Pediatricians encouraged to reframe vaccines to help reverse flagging rates
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ANAHEIM, Calif. — It may be necessary to reframe vaccines to help reverse a downward trend in the rate of routine childhood immunizations, a speaker said at the AAP National Conference & Exhibition.
Data has shown a troubling decline in the rate of pediatric vaccinations during the pandemic, with national vaccine coverage among U.S. kindergarteners falling from 95% to lower than 94%.
In a study presented at the meeting, Kimberly Giuliano, MD, chair of primary care pediatrics at the Cleveland Clinic Lerner College of Medicine, and colleagues found that there was a 10.4-percentage point increase in the Childhood Immunization Series Combo-10 (CIS-10) rate in a 29-practice primary care network in Cleveland from 2015 to 2020, but a 3.5-percentage point decrease from 69.4% in 2020 to 66.9% in 2021.
The CIS-10 rate measures the percentage of children aged 2 years who have received all vaccinations in the combination 10 set, which includes 10 routine vaccines. The rates in the network in 2015 and 2016 were stagnant at 59% and 58.2%, respectively, before the implementation of a 12-week training session that “focused on team integration and leveraging technology to manage primary care panels outside of routine office visits” and provided primary care teams “with access to [electronic health record] integrated registries and dashboards to identify patients with care gaps.” Practices also reached out to patients electronically or over the phone.
Something else that could assist physicians in communicating the importance of childhood vaccines with patients or parents is reframing the typical conversation around vaccination, according to Julie Sweetland, PhD, a sociolinguist and senior advisor at the Washington, D.C.-based nonprofit FrameWorks Institute.
In a plenary address delivered at the conference, Sweetland said her organization was “not happy to see the conversation on vaccines go vitriolic” — which occurred even before COVID-19.
“We saw the conversation going in the wrong direction,” Sweetland said. “But we were happy when the AAP approached us to say, Can we figure out how to change this conversation?”
Framing, Sweetland said, encompasses “what to emphasize, how to explain it, and what we leave unsaid” when ideas are discussed.
“The science of framing can be helpful in your one-on-one clinical conversations where you're counseling families to get their family vaccinated,” Sweetland said. “But our project didn't deal with that. Our project is about changing the cultural surround sound on vaccinations, thinking about how you frame issues when you are authoring an op-ed, leading a Twitter chat, testifying in front of a legislative committee, or even just showing up at a dinner party and offering your perspective.”
Sweetland encouraged pediatricians to explain vaccines as “instructions” for children’s immune systems that serve as proactive measures to set conditions for good health through a comparison to something else taught in childhood.
“[What] helps to make this realistic is comparing gaining immunity to the process of gaining literacy,” Sweetland said. “When we used this metaphor, we tapped into people's beliefs that the ability to read benefits both the individual who can read and society.”
Sweetland also suggested emphasizing the importance of “community immunity” and showing a wide-angle view of disparities in vaccine uptake.
A full report on the institute’s findings will be published in November, she added.
References:
Giuliano K, et al. Maintaining immunization rates through the pandemic of hesitancy. Presented at: AAP National Conference & Exhibition; Oct. 7-11, 2022; Anaheim, Calif.
Sweetland J, et al. Framing immunizations: How to move the needle on vaccine acceptance. Presented at: AAP National Conference & Exhibition; Oct. 7-11, 2022; Anaheim, Calif.