A 2-month-old girl is brought to the office for a well-child visit. The patient was born at term with no complications. She is exclusively formula fed and gaining weight well. Examination is unremarkable today. The mother is informed that several vaccinations are due at this visit. She becomes upset and mentions that her older son, who did follow a standard vaccine schedule, had a "bad reaction" to his last set of shots and had a cough for weeks. She wants to defer immunizations for her daughter at this time. The mother says, "I know you won't agree with me, but I have been reading that these reactions are actually very harmful to the immune system." Which of the following is the most appropriate response?
Show Explanatory Sources
Vaccine hesitancy is the delay or refusal of immunization. Reasons typically include safety concerns, desire to express autonomy, distrust of medicine, or ethical/religious beliefs. Some parents also believe that natural infection is benign and/or the risk of infection is too low to warrant preventive measures. However, vaccination is critical on an individual and community level to decrease the incidence and severity of vaccine-preventable illness.
The first step in approaching parents who are vaccine-hesitant is to initiate an open and nonconfrontational dialogue. The conversation should include:
relaying the shared goal of the parent and provider, which is the child's health and safety.
acknowledging the parent's concern as well as the accessibility to vast amounts of vaccine information, both evidence-based and not, that can be overwhelming and confusing.
dispelling specific misconceptions. For example, this patient's mother is concerned that vaccines can be harmful to the immune system, whereas vaccines in fact elicit an immune response to protect from future infection. In addition, some reported symptoms postvaccination (eg, prolonged cough) are often incorrectly attributed to the vaccination but are more likely secondary to a concomitant illness.
explaining the risks, benefits, and limitations of vaccinations.
In this case, the first step is to establish trust by acknowledging the parent's concern and recognizing a common goal, the well-being of the child.
(Choice B) Although proceeding with vaccination is the objective, this mother has expressed specific concerns that should be addressed first.
(Choice C) Providing a list of evidence-based resources helps educate parents and is recommended when discussing immunizations. However, active dialogue with this parent who is vaccine-hesitant should be pursued first to discuss and correct misinformation.
(Choice D) Reopening the conversation at visits after initial refusal is critical because up to half of vaccine-hesitant parents ultimately choose to vaccinate. However, every opportunity for open dialogue should be taken rather than immediately deferring the conversation to a later time.
(Choice E) Discussing the risks of natural infection is essential in addressing vaccine benefits. However, this mother may perceive her fears about vaccination to be valid if the provider does not dispel her inaccurate beliefs but instead focuses only on the risks of natural infection.
Educational objective:
The first step in approaching parents who are vaccine-hesitant is to initiate an open dialogue that begins with the shared goal of ensuring the child's health and safety. Discussion should also acknowledge parental concerns, correct misinformation, and explain the evidence-based risks and benefits of immunization.