Know your audience, acknowledge specific concerns

Mark R. Schleiss, MD

Vaccine-hesitant parents are very different from frank vaccine refusers, according to Mark R. Schleiss, MD, professor of Pediatrics and holder of the American Legion and Auxiliary Heart Research Foundation Endowed Chair of Pediatric Infectious Diseases, University of Minnesota Medical School, Minneapolis.

“The vaccine-hesitant parent, just as the name implies, is not necessarily going to refuse vaccines for their children but they feel overwhelmed and misinformed. They’re trying to sift through a lot of information and do what’s best for their child. Their hesitancy, I think, comes from the massive amounts of information that are put out there-some of it factual; some of it not factual at all,” he says.

Schleiss recommends pediatricians set aside extra time to speak with vaccine-hesitant parents-acknowledging their concerns and trying to answer their questions.

“I think for a long time we’ve been trying to convince them with dogmatic, factual statements about vaccine safety. All of that is true and seems reasonable but doesn’t seem to be working,” he says. “I’ve drifted in recent years away from trying to convince people with data and more toward trying to be an open-ended questioner.”

In essence, Schleiss’s mission is to uncover what exactly these parents are worried about, and he tries to address the specific concerns. “With time and dialogue, we really do have a good chance of winning over the vaccine-hesitant parent,” he says.

In some cases, it means meeting the vaccine-hesitant parent somewhere in the middle.

“What I’ve tried to do is be more open to alternative schedules, if it means that’s the only way a child will get immunized. I don’t endorse alternative schedules. I state the facts about why the vaccine schedule is the way it is. Then I come to a ‘let’s agree to disagree’ moment with the family,” Schleiss says.

Vaccine-hesitant vs vaccine-refusing

The frank refusers are a different story. Pediatricians struggle with what to do with parents who are dead-set against vaccinating their children. “Do we retain those families in our practice, and by retaining those families in our practice, do we put our other patients at risk because these children come in for sick visits and potentially expose our vulnerable patients?” he asks. “I’ve gone back and forth on that question in recent years.”

Schleiss says he shares his concerns with parents about continuing to care for their unvaccinated children and says that although he cannot endorse their antivaccine stance, he worries about who might care for the children should they get life-threatening, vaccine-preventable infections. So, he’ll often continue to care for the child.

“I like to believe that even the frank vaccine-refusing parents will, with the establishment of rapport over time, begin to at least open up to potentially some vaccines, but they’re much tougher,” he says. “The overarching message I offer from my experience is that you really aren’t going to change these parents with facts. At the end of the day, these refusals are not really related to science or factual information. There is some other deeper element. I think it’s complex. I think there is an evolving and constantly changing distrust of people in authority positions, and the lack of trust in scientists is at the top of that list.”

What pediatricians can do

Pediatricians and others have to be part of an anti–antivaccination movement, aimed at reversing propaganda-much of which has been disproved but continues to live online.

“You don’t have time in the office to engage in a polemic on all these issues, and if the process evolves toward that of an argument or debate, you’re always going to lose. That drives patients away,” Schleiss says. “I do like to point out some simple truths that are uncontroverted, such as the fact that Andrew Wakefield (a leader in the antivaccine movement) attempted to publish fraudulent, fabricated information that was eventually retracted from the medical journal Lancet where it originally appeared.¹ We have all the research that we’re ever going to need about vaccines in practice. They save lives. My bigger strategy is to try to establish rapport and to try to be available for questions.”

For those parents whose children remain under Schleiss’s care and whose children get vaccine-preventable illnesses because of the family’s antivaccine stance, Schleiss says it does not do any good to say, “I told you so.”

Parents know that their refusal to vaccinate their children led to their illness, he says. He’ll care for the children without bringing up the subject until after the child gets well. Then, Schleiss says, he’ll continue to try to build rapport, hoping the experience alone will have opened thevparents’ eyes.