Today in the chart

4 Tips for Talking to Patients About Vaccine Hesitancy

When debating a contentious issue, forcefully explaining your point of view without listening to what your opponent has to say rarely works, and heated conversations about vaccines are no different

Forcefully explaining your point of view without listening to what another has to say is rarely effective when debating a contentious issue. Unfortunately, heated conversations about vaccines are no different, even between a provider and patient. 

Immunizing one’s child didn’t always fall under the umbrella of “hot topics,” but since 2001, the number of people who have not received vaccines for preventable diseases has quadrupled, according to an October 2018 report from the Centers for Disease Control and Prevention. Since then, the U.S. has seen its worst measles outbreak in decades, with 1,182 reported cases. Three-quarters of these incidents can be linked to outbreaks among Orthodox Jewish communities with large unvaccinated populations in New York State and New York City.

There’s no single reason why misinformation around vaccines has spread so widely among this group. However, Blima Marcus, DNP, RN, ANP-BC, OCN, an oncology nurse practitioner, and an Orthodox Jew herself, says one organization is a source of misinformation. PEACH (Parents Educating and Advocating for Children’s Health) was particularly effective in spreading its lies. It used pamphlets and teleconferences packed with “cherrypicked evidence, anecdotal data and straight-up lies” that no one was actively contradicting, Marcus explains.

Marcus, featured in The New Yorker, Washington Post, Wall Street Journal, and more, has become the face of the movement to speak with sensitivity to anti-vax parents. This turned into her cause when the outbreak started sending some of the youngest members of her community to the ICU, and moms began approaching her as someone with medical expertise whom they could trust.

After seeing their fear and desire to do what’s best for their children day after day, Marcus started a nonprofit called EMES Initiative: Engaging in Medical Education with Sensitivity. (Emes means “truth” in Hebrew.) Along with an interdisciplinary team of nurses and physicians, she holds workshops to educate providers about talking to vaccine-hesitant patients and offers tools they can hand out to these worried parents.

Marcus, an adjunct professor at and graduate of Hunter College, sat down with Florence Health to share tips with fellow clinicians to help them navigate these challenging and often frustrating conversations.

Listen to your patient’s stories and be empathetic

This is perhaps the most important, Marcus says. “Validate their experience — if someone tells you they heard about a child who developed epilepsy after a vaccine, don’t say, ‘That never happened,’” she explains. “You can say, ‘That sounds scary,’ and then ask about the timing of the shot.” After they respond, you can introduce relevant data about vaccines triggering bad reactions.

If you can, call upon your own experience as a parent

Marcus often continues the above conversation by talking about the research she’s done on her own because she has two children. In the past, she’s told patients, “I see why you feel that way, but I looked at the research for my own kids, and I found out there are 600,000 studies that show vaccines are safe. That made me feel reassured.”

Counteract concerns with easy-to-understand facts

In Marcus’ experience, some of the most contentious vaccines are:

  • MMR vaccine because of its debunked connection to autism.
  • DTaP vaccine because of its debunked relation to Sudden Infant Death Syndrome (SIDS).
  • Hepatitis B vaccine because it’s given at birth and prevents a sexually transmitted disease.

For each of these scenarios, Marcus explains that:

  • Close to 90 percent of the world’s population vaccinates, but only 2.5 percent of the world population has autism. If there were a correlation, the number of people with autism would be much higher.
  • Millions of babies born yearly receive three doses of the DTaP vaccine before they reach six months. SIDS affects thousands of babies less than 12 months old, so it comes down to the probability that a few of these deaths will occur within a few days after receiving the vaccine.
  • Mothers can pass on hepatitis B to their babies, and up to 90 percent of people with hep B do not know they have the disease. Babies contracting hep B are between 15 and 25 percent more likely to die prematurely from liver disease.

Before you go on a tirade of listing data points, know that “not all people want more data,” Marcus stresses. “Some just want to be heard.”

Understand that these conversations take time

Marcus says research indicates that a successful conversation with a vaccine-hesitant parent usually takes about 20 minutes. And as clinicians know, there’s not usually this much time to talk during a well-baby visit or another kind of check-up. In these situations, Marcus says you can tell them you’d be happy to continue the conversation another time or refer them to EMES via email, 

Involve Vaccine Task Force

(The following is a sample hand-out from EMES.)

“At this time, Vaccine Task Force has a volunteer corps of 30 to 50 providers who are happy to talk to parents any time about vaccine concerns. You can tell them to email and explain their specific worries. A provider with a specialty relevant to their concerns will respond. Clinicians can also email EMES to request helpful resources — such as tables of easy-to-read vaccine data to give patients — and information about provider training.”

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