I wrote 33 pediatricians an e-mail asking what they would say, while in line for coffee, to the parent of a newborn when asked if they “believed in vaccines.” I wrote the e-mail not as a gimmick or a way to frame the issue of vaccine hesitancy, but because this happened to me. Rather, this happens to me. Often. When a new father asked me this question while carrying his newborn baby 2 weeks ago, I told him what I thought. I then ruminated about my response for 24+ hours and wrote a group of colleagues. How do we talk with parents we don’t know, outside of the exam room, to help them understand why we feel so strongly about protecting children with vaccines?
I’m not a believer in scripts. I’m not attempting to suggest there is one, 2 minute segment for every family that will help. I wanted to hear what these expert pediatricians would say to get a sense of their collective insight. I wanted you to see it, as well. I want to be really good at my job as a pediatrician when helping families understand the science, the evidence, and the emotion behind raising healthy kids and preventing illness with vaccines.
But I also really want families to understand why pediatricians work so hard to vaccinate children. I don’t want to increase the divide between those parents who are worried or skeptical of the possible harms of immunization, and those parents, doctors, and experts and who believe in the benefits. Rather, I want to regain our similarities.
We are all so similar.
We all want to do what is right for our children. That’s why everyone is so nuts about this. Simply stated, we all care immensely.
This was confirmed when I wrote docs from all parts of the US. I got over 20 responses.
I’ve arranged these pediatricians’ thoughts based on how I experienced their comments:
These thoughts are not mutually exclusive; you’ll hear evidence in the emotional comments, experience in the evidenced ones, and emotion in the experienced ones. Today’s post includes responses that felt emotional.
As I said in the video, it isn’t just parents who are emotional about vaccines. Read the comments to that post and you’ll see—some 30+ comments, mostly written by pediatricians, full of energy, data, and emotion. Pediatricians (and scientists/public health experts) are ultimately responsible for improving the way families understand immunizations. So this is weighty.
Most of these doctors wrote me about listening more than about talking. But here’s some of what they said:
Dr David Hill, a pediatrician in North Carolina wrote:
Boy is this an issue on all of our minds! For me this question has particular poignancy, as we all watched our partner’s (a pediatrician) 22-year-old daughter die of H1N1 last year. To see her face-down on a ventilator, bloated and pale and then to have a parent tell me, as one did last week, ‘Everyone knows the flu vaccine causes just as much disease as it prevents.’
Gulp. His response to that parent’s viewpoint:
Screaming seems inadequate.
The most effective [technique in talking with families] had nothing to do with science. It was all emotion (cue Jenny McCarthy’s playbook here)–’I vaccinate myself and my family to protect them. I wouldn’t do anything differently for your child.’
Of course, nothing works 100% of the time, but I can honestly say that this message does work more effectively than all the rest, and yes, it takes less than 2 minutes.
Dr Natasha Burgert helps define the scope:
The decision to vaccinate or not to vaccinate is far too important to make based on a “bestseller” or a TV special.
Dr Ed Marcuse, a pediatrician in Seattle:
I don’t have an elevator speech. My objective is not to sell immunization, but to prompt [discussing] the decision not to vaccinate.
Dr Evelyn Hsu, a gastroenterologist, now specializing in liver disease and transplants:
It’s so nuts. I like to describe vaccines as invisible helmets for our children. Given the choice, it is the best way to protect them from unexpected danger. I’ve read about and have witnessed the power of the vaccine against Hepatitis B, one of the most infectious viruses out there. Trust me, there are plenty of Hepatitis B viremic [contagious] kids out there–most that can’t yet be treated, and we just cross our fingers and hope that those around them are appropriately protected.
Pediatricians can feel frustrated with the ongoing task of discussing immunization and vaccine science in the exam room. It’s certainly our job, but it can be arduous. It’s difficult to have to defend science against anecdote. Emotion usually trumps the numbers. Which takes me back to something Dr Hill wrote about:
It’s said doctors crash three times as many airplanes as other private pilots. Why? Because we figure what we do is so hard anything else must be easy by comparison. Likewise it’s the most educated parents who think they can skim the Internet for a half hour and say, “I’ve done some research.” Whenever I hear this I’m dying to shout, “No, I’ve done tissue cultures, run gels, and crunched data. That’s research! You read some [stuff] online, okay?” The immune system is complex enough for doctors. For a lay person, even a very smart one, it’s like learning to fly an airliner. The principles seem simple enough, but what angle do you want the flaps at if you’re landing in Denver with a little too much fuel on board in a 15-knot crosswind on the southeastern approach? The difference is we assume the pilot’s interests are aligned with ours: to land safely. The educated public is skeptical of our motivations, so they figure maybe they’d better grab the stick and land this bird themselves.
Skepticism runs deep in the public. I often hear claims that pediatricians give vaccines to make money. Not true, in any of my experience and teaching. And in many parts of the country, pediatric offices lose money giving shots (it’s expensive to order, stock, refrigerate, give, and document vaccines). But anti-vaccination groups go to great lengths to confuse the public on the intention of pediatricians. With recent ads this month running in movie theaters warning against the risks of flu shots because of thimerisol (I just can’t include a link to these ads or the company who made them), we are not safe from discussion about vaccines, even while chomping on popcorn before the movie. This is everywhere.
Doctors think and worry about this out of the office, too. Dr Hsu describes feeling worried and frustrated when children aren’t protected:
[I feel] the same way I would feel when a non-helmeted kid gets hurt on his bike.
Pediatricians see children with vaccine preventable illness as missed opportunities. It can be very emotional. And the memory of an ill children lingers. I also think pediatricians get emotional partly because of the daily reminders in their work.
Dr Doug Opel a bioethicist, pediatrician, and father says:
I just came from the hospital where we have several kids hospitalized with whooping cough, some so severe they can’t even breath on their own. To me it’s just so tragic seeing these babies motionless on the hospital bed with a tube down their throat, IV’s everywhere. I have my own kids and just can’t imagine what it’d be like to see them like that…struggling to breathe and in pain.
I would make the case that a choice not to get vaccines is not a risk free choice. Rather, it’s a choice to take a different and far more serious risk.
2 minutes. Tight territory for 2 generations of work spent eliminating deadly childhood illnesses. Almost too short a time to change an opinion. I’m going to take a lesson from the antivax warriors…Call it advocacy for those who can’t speak for themselves:
Your daughter has the privilege of being born into the world at a time when deadly communicable diseases of infancy are effectively unheard of. Diseases that at one time could have left this precious baby blind, deaf and retarded are now found only in textbooks…As this baby’s mother you have the sole responsibility to protect her and keep her out of harm’s way. Your baby can’t make the decision. You have to do it for her.
Dr Kronman, a pediatrician and fellow in infectious disease at the Children’s Hospital Of Philadelphia:
I’ve been mulling this over. In fact, two nights ago it kept me up a little bit (which nothing does, other than my daughter’s cries),
He continued with a list of evidence (which will be up in the evidence section). But also said this:
Vaccines DO have some rare side effects. The chances, on an individual level, of having one of the truly significant side effects are FAR LESS than the chances of having a car accident while driving to the office to discuss these things. They are FAR LESS than the odds of being struck by lightning in your lifetime. Bad things happen in this world, and the odds of having one of those bad things happen to you are HIGHER than the odds of a bad thing happening from a vaccine. So the very process of existence in our society carries more risk.
Dr Alanna Levine, a general pediatrician in New York wrote:
One of my ‘family activities’ this weekend was taking my kindergartner to a birthday party where I was approached by one of the moms in his class. She had been to my website and saw that I was emphatically pro-vaccine and asked me about it because she ‘gave her kids the vaccines in the hospital and then not again until 15 months so she would only have to give them the bare minimum’. When I asked her what she was afraid of, she replied ‘It just seems like too much. I breastfed, I let my kids crawl on the floor and eat dirt. I figured that was enough’ She seemed very proud of her decision and I of course could not resist the urge to talk her ear off for a good 20 minutes (I far exceeded the 2 minutes you proposed in your question!). I proudly explained to her that I too breastfed my kids and didn’t shield them from dirt, but that I also vaccinated them and that is what I recommend to my patients. Today I got an email from her about the class Thanksgiving party and at the end she added a PS that read ‘Thank you also for your honesty and candor about vaccinations. Living where we do it must be so hard to get your point across. And yes.. in the end I guess we are lucky nothing happened to our kids.’
Dr Natasha Burgert, a general pediatrician in Missouri said,
I do believe in vaccines. What I believe in even more, however, is my responsibility as a pediatrician to partner with a family to make this decision easier. I know choosing to vaccinate is a very emotional subject and is hotly debated in many families. But, this is not a war.
What do you think? Tell me, and then return for the “evidenced” and “experienced” portions of their (and others’) responses later this week…