Q&A: Back-to-school visits are 'a wonderful time' to focus on vaccinations

Key takeaways:

• Back-to-school visits provide an opportunity to raise immunization rates that have fallen since the COVID-19 pandemic.
• An expert discussed how to handle conversations with vaccine-hesitant patients.

This month is one of the most notable for vaccinations in the United States.

August marks not only National Immunization Awareness Month, but also back-to-school season for many children and adolescents in the U.S. All 50 states require immunization to attend school, but each allows exemptions for medical reasons, and some also allow exemptions for religious or philosophical reasons, which have become more popular in recent years.

Healio spoke with William Schaffner, MD, a professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center, to learn more about the importance of back-to-school immunizations, how to speak with vaccine-hesitant patients and more.

Healio: Given recent outbreaks of diseases like measles, how important are vaccinations, particularly among children and adolescents?

Schaffner: Well-documented reductions in routine childhood immunizations occurred during the pandemic period, when all of us sheltered at home and did not go to the doctor's office. The CDC clearly documented a dip in routine immunizations. This is a very good opportunity for PCPs to review the vaccination status of all their patients before the new school year. That will also facilitate many of the children attending school, because schools all over the country have immunization requirements, and so you don't want children to get hung up because they haven't completed one or more immunization requirements for attendance at school.

Many childhood diseases have been virtually eliminated through vaccination. We must maintain extremely high levels of vaccination protection of our children to preserve this elimination status. That's because these diseases continue to occur in other countries, and of course, we know that we're a global village, and we're no more than 24 hours away from “over there.” What's over there can be over here, right in the middle of our country, within 24 hours. To maintain the protection of all of the children here in the United States and all of our communities, we need to keep vaccination levels very high. This is a great opportunity, preschool, to check those immunization levels and get all of those children who might have skipped one or more immunizations because of the pandemic, to get them well immunized.

Healio: Are lower immunization rates something that primary care providers should be concerned about?

Schaffner: The short answer, of course, is yes. PCPs have been well informed by the American Academy of Pediatrics, the American Academy of Family Physicians and the CDC that immunization rates have dipped because of the pandemic, and we have to play catch up now. And, of course, there are increasing numbers of parents who have expressed — shall we say — a need for more information about vaccines. There's clear vaccine hesitancy, vaccine skepticism out there, and these are all issues that I think PCPs taking care of children all the way through adolescence, will encounter this summer in the preschool environment.

Healio: How should PCPs handle conversations with vaccine-hesitant patients?

Schaffner: First, I will say what not to do, and I think PCPs all know this: don't express alarm, don't diss the patient in any way or make them feel uncomfortable or inappropriate for having asked the question.

Acknowledge that you have heard the patient and that these sorts of questions are actually rather common, and you have to reflect that back to the patient. That puts the patient at ease and then the conversation can continue. Ask the patient what particularly troubles them, and try to provide some general information that would provide a response to the patient's concern.

Information, the psychologists have told us, is fundamental, but it's rarely sufficient to change behavior. So, you have to go on to the next step: you have to influence what the psychologists call the patient's “attitude.” It's not how they think about a problem, it's how they feel about a problem. Information goes to the brain. Feelings have to do with the heart and the gut, if you will. And certainly, when I, as an internist, deal with patients, I immediately become very self-referential. I say, “You know, I've been vaccinated, and so [has] my wife.” So what I'm doing in that context, those words, are trying to make vaccination the social norm. The goal is to reduce the anxiety and make people feel comfortable with getting vaccinated. That, more than statistics, will play a role.

And then you have to be able to accept the patient saying they will think about it. Accept that with a smile and promise the patient you will talk about it again at their next visit, so you leave the door open to further conversation. You have to recognize the fact that you're not going to be successful each and every time, but working at it over time.

It takes longer in real life, and parents will have more questions, and you keep responding in a positive, comforting fashion. This was a big shock 10 years ago, but pediatricians are more used to it now.

It's not easy. Takes time. Takes energy, commitment. And you have to keep at it and do it with a smile, never disparaging. Don't ever get grumpy.

Healio: What is the take-home message for PCPs?

Schaffner: The pre-school checkups for children and adolescents are a wonderful time to focus on immunizations, as well as all the other issues that come up. It offers an opportunity to get immunization levels up again within your practice, the way you want them to be and the way it's set for your patients and the community in which you practice.