A Doctor's Advice to Parents About Vaccinations
There’s been a lot of chatter in recent years about childhood vaccinations and their alleged potential to do more harm than good. Most of the cautionary tales shed more heat than light, and endanger the children they purport to protect.
Writing in the New England Journal of Medicine last week, Dr. Douglas S. Diekema published a thoughtful commentary about the struggle some parents have with the idea of vaccinations and how the medical community can encourage people to get their kids appropriately protected with vaccines.
He recounted the story of a mother who wanted to follow an “alternative” schedule versus that driven by best medical practice. The pediatrician went along, prompting the mother to believe that the recommended schedule was no better than her alternative.
Thousands of parents are like her. Some choose not to vaccinate their children at all. Some have religious or philosophical reasons, some want to spare their children from uncomfortable procedures, some just don’t believe the benefit outweighs the risk. Many have no experience with or knowledge of serious vaccine-preventable diseases like polio or measles.
But that doesn’t mean there aren’t contemporary health threats that vaccines neutralize. In 2010, California reported more than 9,000 cases of pertussis (whooping cough) — more than the state had seen since 1947. Nearly 9 in 10 involved infants younger than 6 months, a group too young to be adequately immunized and largely dependent on “herd immunity” (when vaccinating a significant portion of a population imparts protection for all members who have not developed immunity). Ten of the California infants died from the infection.
Because some parents—those with religious or strong personal beliefs—probably aren’t capable of being persuaded to vaccinate their children, whether for their own good or the good of society—Diekema focuses on the parents who question the safety of vaccines or have logistic or financial concerns.
1. Eliminate money barriers and disincentives to vaccination. Even small co-payments or fees pose substantial barriers for some families. Public health clinics are one option, but can require travel and time away from work — all disincentives to following through. “Incentives can take several forms, including reduced insurance rates, tax rebates or direct payments,” he writes.
2. Strengthen and enforce school-entry requirements. Such requirements effectively boost immunization rates for school-age children, but vary widely by state in terms of exemptions allowed. “All states allow exemptions for medical reasons, 48 for religious reasons and 20 for philosophical reasons.”
Acknowledging that eliminating exemptions for religious and personal beliefs would encounter substantial resistance, Diekema remains resolute. “The exemption process should not be easier or less costly than the vaccination process. Obtaining a religious or personal-belief exemption should at least require a visit to the physician's office, including counseling on the risks posed by remaining unvaccinated; insurance should pay for such visits.” States could require exemption requests to be signed by both parents if both are legally authorized. “Although such measures wouldn't change the stance of the most resistant parents, they would eliminate many exemptions sought because of convenience rather than conviction.”
Diekema also points out that lax enforcement of school-entry requirements communicates that vaccination is merely bureaucratic rather than a way to ensure students' safety.
3. Address misinformation about vaccines promptly and aggressively. “False or misleading information about vaccination is widely dispersed by a few influential individuals, self-described vaccine-safety advocates and some clinicians. Public health officials and professional organizations should respond swiftly to dishonest or unbalanced portrayals of vaccination.”
4. Clinicians, health-care organizations and public health departments must be persuasive. “Data and facts,” Diekema states, “no matter how strongly supportive of vaccination, will not be sufficient to compete with the opposition's emotional appeals. The use of a compelling story about a single victim of vaccine-preventable illness is far more likely than data to move an audience to action.”
This outreach, he says, is the responsibility of primary care providers. “Parents will be most receptive to considering vaccination if they believe their provider is primarily motivated by the welfare of the individual child rather than an abstract public health goal.” As we’ve said over and over, a doctor’s willingness to listen respectfully, encourage questions and respect parental concerns are essential for any professional health-care provider. Accurate information about both risks and benefits is crucial to maintaining trust, and must include a discussion of risks associated with both remaining unvaccinated and delaying certain vaccines.
5. Set an example. “We're unlikely to achieve optimal vaccination rates until health-care professionals comply with vaccine recommendations for themselves and their children. The unwillingness of many clinicians to submit to influenza vaccination each year is disgraceful, sets a poor example and gives patients reason to question the safety and efficacy of vaccines.”
We couldn’t agree more: Doctor, heal thyself.
First published on Technorati.
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