Working with vaccine-hesitant parents: an update

Question 1

What are the 5 CPS recommended ways to work with vaccine hesitant parents?

Answer 1

1. Understand the key role that sound vaccine advice from a health care provider can play in parental decision-making, and do not dismiss vaccine refusers from your practice
2. Use presumptive and motivational interviewing techniques to understand a parent’s specific vaccine concerns
3. Use simple, clear language to present evidence of disease risks and vaccine benefits, fairly and accurately
   - Healthy non-immunized children are often the populations most affected during outbreaks because of wider social networks compared with many adults
   - “Framing” - choose one non-equivalent outcome over another (positive gains vs negative losses)
4. Address pain head on
5. Community protection (herd immunity) does not guarantee personal protection
   - doesn’t exist for tetanus
   - Taking a “wait and see” approach puts children at risk of harm

Question 2

What % of parents ensure children receive all routine immunizations?

Answer 2

> 90%

Question 3

What % of patients never change mind to immunize their children?

Answer 3

<2% estimate in Ontario

Question 4

Of the children who don’t get immunizations:

• is the rate of medical exemption increasing or decreasing?
• is the rate of nonmedical exemption increasing or decreasing?

Answer 4

According to an Ontario study on measles:

• exemption from measles-containing vaccine remained stable (<2.5%)
• rate of nonmedical exemptions for school children have risen
• medical exemption rate declined

Question 5

What is the “physician checklist” for vaccine hesitancy?

Answer 5

Physician approach to vaccine hesitancy
• never dismiss a child from practice
• set aside extra time to counsel vaccine-hesitant parents
• identify specific parent concerns and make a list
• be nonjudgemental and non-confrontational
• start with assuming that child will be vaccinated as needed
• Discuss benefits of vaccines and risks of vaccine-preventable diseases and vaccines
• validate parental concerns and correct misconceptions
• frame data clearly and positively

When discussing risks of vaccine-preventable diseases
• tell compelling stories
• ask parents who have been spared from serious childhood diseases whether they want same protection for child
• remind parents that some complications from diseases are serious and untreatable

When addressing community protection:
• current levels of vaccine uptake are not high enough to prevent all vaccine-preventable diseases
• point out that waiting for an outbreak before vaccinating a child is often too late to ensure protection
• stress personal responsibility: not vaccinating puts vulnerable people at risk