Q&A: How to discuss vaccines with hesitant parents
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Key takeaways:
- The AAP published strategies for discussing vaccines with parents.
- Providers are recommended to welcome questions and address specific concerns.
In a new clinical report, the AAP provides strategies to help pediatricians and other health care providers address parental vaccine concerns and increase immunization rates.
The report, published online in Pediatrics, recommends that providers use evidence-based methods to communicate about vaccines, including making a strong recommendation for scheduled vaccines, welcoming questions from parents and addressing specific concerns, using motivational interviewing to guide families in their decision-making process, and having a good understanding of the science behind vaccines and vaccine safety to best answer families’ questions.
We spoke with Jesse M. Hackell, MD, FAAP, co-author of the report and chair of the AAP Committee on Practice and Ambulatory Medicine, about the guidance.
Healio: What prompted the revisions to this report?
Hackell: It's AAP policy that the reports and policies are reviewed every 5 years, at which time they can be reaffirmed, they can be retired or they can be revised. The original report dates from 2016, and the decision was made to revise it.
There were enough things that we wanted to change in terms of the topics under discussion. We wanted to focus a little bit less on the safety details and a little bit more on the communication techniques and emphasize working with parents using newer techniques that have some evidence behind them in terms of effectiveness. We wanted to bring those into the discussion a little bit as well. This is really focused on the primary care pediatrician, who sees patients every day and gives immunizations every day and runs up against people with questions or hesitancy every day. The revised report focuses a little bit more in that direction.
Healio: Would you consider this report a guide for speaking with vaccine-hesitant parents?
Hackell: A guide is a reasonable way to phrase it. I would look at it as sort of a discussion of the vaccine confidence situation and the reasons that we are addressing this every day. We wanted to provide some suggestions as to how best to address parents who are hesitant about vaccines and the techniques that the pediatrician can use to help answer their questions, and help reassure them and help bring those people who are hesitant along to be willing to vaccinate their kids.
Healio: Should pediatricians have different approaches for talking to anti-vaccine vs. vaccine-hesitant parents? What would the differences be?
Hackell: I think that what's important is that physicians needed to have a toolkit of techniques that they can use in different situations, just like we do when we're dealing with illness. There's usually no one right way to do anything. We want pediatricians to understand that there are different techniques that they can employ. Some parents who aren't even hesitant but just have questions just require reassurance and provision of evidence. Parents who are hesitant might be concerned about one vaccine or about several, and so you need to understand where they're coming from in order to be able to address their concerns. Even when working with a parent who is adamantly opposed to vaccines, these are still discussions that we need to have.
The tools that we talk about in the report are things that you can use to at least keep the lines of discussion open, because there's good evidence that shows that there are very, very few people who are rigidly opposed and unbending. It’s in the range of 1% to 3%. Most people who are hesitant, or even who refuse vaccines initially, are not so firm in their decision that there is no possibility of changing their opinion and changing their mind and bringing them along to vaccinate. If you never have the conversation, you never know what you should be saying or what impact you might be able to have. We encourage everybody to be able to start having that discussion.
Healio: Considering what is occurring in Florida, is there guidance for pediatricians who may be asked for advice about school attendance during an outbreak?
Hackell: Florida is complicated because you have a surgeon general there who's speaking in opposition to all of the recommended guidance from the CDC and from the AAP. You have a public figure who is not supporting the current evidence-based recommendations, and that makes things a little bit tougher because that that might be construed as an official state position.
The purpose of the report is to help the pediatrician understand the reasons that vaccination is so important and the reasons that it's important to have as many people as possible vaccinated against measles in order to prevent the spread and worsening of an outbreak. I would suggest that no matter what you hear ... we as pediatricians need to rely on the evidence-based data that are out there. That data show that measles is dangerous, and measles can be fatal. We need to make sure that pediatricians are current on that. We need to make sure they understand the safety and efficacy of the vaccines and the data behind them and the reasons that we're confident that they're safe and efficacious. We devote a good amount of the paper to providing the evidence behind those decisions about safety and efficacy. The pediatrician should be aware that the evidence shows that when vaccination rates for measles fall below 95%, you run the risk of a widespread outbreak. If you can keep that number above 95% or 97%, and even if measles is introduced into the community, it has nowhere to spread.
What the CDC is recommending is that children who have not been vaccinated should be isolated and excluded from school for a period of 3 weeks. The concept there is if they are exposed to somebody in the classroom who has measles the 3-week period, that is when they will break out with the disease and be contagious. Without isolating unvaccinated people, you can keep having an outbreak that spreads. If you keep the susceptible children out of the classroom, after 3 weeks, there should be no risk from that original case turning into a self-perpetuating outbreak, and that's the reason for keeping them out for that period of time. What the surgeon general in Florida said is that it is up to the parents as to whether they want to do that, and to me, that's just the antithesis of public health. I mean, if parents decide they don't want to keep the child at home, or they're unable to keep them home for any reasons, you run the risk of it spreading from one kid to another, and just perpetuating the amount of time that we have to deal with an outbreak.
I think that the most important part of the report is that we encourage pediatricians to have the knowledge to speak from a position of evidence, and we encourage providers to have this conversation with anybody who is hesitant or uncertain. These are time-consuming conversations, and it may take multiple encounters before you can bring somebody around. But by and large, these are conversations that are worth having because the evidence shows that at least half of all hesitant parents can be convinced over time to get their kids vaccinated, and that's our ultimate goal.
We do say that in situations where it's impossible to reach an accord with the parents, it is acceptable to dismiss these patients from the practice. Fortunately, we don't have to do that too often, because our main role here is providing health care to kids. But there are occasional times where the discussion of vaccines reflects a breakdown in the relationship. Although that's an acceptable choice, it's not something that we encourage without really making rigorous attempt to bring parents around to the understanding of why this is so important. Pediatricians are concerned about providing care for kids and helping them to grow up healthy and happy. Parents are concerned with the exact same thing. We really share the same goal, and sometimes getting to that goal is difficult. But these are conversations that can actually help build rapport with our families, and that's why we're so emphatic about encouraging them, even though we know that they can be time consuming, difficult and often frustrating, quite often they are worthwhile.
Reference:
O’Leary ST, et al. Pediatrics. 2024;doi: 10.1542/peds.2023-065483.
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