“Celebrities are rarely trained in the ability to discern and critique the scientific literature, and they are not often expert in epidemiology, immunology, or toxicology.”
It is important that public health officials take note of the study findings when designing vaccine information media, they added.
“Those who design public health efforts to provide evidence-based information must recognize that different strategies may be required to reach some groups of parents who are currently using other information sources. In particular, because the parents of many of today's infants are more facile with electronic means of communication and social networking websites, newer methods of promulgation should be explored.”
One promising communication strategy may be to target parents who have voiced concerns about vaccine safety with a comprehensive information packet and vaccine information statements before or even at the first vaccination visit, according to a study reported in the same issue of Pediatrics by Kirsten S. Vannice of the U.S. Department of Health and Human Services and her colleagues.
In that study, the investigators provided 272 mothers who had indicated concerns about vaccine safety with a new vaccine-information pamphlet and Vaccine Information Statements from the Centers for Disease Control and Prevention at one of three time points (prenatal visit, 1-week post partum well child visit, or 2-month vaccine visit), and used written surveys to assess their attitudes and beliefs about immunization before and after the review of materials. At all time points, distribution of the information “significantly improved attitudes about vaccination,” the authors wrote. “Allowing adequate time to review vaccine information at any visit may benefit concerned mothers,” they said (Pediatrics 2011;127:S120-6). However, the mothers indicated that they preferred receiving the information in advance of the 2-month vaccination visit.
Talk to Vaccine-Hesitant Parents
Inasmuch as the best defense is a good offense, the antidote to the plethora of vaccine safety misinformation from nonexpert sources is the targeted dissemination of accurate, evidence-based information to parents from their child's health care providers, vaccine experts suggested.
“[Health care providers] have the greatest influence on a parent's decision to vaccinate his or her child,” wrote Dr. C. Mary Healy and Dr. Larry K. Pickering (Pediatrics 2011;127:S127-33). For this reason, “establishing ongoing, nonconfrontational dialogue from the initial [physician]-parent interaction is essential when dealing with vaccine-hesitant parents,” said Dr. Healy of the Center for Vaccine Awareness and Research at Texas Children's Hospital, Houston, and Dr. Pickering of the CDC's National Center for Immunization and Respiratory Diseases
Toward this end, health care providers should take the following steps, the authors wrote:
▸ Make an effort to understand parental concerns about vaccination. “Although parental vaccine concerns vary according to knowledge and personal experience, the underlying premise remains remarkably consistent: fear that vaccines (and/or their additives) are unsafe, will give the immunized person the infection against which they are designed to protect, or that somehow getting the 'natural' disease is healthier.”
▸ Individualize each parent's set of concerns and avoid making assumptions about their attitudes.
▸ Establish an open, honest dialogue from the outset and provide Vaccine Information Statements as well as understandable summaries of research that address some of the common concerns, particularly those that have received media attention.
▸ Acknowledge the potential adverse events and balance them against disease risk.
▸ Provide personal anecdotes and visual imagery that highlight the dangers of refusing vaccination. “These stories are available in publications from reputable sources and online, where parent advocacy groups describe serious consequences of not vaccinating, or from organizations that specialize in vaccine education.”
▸ Ensure ongoing communication with parents, and deviate from the recommended childhood and adolescent immunization schedule only when other options have failed. Rather than discontinuing care for families who refuse or delay immunization, the physician “should reopen a nonconfrontational dialogue, continue to discuss risks and benefits of immunization during subsequent patient encounters, and document these discussions during each visit.”
“As physicians, we have a responsibility to provide guidance to parents,” Dr. Healy said in an interview, acknowledging the occasional difficulty of doing so when competing with other sources of information, including celebrities, non–health care providers, and very vocal antivaccine lobbies. “We have to be cognizant of the various factors that influence parents' perceptions about vaccine safety,” she said.
DR. HEALY disclosed she has a research grant from Sanofi Pasteur and has served on a scientific advisory board for Novartis Vaccines. DR. PICKERING disclosed having no relevant financial disclosures.