Speak from the heart about vaccines

Mark R. Schleiss, MD

Most humans are not moved by data. “You can read a statistic, and it’s just a statistic,” says John V. Williams, MD, professor of Pediatrics, chief, Division of Pediatric Infectious Diseases, and Henry L. Hillman Endowed Chair in Pediatric Immunology at the University of Pittsburgh Medical Center (UPMC) Children’s Hospital of Pittsburgh, Pennsylvania.

So, when Williams talks with vaccine-hesitant or opposed parents, he’ll often talk about what he has seen as a pediatrician and done as a parent. He’ll share stories such as this one of suffering and preventable mortality.

Williams saw a child a few years ago. The parents had 3 children. The older boys were both vaccinated, but when the “pro-life” family heard that vaccines were made of aborted fetuses, they questioned whether they should vaccinate their youngest daughter. The mother asked her pediatrician at the time about what she had heard. Instead of explaining to the mother that it wasn’t true and educating her about vaccines, the pediatrician responded with a simple “I don’t know,” according to Williams. As a result, the mother decided to put off the vaccinations until the child turned a year old.

“One week shy of her first birthday, that little girl got bacterial meningitis, a vaccine-preventable form,” Williams says. “Fortunately, she did really well. She lost hearing in one ear but otherwise it was a good outcome. The mother became a very passionate advocate for vaccines.”

The story represents a missed opportunity to move parents who were misinformed to vaccinate their children, but it also is an opportunity to educate others who might be on the fence about vaccines.

Williams doesn’t shy away from making the issue of vaccines a personal one as well.

“I explain that I have 4 kids, and they’ve all gotten their vaccines. They’ve even taken part in vaccine trials. That’s how strongly I feel,” he says. “Families often say, ‘Hmmm. If you do it for your kids, maybe it’s not so bad.’”

He’ll also share the triumphs, solely from vaccines. “We see a lot less bacterial meningitis than we did when I was a young doctor 25 years ago. The vaccine is the only reason for the dramatic decline in bacterial meningitis. Thirty years ago, I knew people who had bacterial meningitis as children-it was that common. It’s not now. Most people under age 40 don’t know anybody-they don’t have a neighbor or a family member-who had bacterial meningitis as a child,” he says.

People forget these diseases exist. So, pediatricians need to remind people that lots of these germs are still around.

“The germs that cause bacterial meningitis still live in a half to two-thirds of kids’ noses. The reason there is no meningitis is not because the bacteria are gone. They’re not. And they still cause ear infections and sinus infections. Rather, what’s keeping kids safe is the vaccine. It’s preventing the germs from invading,” Williams says. “Maybe vaccine-hesitant people are aware of tetanus and that it remains a risk, but I think they believe a lot of the other germs are gone. Some are gone: Smallpox is gone from the world. Polio is gone from the Western Hemisphere. But many of these germs are still around right here in our country- right here in our kids’ noses.”

How to address hesitancy

For parents who argue vaccines aren’t natural, Williams stresses that death from infection in childhood is natural. Until 150 years ago, childhood mortality was 20% before age 5 years, according to Williams. Parents, in this case, might choose vaccines to combat what’s natural and deadly.

The conversations can be long and arduous-especially for pediatricians trying to see a patient every 15 minutes.

“I’ve personally cared for many children who suffered and even died from vaccine-preventable infections and yet I feel sometimes like I just don’t want to go there and have that conversation,” he says. “But we need to go there.”

Williams says he often schedules time just for the conversation, as a separate visit. He says it helps to stay focused on the topic and this is more efficient than trying to tackle the talk during a regular pediatric appointment.

“This is true for almost any health behavior-smoking cessation, quitting alcohol, exercising more. Everybody knows they should be doing these things, but if the doctor thinks it’s important enough to talk about, that does move people. It is important for physicians to realize that they may not change that family’s mind today, but if they discuss it they are helping move that family toward acceptance,” Williams says.