Vaccine Hesitancy & Update - Children's Mercy … Hesitancy & Update Angela Myers MD, ... •You overhear 2 mothers talking about vaccines ... Getting vaccines is a good way to

10/15/2014

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© The Children's Mercy Hospital, 2014. 03/14

Constructing effective communication

strategies about vaccines to parents and

teens.

Vaccine Hesitancy & Update

Angela Myers MD, MPH

Associate Professor of Pediatrics

Children’s Mercy Kansas City

UMKC School of Medicine

© The Children's Mercy Hospital, 2014. 03/14 2

Learning Objectives

• Review the current immunization schedule

• Review methods to create a vaccine plan for any

pediatric patient

• Describe current barriers to immunization

• Analyze evidence based techniques to increase

immunization rates.

• Discuss methods to make a strong vaccine

recommendation


Case Scenario • You overhear 2 mothers talking about vaccines

while you are at your child’s pre-school for parent-

teacher conferences

• The first mother says that she has not let her

children get their vaccines because you get better

immunity from disease than from vaccines

• The other mother recognizes that you are in

healthcare and pulls you into the conversation by

asking your opinion

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What every child needs….. • Hep B (3 doses; 0, 1-2, 6-18 mos)

• Rotavirus (2-3 doses; 2, 4, 6 mos)

• DTaP (5 doses; 2, 4, 6, 12-18 mos, 4-6 yrs)

• Hib (4 doses; 2, 4, 6, 12-15 mos)

• PCV (4 doses; 2, 4, 6, 12-15 mos)

• IPV (4 doses; 2, 4, 6-18 mos, 4-6 years)

• Influenza (annually ≥ 6 months)

• MMR (2 doses; 12-15 mos, 4-6 years)

• Varicella (2 doses; 12-15 mos, 4-6 years)

• Hep A (2 doses; 12-23 mos)


What every adolescent needs...

• Tdap (1 dose; 11-12 yrs)

• HPV (3 doses; 11-12 yrs)

• MCV (2 doses; 11-12, 16-18 yrs)

http://www.google.com/url?url=http://www.pharmacytimes.com/publications/issue/2010/August2010/RxFocusVaccines-0810&rct=j&frm=1&q=&esrc=s&sa=U&ei=TgArVJPYC8eqyATVk4KIDw&ved=0CCYQ9QEwCA&usg=AFQjCNHs9R6ZtAZBeE-I1CK2MZa3U-k-Yg

http://www.google.com/url?url=http://www.skepticalraptor.com/skepticalraptorblog.php/court-decides-parents-refusal-vaccinate-kids-free-exercise-religion/&rct=j&frm=1&q=&esrc=s&sa=U&ei=nwArVM25CYKgyATDiQI&ved=0CCoQ9QEwCg&usg=AFQjCNH8cLLCWKgF2IH4QI7WeBHLqBw4zg

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What is Vaccine Hesitancy?

• An expressed concern over a particular

vaccine(s) regarding its benefit and/or

potential for side effects; which may or

may not lead to refusal or acceptance of

the vaccine(s).


Parents worry about the well being of

their children


Vaccine Hesitancy

• The vaccine does not prevent the disease it is meant to

protect you from (disease is not dangerous)

• The vaccine may cause harm (concern for serious side

effects)

– the vaccine itself or “toxins” within the vaccine

• The vaccine is no longer necessary (child not at risk)

• The vaccines overload the immune system (too many,

too soon)

Salmon DA et al., Arch Pediatr Adolesc Med (2005) vol. 159 (5) pp. 470-6

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What are the concerns? Perspective % Agree or strongly agree

Getting vaccines is a good way to protect my child(ren) from disease.

90

Generally, I do what my doctor recommends about vaccines for my

child(ren).

88

I am concerned about serious adverse effects of vaccines.

54

New vaccines are recommended only if they are as safe as older vaccines.

51

Parents should have the right to refuse vaccines that are required for school

for any reason.

31

Some vaccines cause autism in healthy children.

25

My child(ren) do not need vaccines for diseases that are not common any

more.

11

Freed GL, et al. Pediatrics. 2010;125:564-659.


Our Current Environment


Know Your Audience

• Tailor your dialogue to match the needs

of your patient/parent

• 4 parent types:

– The believer

– The relaxed

– The cautious

– The unconvinced/conscientious objector

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Parent Types

• Believers

• Relaxed

• Cautious

• Unconvinced

High commitment to vaccination

May ask about safety and side effects

High commitment to vaccination

Less likely to ask questions

May need to probe for unanswered questions

Moderate to low commitment to vaccination

High emotional involvement with child

Rigid thought patterns

May pick and choose some vaccines or delay

No commitment to vaccination

Serious doubts about efficacy and need

Potential harm outweighs benefit


Parent Types

Spend Your Time Wisely

Believers Rejecters

Vaccine-hesitant

or

cautious

Cautious parent – 80/20 principal 80% of our time, 20% of our patients

© The Children's Mercy Hospital, 2014. 03/14 15 15

The Unconvinced/

Conscientious Objector

These patients choose the risk of

getting the disease versus the risk of

getting immunized.

In their context, they feel this choice is

the safer choice for them.

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The Unconvinced/

Conscientious Objector • Steer your conversation to a close;

• DON’T get into a lengthy debate

• Explain their responsibilities if unimmunized

• Closing idea:

– “I’m sensing that you won’t be immunizing your child

right now. Is your decision final? Is there anything

more I can say? I support immunizations as a healthy

choice for children. Let’s talk about this again later this

year”.


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A: Acknowledge your Client’s Concerns

and Clarify Your Understanding of Your

Client’s Needs

“I hear what you’re saying. That’s a common question I get. Tell me more about what you know.”

“That’s a scary story. I can see how you would be worried. Tell me more about your concerns.”

“It sounds like you want to do the right thing for your child. I’m hearing you say that you have concerns about….”


S: Steer your Conversation.

First refute the myth(s), then continue…

Two steering choices

OPEN

your conversation to ensure

your client’s questions and

concerns are addressed

SKILLFULLY CLOSE

your conversation for now

Rational: your client is a

conscientious objector and has

firmly made up their mind not to

immunize at this time.

OR


S: Steer your Conversation.

First refute the myth(s), then continue…

• “Actually, that’s a common myth. Vaccines protect you from the flu, they cannot give you the flu.”

• “Unfortunately the internet can have inaccurate information depending on where you look. The HPV vaccine prevents cancer and is very safe.”

• “When something like that happens it’s natural to look for a reason. Vaccines do not cause autism.”

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K: Knowledge – Know the Facts Well

1. Provide further knowledge tailored to your clients

needs.

Give-listen-clarify as needed

Use your toolkit

2. To close, reinforce discussion with a benefit statement

3. Provide further resources as needed

4. Provide your recommendation and immunize now, book

an appt, or ask what they plan to do

Prepare an immunization

communication toolkit

ready for use when the

crucial conversations

arise


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Understanding Vaccines & Vaccine

Safety

Topics of

concern/interest

to providers and

parents

Summary of key

points

Co-branded with

AAFP and AAP The science

Q&A format

Date

Current

stories

from

families

affected

by VPDs

Vaccine

risks and

benefits

VPD

risks

Quotes from

health care

professionals

Co-branded

with AAFP and

AAP

References

SERIES: Diseases & the

Vaccines that Prevent Them


Parent-Targeted Materials

• Providers requested more

plain-language pieces for

parents

• More basic overview of

disease and vaccine

• Most have no story (or an

abbreviated version)

• Clearly shows benefits

and risks

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Websites • Provider Resources for Vaccine Conversations with

Parents

– www.cdc.gov/vaccines/conversations

• Give Feedback on Provider Resources

– www.cdc.gov/vaccines/tellus

• Health Care Professional Home Page

– www.cdc.gov/vaccines/hcp

• “Get the Picture” Childhood Video

– www.youtube.com/user/CDCStreamingHealth


Being an Effective Communicator

Takes Purposeful Practice

Master the first seconds,

they count.

Communications and Public Relations:Presented by Andrew Hume and Associates Ltd.


DON’T use: Medical Jargon

“Some children will have an adverse reaction

post immunization. They may develop

induration, erythema and an arthus type of

reaction. There is a 16.7% chance that your

child will develop a fever after DTaP-IPV-HIB.

There is a minute chance of anaphylactic

reaction. Therefore it is very unlikely that your

child will have a serious reaction.”

http://www.cdc.gov/vaccines/conversations

http://www.cdc.gov/vaccines/tellus

http://www.cdc.gov/vaccines/hcp

http://www.youtube.com/user/CDCStreamingHealth

http://www.cdc.gov/vaccines/spec-grps/hcp/provider-comments.htm

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DO use: Plain Language

Common side effects are redness, sore arm,

and fever. Tylenol helps. More serious

events are very rare.


Plain Language Pyramid

Q: Does MMR cause autism?

“The MMR vaccine is very safe and protects

children, it does not cause autism.”

“The MMR vaccine is very safe and protects children. There is no increased risk of

autism with MMR vaccine. Because children are often diagnosed with autism at

around the same time as they get their shots people sometimes think it’s related to

the shots.”

“The MMR vaccine is very safe and protects children. The controversy about a possible link

started with a small study of 12 (8 had autism) children that appeared in the Lancet. Most of

the authors later retracted their findings. In May 2010 the lead author, Dr. Andrew Wakefield,

was found guilty of serious professional misconduct over “unethical” research and struck

from the medical registry in the UK. 23 studies refute this myth. One study looked at over

500,000 children and concluded there was no difference in rates between unvaccinated and

vaccinated children. You may wish to review the safety reviews posted at the IOM.”


Use Stories • Stories are an acceptable and powerful

approach to teaching

• People relate to them

• They are easier to remember

• Talk from your own experience

• Stories can trump research

• Good book: Vaccine Preventable Disease: the

Forgotten Story

– http://www.texaschildrens.org/carecenters/vaccine/Vaccine_Book/default.aspx

http://www.texaschildrens.org/carecenters/vaccine/Vaccine_Book/default.aspx

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PAGE 1 OF 2

HALEIGH THROGMORTON

Pertussis or whooping cough

“It’s tough to see your child in

pain because of getting a shot,

but it passes. To see him or

her on a respirator, that’s

really tough. But to have to

plan a funeral for your child,

that’s the worst thing in the

world.”

– Rodney Throgmorton


The Power of Painting Mental

Pictures

1. Does the picture tell a simple story?

2. Does it use basic emotional appeal?

3. Does it use easy arguments?

4. Does it match the message?

5. Does it pack a powerful impact?

6. Does it incorporate a call to action?


SCENARIO

http://www.texaschildrens.org/carecenters/vaccine/Vaccine_Book/Haleigh2.aspx

http://www.texaschildrens.org/carecenters/vaccine/Vaccine_Book/Haleigh2.aspx

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Client Says…

Parent: “I think vaccines are good and my

other children have been vaccinated, but

what I read recently makes me wonder

about some things. I read on a vaccine

website that it’s better to get my baby

daughter’s shots one at a time over more

visits so her immune system can handle it

and won’t be overwhelmed.”


You Say

HCP: “I hear what you’re saying, I

sometimes hear that concern from

parents. Tell me more about what you

read.”

Parent: “Well, I think it would be best if we

just get one vaccine today and hold off on

the rest until next time.”


You Say

HCP: “Actually, what you read is a common myth.

I have a lot of experience giving multiple shots at

the same visit and babies handle them very well.

It’s very safe and helps babies get protection as

early as possible when they are most at risk.

Unfortunately, the internet can have a lot of

inaccurate information depending on where you

look. Do you have other concerns?”

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The Conversation

Continues…

Parent: “ Well yes, what about the side-effects,

are they greater?”

HCP: “Actually, that’s a common myth too. The

side-effects will be similar whether it’s one or

four. Giving all the shots now is the best way to

protect your daughter. Shall we give them all

today?”

Parent: “Yes, it sounds like that’s the best way to

do it”.



Making the CASE for

Vaccines • Corroborate: Acknowledge the parents’ concern

and find some point on which you can agree. Set

the tone for a respectful, successful talk.

• About Me: Describe what you have done to build

your knowledge base and expertise

• Science: Describe what the science says

• Explain/Advise: Give your advice to patient,

based on the science

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I heard on TV that vaccines cause autism

• Corroborate: There’s certainly been a lot of coverage on television about

vaccines and autism so I can understand why you have questions

• About Me: I always want to make sure I’m up to date on the latest information

so that I can do what’s best for my patients, so I’ve researched this

thoroughly. In fact, I just returned from a professional conference…

• Science: Dozens of studies have been done, and they all showed that the

MMR vaccine is very safe and protects children. It does not cause autism.

• Explain/Advise: Vaccines are critical to maintaining health and help prevent

diseases that cause real harm. Choosing not to vaccinate does not protect

children from autism, but does leave them open to diseases. Kids need these

vaccines.


1. Are you comfortable using personal stories?

2. Do you feel defensive when answering questions

about vaccines? Why? Why not?

3. Do you feel confident? What makes you feel that

way?

4. Do you know an immunizer who has personal issues

or biases?

5. What does making a recommendation mean to you?

6. What could I have said differently (in a talk that didn’t

go so well)?

Self Reflection Questions


Thank you for your

attention and participation

today!

Documents

Vaccine Hesitancy & Update - Children's Mercy … Hesitancy & Update Angela Myers MD, ... •You overhear 2 mothers talking about vaccines ... Getting vaccines is a good way to