Change the equation: The risk of vaccines is greater than the risk of disease

Mark H. Sawyer, MD

One can’t underestimate the challenge that pediatricians are facing when it comes to the antivaccination movement.

“The amount of information and disinformation that’s circulating has created a climate where this is a big problem and one that’s not easily solved,” says Mark H. Sawyer, MD, professor of Pediatrics at the University of California San Diego (UCSD) School of Medicine and a pediatric infectious diseases specialist at Rady Children’s Hospital-San Diego. “I think that one of the most important ingredients for pediatricians to keep in mind is to enter these discussions with both respect and empathy for the family.”

The families that question or refuse vaccines are, by and large, not on the fringes of society. Rather, they’ve gotten hold of information that makes them anxious about vaccines in particular and, based on the information, they’ve reached the conclusion that the risk of the vaccine is greater than the risk of disease, according to Sawyer.

“First of all, you need to find out what information families are reacting to that’s making them hesitant-whether it’s specific issues they’re concerned about or it’s a more generic feeling that vaccines are just bad,” he says.

That’s where the hard work starts, according to Sawyer. “You can’t simply say that. You can’t quote a bunch of statistics that would illustrate that because these people are pretty invested in their decision-making up to the point that you’re seeing them, and it’s not something that you’re going to turn around necessarily quickly or with any particular set of facts,” he says. “So, you sort of have to feel your way with each patient interaction for the kind of information that will at least cause these parents to rethink their decision, eventually.”

Role of the pediatrician

It is important to emphasize that as a pediatrician you’re recommending vaccines because you have the same goal as parents do: to maximize the health of their children and protect them as much as possible.

“That sometimes can be done by sharing personal stories about vaccine preventable disease that you have seen as a pediatrician, which makes it more real to families. It’s not something that is rare or unusual,” Sawyer says. “Sometimes it’s effective to share that your own children or your extended family’s children are all vaccinated as an illustration that you are putting your money where your mouth is and have come to the conclusion that the risk of the disease is much greater than the risk of the vaccine.”

Another option that can be effective: connect parents to other parents who have had children suffer from vaccine-preventable diseases. This can be done virtually, as there are such videos on the Internet, or with parents in the practice who might want to share their stories. For some people, the science will work. For others, a more personal approach might help parents rethink the equation between vaccine safety and disease risk.

“Those are guidelines or road maps, but the trouble is there’s not one solution for all families. It depends on what their concern is, what their experiences are, what your relationship with them is, and how powerful the network they’re circulating in is to immunize or not to immunize,” Sawyer says.

Still, not every family will agree to vaccinating their children. That can be difficult for pediatricians who have put in the time and effort.

“I’m well aware of the evolution of the American Academy of Pediatrics’ recommendations about whether to continue working with these families or consider not working with these families and refer them to some other provider,” Sawyer says. “I am in the camp of saying that we really should try and continue to work with these families. The only hope of them eventually immunizing their children is to have a long-standing and supportive relationship with a provider who can keep discussing the issues with them. I don’t think it really serves either the child or community in general to get frustrated and say I’m not going to deal with these families anymore.”

Sawyer says he appreciates physicians’ concerns about having unimmunized children in their offices. Solutions to that dilemma include having unimmunized patients wait in a separate place in the waiting room; having them come in at the end of the day; or enhancing pediatricians’ screening of them when they come into the office to make sure they’re not symptomatic with something that might be a vaccine-preventable disease.

References:

1. Paules CI, Marston HD, Fauci AS. Measles in 2019-going backward. N Engl J Med. 2019;380(23):2185-2187. Available at: https://www.nejm.org/doi/full/10.1056/NEJMp1905099. Accessed June 21, 2019.