Immunizations are one of the greatest public health achievements of the last century and have had an enormous impact on the health of children. According to the Centers for Disease Control (CDC) there are currently vaccines for 25 preventable diseases, and these vaccines have prevented 3.5 million to 5 million deaths each year. However, the pandemic has brought forth increasing debate over refusal of vaccinations.
Vaccination coverage declined in 2020 with 23 million children missing out on their vaccinations, the highest number since 2009. In 2021, preliminary data from the World Health Organization showed continued disruption, but the numbers appear to be improving. While most parents accept vaccines, the increased refusal and the requests for alternative vaccine schedules indicate there are many barriers to overcome. Some parents continue to express concern about the safety and necessity of vaccines for myriad reasons.
Pediatricians, family health physicians and other healthcare providers play a major role in educating parents about vaccine safety and efficacy. Healthcare professionals are reported to be the most trusted source of vaccine information. Evidence supports that healthcare providers who demonstrate a strong commitment to vaccinations can help influence hesitant parents. There is a need for training to help them understand parental concerns and provide targeted information to help them make an informed decision. It is important to be mindful of vaccine-hesitant individuals and their individual concerns should be respected and addressed. Using a personalized approach about vaccine acceptance has proven helpful. Most parents were found to be accepting of their provider’s vaccine recommendations when they were presented as “required immunizations to maintain optimal disease prevention.”
Below are some strategies to implement when addressing vaccine hesitancy in parents.
Presumptive vs. Participatory Recommendations
Research cited by the American Academy of Pediatrics (AAP) found that pediatricians who provided a “presumptive recommendation” (informed parents that shots were due), rather than a “participatory recommendation” (asking what the parent thought about shots) were more likely to see parents accept vaccines.
Examples of Participatory Recommendations:
- “Do you want to vaccinate your child today?”
- “What do you think about vaccines?”
- “Would you like to hear about the vaccines we offer for today’s visit?”
Examples of Presumptive Recommendations:
- “Today your child is due for two vaccines. We will be giving MMR and Varicella.”
- “It’s time for an annual influenza vaccine. Your child is old enough to receive either the inactivated shot or the live nasal spray.”
The acronym “CASE” (Corroborate, About Me, Science, Explain/Advise), developed by Alison Singer, MBA, of the Autism Science Foundation, can assist providers in addressing vaccine hesitancy in parents:
- Corroborate: Acknowledge the parents’ concern and find some point on which you can agree. Set the tone for a respectful, successful talk.
- About Me: Describe what you have done to build your knowledge base and expertise.
- Science: Describe what the science says.
- Explain/Advise: Give your advice to the patient based on the science.
How providers initiate their vaccine recommendations to vaccine-hesitant parents is related to the amount of parent resistance. Also, if providers continue to pursue their original recommendation after encountering parental resistance, many parents may then agree to it.
What If Parents Refuse to Vaccinate?
If parents decline immunizations after your strong recommendation and conversation, use the following additional strategies provided by the CDC:
- Continue the conversation about vaccines during the next visit and restate your strong recommendation.
- Inform parents about clinical presentations of vaccine-preventable diseases, including early symptoms.
- Remind parents whose children are not vaccinated to call before bringing their child to the practice when the child is ill so appropriate precautions can be put in place to protect others. Explain that when scheduling an office visit for an ill child who has not received vaccines, you will need take all possible precautions to prevent contact with other patients, especially those too young to be fully vaccinated and those who have weakened immune systems.
- Consider launching a vaccine awareness campaign aligning with National Immunization Awareness Month (NIAM) in August.
- Review the resources addressing vaccine hesitancy published by the CDC, AAP and the American Academy of Family Practitioners.
Some practices have taken the position to either not accept families who decline vaccinations, or to dismiss active patients where the parents decline vaccinations. The decision to dismiss a family who refuses to vaccinate should not be made lightly. Being open, clear and consistent with the office’s policies on vaccination is essential. The attorneys of Mercado May-Skinner are available to address your questions related to dismissing patients who decline vaccinations.