Having a conversation with a vaccine-hesitant parent can feel high-pressured and stressful because as much as you may recognize that vaccines are crucial pieces of preventative medicine, you also know that safety fears could prevent this valuable healthcare as well as break the trust of the parent. Leading conversations with compassion and meeting parents where they are can help make conversations about vaccines productive both for your relationship with families and the health of kids.
How to Talk about Vaccines with Hesitant, Delayer, and Refuser Parents
Parents enter your office with opinions about vaccination that are informed from many possible sources -- personal stories are a large factor, as well as insights from their friends, family, and their own healthcare providers. However, among all parents, their child’s pediatrician is most frequently reported to be a trusted information source. This means that while nearly all pediatricians will happen across families that refuse vaccines, different approaches may be helpful for different circumstances and individual families to help reassure fears and reverse refusal decisions.
Assessing whether a parent is “vaccine-hesitant” versus a “delayer” or “refuser” is somewhat up to the clinician, as it best suits their practice of medicine and their judgement. For the purposes of this post, we’ll assume that first, a parent is “hesitant” if they haven’t expressed a wish to delay or refuse a vaccine, but may have questions about safety, efficacy, and more; second, that a “delayer” expresses a wish to delay vaccination significantly beyond AAP-recommended schedules; third, that a “refuser” is more steadfast than not about their decision to refuse vaccination for their child.
Hesitant Parents
A physician or vaccine provider addressing a parent whose attitude is hesitant has an important opportunity to lean on the trust between themselves and the parent, while pursuing the parents’ concerns with compassion and providing guiding information.
In a method recommended by the AAP, many physicians may find success using presumptive rather than participatory language: “Today your child is due for 2 vaccines. We will be giving MMR and Varicella.” instead of “Do you want to vaccinate your child today?”
The AAP also suggests addressing concerns with the CASE response, an acronym for Corroborate, About Me, Science, and Explain/Advise. This allows the physician to validate the parent’s fears while explaining their personal efforts to provide the best-informed care for their child, backed by science, and conclude with their professional advice.
Delayer Parents
Parents who express a desire to delay their child’s vaccination schedule may fall into two camps: parents who are hesitant about vaccine safety but accept that they’re necessary, and parents who have a stronger disinclination to vaccinate but accept a delayed schedule or selective schedule, perhaps to accommodate school, sports, or other community vaccination requirements. To both camps, delaying vaccinations may seem a compromise.
Pediatricians may find more success in reassuring parents who are more worried than begrudging or resentful about vaccination for their child, so carefully gauging a parents’ beliefs before selecting your messaging tactic is crucial, as pro-vaccine messaging can be perceived as an attack by some parents. Still, it’s important that physicians make, according to the AAP, “a strong recommendation for all vaccines. A strong recommendation can make some parents more likely to accept a vaccine.” They continue that physicians should “be respectful of parents’ concerns and values, and balance this respect with strong recommendations to avoid pushing too hard.”
Refuser Parents
Parents who refuse vaccines for their child may eventually reverse this decision with the support and guidance of their pediatrician, especially as the child matures enough to have a say in the matter. While pediatricians are perhaps the best possible advocates for vaccines, it’s important to weigh how much time and effort to extend toward changing a refuser-parent’s decision. This counseling decision is very much up to the individual physician and their practice’s rules in accepting vaccine-refusal families, but there are a few important tactics to help you make an appropriate choice.
Dr. Paul Offit spoke at the 2020 American Academy of Pediatrics’ National Conference & Exhibition on the subject of vaccine hesitancy, and when it came to addressing parents who refuse vaccinations for their children, his advice for pediatricians concerned about parents’ misguided information or beliefs was direct and succinct. He quoted astrophysicist Neil deGrasse Tyson’s supposition that:
“If you have reached a conclusion without using reason or logic, neither reason or logic will change that conclusion.” Essentially, if a physician and parent are coming to different conclusions using two totally different sets of values, reversing the parent’s beliefs may be a misguided effort.
It’s an important part of practice management to decide whether your practice will dismiss families who flatly refuse vaccination for their children. On the one hand, if you believe long-term care for the child will build trust and therefore give the parents a chance to reverse their decision, you may choose to accept these families or engage them in a trial period to extend the conversation for a limited period. On the other hand, if you believe a dissonance in values will prevent you from building this trust with the family, it may be better for them to seek care elsewhere, after you have made sure that a parent signs a vaccine refusal form to document this choice.
No matter your practice’s decision, be sure to state your position clearly on your website and in the office, and to train all staff to respond with similar messages about vaccinations. You should also be able to provide resources, such as vaccine information statements and websites such as healthychildren.org for parents who have questions.
Addressing Common Concerns
Common concerns among parents include vaccine safety, purported connections between vaccines and autism, and negative side effects. A hopeful finding in a 2016 study in Pediatrics was that “up to 47% of parents ultimately accepted vaccines after initially refusing them”. This study also provides wonderful explanations of the safety of vaccines, as well as rebutting other common concerns, which may be useful for pediatricians when speaking to parents.
By acknowledging and discussing parents’ concerns and providing evidence for safety, efficacy, and more, pediatricians can help parents come to the conclusion that vaccination is the safest medical decision for their children.
COVID-19 vaccines
In his AAP National Conference & Exhibition talk, Dr. Offit conceded that a certain amount of skepticism around a COVID-19 vaccine was entirely reasonable for parents to have, given common media reports of a ‘vaccine race’ and doubts around how safe a hastily-made vaccine might be. He also predicted that families with children may face a longer wait than others to return to post-pandemic activity even after a vaccine for adults was developed, due to limited testing on a vaccine for children and increasing evidence that children can contract the virus.
As of October 2020, vaccine manufacturer Pfizer announced that it would reduce the age of vaccine trials to include children aged 12 and older. The AAP supported this step as important progress in the efforts to produce a safe COVID-19 for children as well as for adults. In your practice, it will be important to point out the safety of the several trials currently in development at the time of this posts’ writing. You might briefly explain how vaccines are developed and tested, and how the FDA advisory committee is committed to providing a safe and effective vaccine to the public.
Vaccine-related messages and talking points for pediatricians may vary in success from practice to practice. The complexity and individuality of each families’ choices means that further research is required to study different models and messages’ effects on vaccine-hesitant parents. What we do know at present is that many parents begin to form opinions on vaccines even before their child is born, and their beliefs continue to take shape over their child’s lifetime, which includes the important insights of a trusted pediatrician. Vaccines make up only one part in a crucial service of pediatric practice -- the preventive care visit. Learn more about why preventive care is not only at the heart of a child’s health, but also your practice’s.
