Home > Get Involved, Parent Perspective > Addressing Vaccine Hesitancy: What Advice Would You Give Your Pediatrician?

Addressing Vaccine Hesitancy: What Advice Would You Give Your Pediatrician?

Later this week, I will have the privilege of speaking with a group of pediatricians about the topic of vaccine hesitancy.  While it’s not a subject that is new to any pediatrician, it continues to be an area that they are concerned about.  Although there are some doctors who refuse to see patients who remain unvaccinated, and others like Dr. Bob Sears who prefer to accommodate parental hesitancy by suggesting that unvaccinated patients will still be protected by the benefits of herd immunity, there are plenty of doctors who are committed to helping parents overcome vaccine hesitancy and ensure parents are comfortable with their decision to vaccinate their children.

It’s evident that pediatricians often play a critical role in helping to ensure that parents are informed about the recommended immunizations for their children and are encouraged to keep their children on schedule.  And I imagine that every pediatrician feels a responsibility to keep their patients safe and healthy.  However, it’s understandable that they may each differ in their approach. But with the popularity of the internet and social media, today’s parents are often seeking information and advice about immunization long before they have a face to face conversation with their pediatrician.

This can be a challenge.  Parents can easily fall prey to anecdotal stories that instill fear, as we often see with the recurring suggestions of those who adamantly believe in a vaccine/autism link, despite the fact that no such link has ever been scientifically supported.   It’s also common to see evidence of vaccine biases on websites that sell homeopathic remedies for ailments they claim are caused by vaccines.  And it’s likely that some parents are unaware of, or unable to adequately understand, the abundance of scientific research that supports the safety and efficacy of vaccines.

Therefore, it’s nearly impossible for pediatricians to anticipate exactly what is influencing parental hesitancy about vaccines.  And it’s even more difficult for pediatricians to determine the best way for them to address parental concerns.

But that is exactly why I’m writing this post.

As a parent myself, I know the types of questions I have asked and the ways in which I would prefer for my pediatrician to respond.  But what advice would you give?  How can health care providers effectively ease parental concerns regarding infant immunizations?  Should they be prepared to reference and explain the latest studies?  Should they share personal stories of vaccine preventable diseases that they have witnessed in their own practice?  Should they elaborate on the process by which vaccines are extensively tested and monitored for safety?

What are your thoughts?

Share them with me and I will try to incorporate them into my upcoming presentation.  After all, while parents often rely on their pediatrician’s expertise and advice, pediatricians are also relying on the understanding and cooperation of parents.  I’m sure we could all benefit from a courteous discussion pertaining to vaccine hesitancy - especially among the diverse group of parents we often see contributing to the immunization conversations on both the Shot of Prevention blog and our Vaccinate Your Facebook page.   So let me hear what you have to say and ask your friends to contribute their comments as well.  It would be especially helpful to hear from people who had been reluctant to vaccinate but who had doctors who helped address their concerns.  The more discussion we generate, the more I will have to offer up to these interested and concerned pediatricians.

  1. kathy
    April 17, 2012 at 12:17 pm | #1

    I think the pediatrician or family doctor does best by talking respectfully to the patient or parents. When it is time to talk about vaccines, if a doctor brings it up with respect and concern for health and tells the parent something like “so, now is the time in the appt when we do the vaccines, is that okay?” Then, the parent or patient can lead the discussion. My own family doctor is awesome! He does not act like he knows more than I do, even though he does. He has geniune respect for what I say and for our well-being. He listened thoughtfully to my story of having a severe reaction to the MMR myself and my concerns and he answered all my questions, did not lord over my concerns with admonishments of not being informed. He went and got all the VIS for each vaccine my children might get for that appointment and we talked about them, decided together to split up the MMR and the others by a few months, given my history of vaccine reactions and drug allergies. He was patient and kind and respectful. He listened and worked with me, not against me. If a patient or parent is willing to be flexible, then this kind of discussion will work wonders.

    If the patient is already set against vaccines, then a kind and respectful doctor will ask if he can give them the VIS for each vaccine and ask if they would like to discuss anything and leave the appointment with the patient or parent understanding the doctor respects their choices but is concerned for their well being and would like to help them understand why vaccines are the less risky choice. The patient needs to be heard and not feel like the doctor is bullying them. But, the doctor also needs to convey that he or she is genuinely concerned for the patient’s health and has knowledge of why vaccines are a boon to health.

    A good doctor-patient relationship is built on mutual understanding, respect, and trust.

  2. Christine Vara
    April 17, 2012 at 12:20 pm | #2

    Kathy, Thank you for your comment. This is exactly the kind of insight that I believe can be helpful to share.

  3. April 17, 2012 at 1:38 pm | #3

    Quite often parents can feel rushed during their child’s well-visits. The causes can stem from an anxious over-tired child, the need to meet other appointments or obligations, or even long waits. Sometimes a parent may even feel their questions can be bothersome to a pediatrician, may not feel comfortable seeking information. What may be an adequate alternative, especially for large practices, clinics and hospitals, is hiring or training an Advanced Practice Nurse who can be available to address immunization concerns. I have found that patients and families sometimes are more candid and open in asking questions and expressing concerns with nurses. If a specially trained nurse was available to spend additional time with families, and/or alloweded contact via email or by phone, perhaps many of these concerns addressed and much of the misinformation could be clarified.

  4. April 17, 2012 at 1:41 pm | #4

    “The patient needs to be heard and not feel like the doctor is bullying them. But, the doctor also needs to convey that he or she is genuinely concerned for the patient’s health and has knowledge of why vaccines are a boon to health.”

    At the first visit with a vaccine-hesitant family, I ask about specific concerns and provide them with a reading list of helpful websites and vaccine books, including “Do Vaccines Cause That?!” by Martin G. Myers, MD and Diego Pineda and a few of Dr. Paul Offit’s books.

    Of the websites, in addition to the American Academy of Pediatrics and CDC, I am sure to suggest that they review sites of parents who have children with autism and who don’t believe that vaccines cause autism. They are often very surprised that so many parents don’t buy into the vaccines cause autism misinformation.

    http://pediatrics.about.com/od/vaccinesafety/a/vaccination-autism.htm

  5. Sarah
    April 17, 2012 at 2:13 pm | #5

    Very important for doctors and other medical professionals: Never EVER claim that there are no side effects, no risks, etc. when talking to a vaccine-hesitant family. You must explain that yes, this and this and this are risks of getting the vaccine. BUT this and this and this are why NOT vaccinating is MUCH more risky and why the benefits of vaccinating outweigh the risks. Evading the issues just turns people off. I understand that the reason medical professionals want to hide the risks is that they’re trying to make sure vaccine-preventable diseases continue to be vaccinated against, but people who are already suspicious will just distrust vaccines even more with this attitude from medical professionals. They will see it as confirmation of the conspiracy theory that they already believe.

  6. Lara Lohne
    April 17, 2012 at 3:27 pm | #6

    While I’ve not ever been vaccine hesitant when it came to my children, I have felt pediatricians weren’t available or lacked the time it may have taken to sit and talk with me about any concerns for vaccination I may have had. I was given the VIS and told to read it thoroughly and contact them if any of the severe reactions appear, but I feel a better approach would have been for the doctor to take the time to sit down with me and go through the VIS to make sure I understood it completely. My children only ever had mild reactions to certain vaccines so there wasn’t any real cause for concern, but speaking as a parent who has felt rushed through immunization appointments, a more personal touch with each parent would benefit everyone in the long run. It would help parents appreciate that your doctor really does care about the well being and health of the child rather then just ‘going through the motions’ making sure everything is working correctly and everything is completed on schedule. There is a time and a place for efficiency, but a well baby/child visit shouldn’t be one of those times. It can leave a parent feeling overwhelmed, unappreciated and unimportant as well as fearful of returning because of the sterile nature of the visit.

  7. JohnFryer
    April 17, 2012 at 4:14 pm | #7

    Does Dr Sears recommend no vaccines? It appears we use loaded language. My idea of Dr Sears is that he claims less side effects come from spreading out the vaccine load. It seems almost common sense that a strong person will resist harm or discomfort better as they themselves grow stronger and older.

    If a fully grown man groans about one tetanus vaccine then what for an 8 week child taking tetanus with a dzen other antigens and if we take weight into account probably 20 times as much of EACH.

  8. Lawrence
    April 17, 2012 at 4:16 pm | #8

    @John – except a grown man is less likely to die or suffer severe complications from vaccine-preventable diseases.

  9. April 18, 2012 at 9:22 am | #9

    “I have felt pediatricians weren’t available or lacked the time it may have taken to sit and talk with me about any concerns for vaccination I may have had.”

    The American Academy of Pediatrics recommends that pediatricians and other health care providers “establish an open, nonconfrontational dialogue with vaccine-hesitant parents at an early stage and provide unambiguous, easily comprehensible answers about known vaccine adverse events and provide accurate information about vaccination.”

    It is unfortunate that it doesn’t always happen.

    One reason is likely the pre-conceived notions that pediatricians have of the conversation when a parent brings up any questions or concerns. Instead of a vaccine-hesitant parent, who is really seeking information and advice, they likely remember their ‘discussions’ with truly anti-vax parents, who won’t have their mind changed no matter what study you cite or information you provide them.

    Of the parents who don’t vaccinate their kids, selectively vaccinate, or have questions, and it is important to remember that the vast majority are still vaccinating their children according to the CDC schedule, most seem to be vaccine-hesitant and just need good information to combat the misinformation that has scared them.

    While well child visits might seem rushed because there is so much information to cover, including nutrition, safety, development, etc., you should have time to ask questions and shouldn’t feel unappreciated or unimportant. Maybe try to ask your questions at the very beginning of the appointment so that you are sure they will be covered and consider finding a new doctor if the visits still leave you feeling overwhelmed.

  10. Amanda
    April 18, 2012 at 1:50 pm | #10

    Melody, I think your idea of a specially trained person to answer questions is great. I think practices should consider a health educator; less expensive than a nurse and specifically trained in communicating health information to the public.

  11. cia parker
    April 18, 2012 at 5:12 pm | #11

    A grown man is more likely to suffer a severe case of measles or chickenpox than a child, but is less likely to suffer a severe case of whooping cough or hib meningitis than a young baby.
    Dr. Sears does say that it’s better to spread out the vaccines, avoid more than one aluminum-containing vaccine per visit, avoid all that still contain mercury, like the flu vaccine, and decline pointless vaccines like those for polio, diphtheria, chickenpox, hepatitis-A, and, especially, hepatitis-B. He would prefer to break up the MMR into its three separate vaccines, but Big Pharma is no longer willing to permit this. Dr. Sears recommends the DTaP, Hib, Prevnar, and rotavirus for babies, and the MMR for older kids. His approach is better than the totally pro-vaccine approach, but last week he said that even in his office he has to give the autism talk pretty often, and I suggested that it was because he recommends too many vaccines.
    Kathy, I liked your post and your respect for parents who fear vaccine damage. I’d just like to add, though, that if you were damaged by the MMR, there was really no way for any doctor to safely give it to your child. It’s a dangerous, very reactive vaccine, and has caused hundreds of thousands of cases of autism. No words could dispel the very real danger of the vaccine, and his acting as though they could showed reckless disregard for your child’s well-being. He can control the way an immune system would react to the antigens in a vaccine? How could he? My baby was damaged by the hep-B vaccine and DTaP, and is autistic. There are no words that any doctor could use to induce me to damage my child further by giving her any more vaccines.

  12. Lawrence
    April 18, 2012 at 5:19 pm | #12

    @cia – really? Repeating the same lies over and over again won’t make them true.

  13. Nathan
    April 18, 2012 at 9:59 pm | #13

    A grown man is more likely to suffer a severe case of measles or chickenpox than a child, but is less likely to suffer a severe case of whooping cough or hib meningitis than a young baby.

    In the case of measles it is both adults and the very young that are at increased risk.

    http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/meas.pdf

    “Approximately 30% of reported measles cases have one or
    more complications. Complications of measles are more
    common among children younger than 5 years of age and
    adults 20 years of age and older.”

    “Death from measles was reported in approximately 0.2%
    of the cases in the United States from 1985 through 1992.
    As with other complications of measles, the risk of death
    is higher among young children and adults. Pneumonia
    accounts for about 60% of deaths. The most common causes
    of death are pneumonia in children and acute encephalitis
    in adults.”

    And don’t forget SSPE, usually from infection under the age of two:

    “Subacute sclerosing panencephalitis (SSPE) is a rare degenerative
    central nervous system disease believed to be due to
    persistent measles virus infection of the brain. Onset occurs
    an average of 7 years after measles (range 1 month–27
    years), and occurs in five to ten cases per million reported
    measles cases. The onset is insidious, with progressive
    deterioration of behavior and intellect, followed by ataxia
    (awkwardness), myoclonic seizures, and eventually death.
    SSPE has been extremely rare since the early 1980s”

    Dr. Sears does say… decline pointless vaccines like those for polio, diphtheria, chickenpox, hepatitis-A, and, especially, hepatitis-B.

    Yes, who would want to save all those pointless lives. And pointlessly preventing paralytic polio – I mean, that’s why we have two limbs, right?

    last week he said that even in his office he has to give the autism talk pretty often, and I suggested that it was because he recommends too many vaccines.

    I suggest you and Dr. Sears consider that he gives “the autism talk” because he has become undeservedly viewed as an autism and vaccine guru though he is demonstrably ignorant on both subjects. But I do wonder how often he gets the “So, your unvaccinated patient caused the San Diego measles outbreak” talk.

    It’s a dangerous, very reactive vaccine, and has caused hundreds of thousands of cases of autism.

    Citation needed. Example:

    Parker C. Number of vaccine-induced autistic children and my wild imagination – is there a link? J Thin Air 0(0): 0. (Abstract available, but not anything concrete.)

  14. cia parker
    April 19, 2012 at 11:54 am | #14

    Childen who get measles at what used to be the normal age (5-10) for it are very unlikely to have a serious case. Women who have had natural measles protect their nursing children with their own antibodies to measles, yet another advantage to having the natural disease. I had it when I was six, and have been happy to enjoy these advantages, both the permanent immunity to measles and the ability to protect my daughter in her nursing years.
    Some of us, Dr. Sears included, don’t believe in a one-size-fits-all schedule, since we are concerned about preventing pointless cases of autism, asthma, ADHD, seizure disorders, bowel disease, diabetes, food and respiratory allergies, eczema, paralysis, and multiple sclerosis. Of course those who still worship St. Vaccinia much prefer skyrocketing rates of chronic disease to promoting health in children.

  15. Kelly
    April 19, 2012 at 12:07 pm | #15

    More lies, cia?

    If natural immunity is so great, why did children under <1 year old die of measles in the pre-vaccine era?

    Just because you and Dr. Sears believe something, doesn't make it true.

    Of course those who still worship St. Vaccinia much prefer skyrocketing rates of chronic disease to promoting health in children.

    Strawman, cia. Which vaccine advocacy group/person prefers skyrocketing rates of chronic disease? In fact, vaccines do not cause the chronic diseases you mentioned, as you are well aware because we have discussed it before, and promoting vaccines is promoting heath in children because vaccines help prevent children from getting sick. You are the pro-disease advocate, here, cia. You would much prefer to see children be harmed by preventable diseases by spreading your lies and misinformation.

  16. Chris
    April 19, 2012 at 12:10 pm | #16

    Childen who get measles at what used to be the normal age (5-10) for it are very unlikely to have a serious case.

    Then what happened to Roald Dahl’s oldest child when she was seven years old?

    Why are there these kinds of statistics (from CDC Pink Book Appendix G):
    Measles in the USA
    Year__Cases____Deaths
    1950__319,124__468
    1951__530,118__683
    1952__683,077__618
    1953__449,146__462
    1954__682,720__518
    1955__555,156__345
    1956__611,936__530
    1957__486,799__389
    1958__763,094__552
    1959__406,162__385
    1960__441,703__380

    Why does >this paper say:

    Approximately 1 in 1000 children with clinical measles develops encephalitis.36, 39 Although most children with encephalitis recover without sequelae, approximately 15% die and 25% of survivors develop complications such as MR.39 We assumed that approximately 1 in 5000 cases of measles leads to MR.

    What evidence do you have that the MMR vaccine is more dangerous than measles? Post the title, journal and dates of the PubMed indexed paper to support your statements. You have a habit of saying things that are not true, so we cannot trust anything you write.

  17. Chris
    April 19, 2012 at 12:13 pm | #17

    Mucked up the link, here it is:
    http://archpedi.ama-assn.org/cgi/content/full/160/3/302

    Cia, you really need to stop lying.

  18. Nathan
    April 19, 2012 at 7:04 pm | #18

    The average age of measles infection prior to the vaccine was five (http://tinyurl.com/measl5), meaning that a significant number of young children under five got the disease and a significant number of the younger ones were at increased risk of complications. Before the vaccine, 500 deaths were reported annually, now, almost none. The benefits of the vaccine are far superior to the benefits of natural infection when it comes to preventing measles deaths. Your history of measles is not preventing your children from getting measles, Cia. Everyone else’s vaccines are doing it for you.

    Yes, I am concerned about the rise in certain chronic disorders as well, in fact I would say I am more concerned than you are, as I am willing to recognize the literature about what does and does not cause these disorders, instead of perseverating on the idea that it must be vaccines.

  19. cia parker
    April 20, 2012 at 9:56 am | #19

    But even so, the vast majority of even young children who got and get measles recovered uneventfully, the way the vast majority of even very young babies recover uneventfully from pertussis. The rate of severe cases is higher in the youngest groups, but it still isn’t very high. It’s unfortunate for most doctors still don’t know how effective intravenous vitamin A is in preventing or reversing complications from measles (and vitamin C from pertussis), nor how devastating fever reducers like Tylenol are to those with fever. Deliberately impeding the efforts of the immune system to defeat the invaders is an extremely foolish thing to do, and greatly increases mortality. Breastfeeding used to protect babies in their first year from measles, and possibly pertussis, when the disease can be (but usually isn’t) most dangerous.

    You should read the book The Age of Autism. It traces the history of mercury poisoning through medicines and exposure through mercury (etc.)-polluted air through two hundred years. The first cases of autism in the 1930s were all in children born to families with significant mercury exposure, occupational, many of the first autism fathers were scientists who worked in laboratories to develop mercury-containing fungicides which were new at that time, or through exposure to the mercury in the diphtheria vaccine, which was taking off at that time. The symptoms of autism are identical to those of mercury (or heavy metals in general, like aluminum) poisoning. The notable thing is that only a minority of people exposed develop the symptoms, but since we are not surprised that only a minority of people are allergic to peanuts, it should not surprise us that there can be such a wide variance in the severity of reaction to a toxic agent. And it may be that it is more a threshold set at varying levels in different people, rather than a present/not-present issue, which might account for the soaring levels of autism and other chronic diseases. Everyone has a limit, and the child who was fine with ten vaccines might display damage at the eleventh.

    I’m reading now about how clueless Kanner was, even after having dutifully made record of the toxic exposures, he still went off on the tangent of autism being caused by refrigerator mothers, which was than taken to an extreme by Bruno Bettelheim. He noted, however, that other children of the same couples did not have autism. The authors say that now research has gone off on another useless tangent, looking for a genetic cause. It seems obvious that there is a genetic predisposition to react to these toxic exposures, but that the genes do not cause the disease without such a trigger.

    This book obviously does not address the reasons the MMR often triggers autism. I’ve been wondering if it depends on a reaction of the disease pathogens with the residue of stored heavy metals from previous vaccines, or if it could be accounted for just by a reaction to the pathogens in the vaccine independent of interaction with heavy metals. The jury is still out, but I’ll continue to read until this question is settled. But I and my daughter both have this predisposition to react to the ingredients in vaccines. One size does not fit all. And we won’t get any more vaccines.

  20. Chris
    April 20, 2012 at 10:20 am | #20

    But even so, the vast majority of even young children who got and get measles recovered uneventfully, the way the vast majority of even very young babies recover uneventfully from pertussis.

    So you are okay with at least one in a thousand having a very bad outcome. Yes, 999 is bigger than one, but still several hundred died and thousands more were permanently disabled.

    You are not just a liar, but an evil cruel person.

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