Feb 2015

Vaccine Skeptics; How to Deal with Them

Late night comedians to potential Presidential candidates have weighed in lately on the wisdom of requiring parents to vaccinate their children against diseases such as measles.  For public health professionals, the answer is generally predictable; yes, unless there is a legitimate medical reason the child should not be vaccinated.

But that nearly automatic response fails to acknowledge the reality that some otherwise thoughtful parents don’t accept the wisdom of vaccination, either because of a distrust of medical professionals specifically or government generally, or persistent (and disproved) beliefs that vaccines may lead to autism or other medical problems.

In a recent New York Times commentary, Prof. Saad B. Omer of Emory University argued against eliminating exemptions, but in favor of tightening the requirements that must be met.

“For epidemiologists like me,” he wrote, “eliminating exemptions may seem satisfying, but it is not the wisest policy for protecting kids. Instead, we should borrow a concept from behavioral economics, and use administrative rules and procedures to ‘nudge’ parents to immunize their kids, rather than trying to castigate or penalize these parents.”  His complete commentary may be found here.

Another approach recently was offered on National Public Radio by Dr. Doug Opel, a pediatrician at Seattle Children’s Hospital and a researcher at the University of Washington, who reported on a study of more than 100 parents he and colleagues observed when it was time for their children to be vaccinated.  He videotaped parents speaking with their children’s pediatricians, he said, and the physicians took one of two approaches, one presumptive and the other collaborative.

In some cases, the doctor “simply presumed that the parent was going to be fine with the vaccines that the doctor was going to recommend.”   Other doctors invited parents to discuss their feelings about vaccines — “sort of invoking a shared decision-making approach, inviting the parent to be part of this conversation.”

When doctors assumed parents would be OK with vaccines, they were. More than 70 percent had their child vaccinated, but when physicians were more flexible and allowed for discussion, most of the parents — 83 percent — decided against vaccination.  (The complete story may be found here.

So, should we as medical professionals nudge parents by making exemptions harder to obtain, or should be perhaps just presume that parents will follow our lead, and simply “Don’t Ask, Just Tell?”

Taking yet another approach is Pediatrician Ken Haller, a colleague at Saint Louis University, who counters parents’ fears of illness from vaccines with fears of his own.  In a  recent radio interview, Haller said he responds to those  fears by saying that what he fears is that a patient of his may contract a serious – and preventable – illness because the child wasn’t properly vaccinated.  A summary of his interview may be found here.

Regardless of how we do it, since it’s clear that vaccines save lives, it’s up to all of us to do what we can to assure as many people as possible are vaccinated.  It’s better for all of us!

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