August 2016

How healthcare professionals can talk to vaccine-resistant parents.

Figure 1 is healthcare’s home-screen app.Used by more than a million healthcare professionals —including 75% of U.S. medical students — Figure 1 helps doctors and nurses around the world make smarter decisions to improve patient outcomes.

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Introduction

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The healthcare professionals of Figure 1 are on the front lines of the vaccination debate.

Effective vaccination can prevent and eradicate infectious diseases. Vaccine-preventable diseases such as measles and pertussis (whooping cough) are on the rise in the United States. This trend coincides with an increase in refusals to vaccinate.* Figure 1 aims to help healthcare professionals vaccinate as many children as possible. To do so, we surveyed our community on the strategies they use to engage vaccine-resistant parents.

Backstory

*Toward High-Reliability Vaccination Efforts in the United States Matthew M. Davis, MD, MAPP, Journal of the American Medical Association,

March 15, 2016, Vol 315, No. 11

At right, a case of diphtheria seen on Figure 1.

We asked 1,107 healthcare professionals how they talk to parents who refuse to vaccinate.

Survey Results

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Through an in-app survey of multiple-choice and short answer questions conducted during the week of August 15-19, we compiled quantitative and qualitative data on strategies. These will be shared with our community.

Discuss the risk of severe illness78%

Discuss the risk to vulnerable patients62%

Refer to evidence-based studies53%

Discuss the science of immunization51%

Explain the concept of herd immunity42%

Appeal to emotion with anecdotes16%

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How to talk to an anti-vaxxer.

Guided by the healthcare professionals in our community and in consultation with experts, we have created a five-part guide to discuss vaccination.

1. Listen. 3. Educate. 5. Keep talking.

2. Know the facts — and the fictions.

4. Negotiate.

Step 1: Listen.

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How To Talk To An Anti-Vaxxer

The first rule of talking to a parent reluctant to vaccinate: Stop talking. Understanding the parent’s concerns and ensuring they are heard is crucial.

“First of all, you have to listen to what they have to say, their fears, their beliefs, without judging: they love their child and just want the best for him/her.”

Registered Nurse

“Listen to their concerns and calmly provide information on the science behind immunizations.

Remaining calm during these discussions will go farther than if everyone gets worked up.”

Registered Nurse

“Recognize that parents are wanting the best and they are scared.“

Advanced Registered Practical Nurse

“Show empathy. Parents are fearful.“General Practitioner

“Start with asking why.... Let the parents’ concerns be heard before attempting to educate. I am always amazed with the reasons, and find people are much more willing to accept change once their concerns

are addressed with respect.”Women's Health Nurse Practitioner-Board Certified

Step 2: Know the facts — and the fictions.

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How To Talk To An Anti-Vaxxer

Read up on common concerns and be ready to discuss details the parents might be missing.

“Stand firm. Repeat the scientific evidence. Educate yourself on the anti-vax arguments and

have very specific responses to any of these mistruths that patients will throw at you. Be

prepared to accept that some people are as thick as 2 short planks and very selfish but will be straight back for help when their child is sick. And you will

be there for them without question.” General Practitioner

“Try to explain the science behind the benefits and the risks without aggressiveness. Also present the

facts of the initial anti-vax reports and why they are not reliable sources.“

Thoracic Surgeon

“Parents will often ask about specific vaccines, so it’s important to have specific answers. Just saying

‘all vaccines are good’ is not, in my experience, convincing.“

Registered Nurse

“Especially with new laws coming in I let parents know if they plan to wait to the very last minute to

vaccinate before school entry requires them, it will be not only more traumatizing to their child but will

also put them at higher risk. It's all about tone, approach, and making the parents feel like you

respect their decision as a parent.” Pediatric Nurse

Step 3: Educate.

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How To Talk To An Anti-Vaxxer

Explain herd immunity, vulnerable populations, and relevant statistics. Show what polio, measles, and diphtheria can do to a child.

“[Show] photos of the effects of the disease especially those of VERY young children & very

simple graphs/stats showing the decline and rise of certain diseases nearly wiped out by

immunizations.” Registered Nurse.

“Parents who do not immunize, from my

experience, are not interested in scientific studies. As a school RN, I educate them about the risks

associated with not being immunized and that by law, unless they are medically or religiously exempt,

they may be excluded from school. If there is an outbreak, they will be excluded from school even with an exemption. I also educate the parents on

the effects these diseases can have on their child, including death (‘yes, Mr./Ms. Yaddayadda,

meningitis can be lethal’). Sadly, even this doesn't get through to most, but we keep trying anyway.”

Registered Nurse.

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‘Individualize your teaching to the parent's level of education and don't be afraid to show pictures.’

How To Talk To An Anti-Vaxxer

Chicken pox, as seen on Figure 1. .

Measles, as seen on Figure 1. .

Rubella, as seen on Figure 1.

Step 4: Negotiate.

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How To Talk To An Anti-Vaxxer

Are there specific pain points you can minimize, perhaps with a modified schedule or different form of vaccine? Subtly underline the consequences of the decision.

“I give them the ‘walking through a firefight with no bulletproof vest’ analogy. I explain that it doesn't

mean the child will never get sick or have complications that are unforeseeable, it just means

they have the best protection that can be given. It is not perfect, but none at all has been proven to be

way more hazardous.” Registered Nurse

“We originally wanted a delayed vaccination schedule for our first child until our pedi asked what

diseases we would choose to let our baby be exposed to.”

Registered Nurse

“Our own daughter has chosen to alter the established scheduling of vaccination for our

precious, precious grandbabies. She is very well read and feels she can support her beliefs. We hang

onto the hope that she WILL have them vaccinated and always leave the discussion open in hopes of

modifying her lack of trust in traditional medicine's vaccination programs.”

Registered Nurse

Step 5: Keep talking.

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How To Talk To An Anti-Vaxxer

For everyone’s health, an ongoing conversation is better than a closed door.

“Leave the door open for parents to change their minds. They may revisit the immunization question

at next encounter. For example: ‘So I recall we discussed immunizations at our last visit. Have you had any time to investigate further or do you need

more information?’” Neonatal Nurse

“In my state it is not uncommon for families to decline vaccines. Before I attempt to discuss their

rationale I start with getting to know my clients and establish rapport. Once this has been accomplished

I then ask them why/how they have made this decision. This approach allows me to have an open

discussion that targets their individual concerns rather than making assumptions. I am usually

surprised by their answers, and can then target my teaching directly.” Registered Nurse

“It feels to me that vaccination choice has become

a symbolic struggle in parenting and as such has more emotion than sense in the argument on both

sides. As healthcare professionals we need to de-escalate the conflict and try to understand the various view points so that we can support people

in the bigger picture health issues.” Registered Nurse

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And here’s how healthcare professionals recommend you talk to vaccine-resistant parents.

How To Talk To An Anti-Vaxxer

“Open discussion of vaccination where the concerns of all parents can be addressed without anger is needed. Remember that parents want what is best for their children. The best way to protect your children is to vaccinate them.” Registered Nurse“Suggest that they talk to the school administrator and see if it can be arranged so only vaccinated kids are in their classes and that the school notify the parent if there's a vaccine-preventable illness going around so the unvaccinated child can be kept home during that incidence.” Critical Care Registered Nurse“Explain the theory of herd immunity.” Emergency Medicine Physician

“Advise parents and teachers to be vigilant for symptomatic children.” Registered Nurse

“Ensure the school has protocols on what to do with immunocompromized children who may be interacting with unimmunized children. If not, be proactive and initiate the process.“ Family Nurse Practitioner“Reinforce basic preventive methods: handwashing, covering coughs/sneezes, etc.”Physician

“Make certain your own children are current with their own vaccinations. Teach them hand hygiene. Make certain everyone in your household is up to date on vaccinations.” Registered Nurse

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Further guidance from Mark Largent, author of Vaccine: The Debate in Modern America.

How To Talk To An Anti-Vaxxer

“Lumping together vaccines like tetanus — which has nothing to do with public health — with pertussis becomes problematic, because any criticisms of the most minor vaccine becomes a criticism of all vaccines. So to be pragmatic, I would recommend helping parents understand what each individual vaccine is.” “I don’t advocate the goal of getting people to stop worrying about vaccines and to embrace them wholeheartedly. I advocate getting the parent to vaccinate their child with as many vaccines as is reasonably possible.”

“If your goal is getting as many children vaccinated as possible, throwing them out of the doctor’s office or changing the waiver law so children are no longer under any pressure at all to get vaccinated will not achieve that.”

From an interview conducted August 25, 2016. Professor Largent is an historian of science, technology and medicine and director of the Science, Technology, Environment and Public Policy Specialization (STEPPS) at Michigan State University and the author of

Vaccine: The Debate in Modern America (Johns Hopkins University Press, 2012).

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Further guidance from Mark Largent, author of Vaccine: The Debate in Modern America.

How To Talk To An Anti-Vaxxer

“California’s example — where now you can’t send your child to a publically regulated school or a licensed daycare unless they are fully vaccinated or have a medical waiver — has decreased waiver rates but generated tremendous backlash. When public health becomes a political issue, it’s decided by 50% plus one and we’re screwed. We can’t let that happen.”

“Michigan faced a similar program, and they simply made the waiver policy more cumbersome. You had to meet with a nurse and have a 15-minute conversation where you learn what precautions you will need to take with an unimmunized child. Their waiver rates dropped 50% more than California’s did.”

“Research now is looking at how to separate the truly anti-vaxx parents from those who are merely vaccine-anxious. It’s in identifying the vaccine-anxious parents and figuring out productive ways to collaborate with them that I think the most headway can be made.”