Immunization Conversations -

A Nonjudgmental Approach

Parents have been bombarded for many years with a steady

diet of scare tactics and misinformation !

“…a mother came up to me last night here in Tampa, FL, after the debate. She told me her little daughter took that vaccine, that injection, and she suffered from mental retardation thereafter. It can have very dangerous side effects. The mother was crying when she came up to me last night…this is a very real concern and people have to draw their own conclusions. There are no second chances for these little girls if there are any dangerous consequences for their bodies …”

(Michele Bachmann, Congresswoman from Minnesota, potential candidate for President of the United States, regarding use of Gardisil vaccine)

Facts regarding HPV vaccines:

The vaccines are exceedingly safe, studies show. There have been very few reports of serious problems from them, none proven. It is simply a lie to say they can cause retardation.

The American Academy of Pediatrics issued a statement in response to Bachmann's comments. "There is absolutely no scientific validity to this statement," according to AAP President Dr. O. Marion Burton. "Since the vaccine has been introduced, more than 35 million doses have been administered, and it has an excellent safety record."

The Refusal Continuum

VHPAccepters

Refusers

Accepters: Agree with or do not question vaccination

Vaccine-Hesitant Parents (VHP): Accept vaccination but have significant concerns

Late Vaccinators: Either purposely delay vaccinating or choose only some vaccines

Refusers: Completely reject vaccinations

The Refusal Continuum

Accepters: Agree with or do not question vaccination

Vaccine-Hesitant Parents (VHP): Accept vaccination but have significant concerns

Late Vaccinators: Either purposely delay vaccinating or choose only some vaccines

Refusers: Completely reject vaccinations

The Refusal Continuum

Build a Trusting Relationship

Parents view the risks and benefits as intangible, therefore they may decide

based on who they trust

DO’S AND DON’TS

Don’t over-science parents – all they hear is “blah blah blah”

Don’t Threaten

… and don’t be judgmental

Things You Can Do

• Try to avoid “affective bias”– don’t tell “stories” (Crucial Conversations)

• Take the time to review the risks and benefits in a non-judgmental approach and remember to avoid threats

– legal: please sign on the dotted line– guilt: placing your child and others at risk for disease and death– patronizing: do as I say because I know best

• Investigate and understand the true parental fears and apprehension– seek first to understand (Crucial Conversations)

• Don’t underestimate the power of the anecdote– tell your own true story

Radical Acceptance

Be pleased and supportive of any movement in the right direction

It is not a failure if you: a. Don’t immunize the childb. Lose a family from the practice – it happens in spite of our best intentions

Interesting Reading

1. Benin, et al. Qualitative Analysis of Mother’s Decision-Making About Vaccines for Infants: The Importance of Trust. Pediatrics, 2006; 117,(5).

2. Lantos, et al. Controversies in Vaccine Mandates. Curr Probl Pediatr Adolesc Health Care, March 2010.