?

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.

Then why don’t they vaccinate and protect their kids?

“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

They are likely afraid.

What are they afraid of?

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.

You can answer specific questions about vaccines, but it is harder when they are afraid because they see anecdotal vaccine scare videos or because friends and family members are feeding them misinformation.

“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.

It is also clear that we need new ways to talk about vaccines.

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

Immunization Education Agreement

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.”

CDC on Talking to Parents about Vaccines

They never were though.

The anti-vaccine movement, concerns about the pain from the shots, and worry about side effects have been around for as long as there have been vaccines.

Options When You Disagree About Vaccines

So what should you do if you disagree with someone about vaccines and you don’t want to get your child vaccinated?

It depends on who it is.

For example, if the person you disagree with is your pediatrician, then simply arguing about it likely isn’t a good idea, on either side.

Most pediatricians understand that many vaccine-hesitant parents are simply scared because of things they read and see on the Internet and they want to help you get educated, see through the myths and misinformation that are out there, and eventually get caught up and vaccinated.

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.”

Immunization Education Agreement

So what can you do besides arguing?

Will you agree to get educated about vaccines?
Will you agree to get educated about vaccines using recommended and reliable sources of information?

Pediatricians and other health care providers can agree to get better educated about all of the different ways to talk to vaccine-hesitant parents.

And vaccine-hesitant parents can agree to get educated about vaccines and vaccine-preventable diseases using books and websites that are recommended by their provider.

Reassure your pediatrician that you are not done talking about vaccines and agree to get educated about vaccines:

Immunization Education Agreement Form

Even if you think that you have already done enough research, do just a little more. And then talk to you pediatrician again. And again if you have to.

Vaccines are safe. Vaccines are necessary. Don’t let anyone scare you into thinking that they aren’t.

What to Know About the Immunization Agreement

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.

More on the Immunization Education Agreement

We Don’t Know How To Talk About Vaccines

There is a dirty little secret about vaccines that people don’t seem to like to talk about.

No, it’s not about toxins or autism.

“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.

Why do anti-vaccine websites still post misinformation about fake recommendations to stop breastfeeding?
Why do people continue to believe misinformation about fake recommendations to stop breastfeeding?

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.

It’s just hard for many of them to do what is best when their decisions are getting influenced by vaccine scare videos and many of the 100s of myths about vaccines that are out there.

“…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

So while we need more studies on the best ways to talk to vaccine hesitant parents, don’t dismiss all of the ways that might be effective, such as:

It is also important to become familiar with the myths and anti-vaccine talking points that may be scaring your patients away from getting vaccinated on time.

Why is this important?

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.

More on Vaccine Hesitancy Studies

 

Who’s Who in the Anti-Vaccine Movement

No, this isn’t another article about Andy Wakefield or Jenny McCarthy.

Defining the Anti-Vaccine Movement

The great majority of people know that vaccine work and that they are safe and necessary.

And then there are the folks who don’t.

“The term movement as a description for vaccine deniers is also very misleading. A movement implies the image of a powerful, coordinated group, united by a shared collective identity.”

WHO on How to respond to vocal vaccine deniers in public

It is important to understand that this minority of people who do not believe in vaccines do not have uniform beliefs. Calling them a movement is simply for convenience, as a way to group them all together.

Who’s Who in the Anti-Vaccine Movement

So who are the different types of people that you might come across in various discussions about vaccines?

More importantly, why do you want to know?

You don’t want to think that everyone who questions the safety or efficacy of vaccines is totally anti-vaccine and is going to refuse some or all vaccines. Some of these parents really do just have questions, want to get educated, and may have just been scared by misinformation. On the other hand, others won’t change their minds no matter what new evidence you bring to the table or how long you talk.

“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

However you characterize the groups, you will be much less frustrated when talking about vaccines if can quickly recognize if you are talking to someone who is:

  • a go along to get along immunization acceptor – this type of cautious acceptor understands and accepts that vaccines work and that they are safe and necessary, but still may have some doubts about one or more vaccines.
  • an immunization advocate – understands, accepts, and helps teach others that vaccines work and that they are safe and necessary.
  • a vaccine denier – someone who does not accept the process of vaccination while denying scientific evidence and employing rhetorical arguments to give the false appearance of legitimate debate. These are the vaccine rejectors who are “unyieldingly entrenched in their refusal to consider vaccine information.”
  • vaccine hesitant – usually a classic fence-sitter, who has doubts about whether vaccines are really safe or necessary or has simply been scared and influenced about something they read on the Internet. They may skip or delay some vaccines, but are typically willing to listen to why getting their child fully vaccinated is their best and safest option.
  • a vaccine refuser – doesn’t vaccinate their kids or themselves, but unlike the vaccine denier, probably doesn’t have very strong beliefs in conspiracy theories and may be willing to listen if you address their concerns about vaccines. They are also sometimes called the vaccine resistant. Often seem to put aside their beliefs against vaccines in special circumstances, like during outbreaks or other high risk situations.
  • a vaccine skeptic – this term is often misused, as classically, a vaccine skeptic would be defined as a person who has questions about vaccines, but then accepts that they are safe and necessary once they have examined all of the evidence. As a skeptic, they would also question all of the “science” of the anti-vaccine movement too, and would find it lacking. Folks who question vaccines, but then ignore all of the evidence that supports their safety and effectiveness are in denial – they are not vaccine skeptics.
  • a vocal vaccine denier – a vaccine denier who influences others, especially on the Internet.
  • one of the worrieds – often immunization acceptors who are still a little worried about vaccine side effects.

What about those who say that they are pro-safe vaccines or pro-choice about vaccines?

Don’t be fooled, these are simply anti-vaccine arguments of a vaccine denier or refuser.

Jenny McCarthy and Jim Carrey went on a mission to Green Our Vaccines in 2008.
Jenny McCarthy and Jim Carrey went on a mission to Green Our Vaccines in 2008. How would you classify them?

Still having trouble telling the groups apart?

Try asking the person you are talking to what would change their mind about vaccines.

Would new evidence work? Or would they dismiss any new evidence as being biased, just as they already dismiss all of the evidence that  so strongly supports that vaccines are safe and necessary?

It is important to identify who’s who, because while you will likely not change the mind of someone who is at the stage of being a vaccine denier, you have a much better chance to help the others get their kids vaccinated and protected.

What to Know About Defining the Anti-Vaccine Movement

The anti-vaccine movement includes a lot of different groups of people, from those who are simply hesitant because a friend or family member is scaring them on Facebook to the vocal vaccine denier, who probably wouldn’t even change their mind if they were bitten by a rabid dog.

More About Defining the Anti-Vaccine Movement