Vaccinations Rock! How to Get Parents to Think So

[jeastridge, BSN, RN]

A few weeks ago a friend with a new grandchild whispered to me, "What am I going to do? My daughter doesn't want to get the baby vaccinated!" My dismay must have been evident as I spoke gently to her, "Oh Linda, I'm so sorry. What have you tried so far to convince her?" She went on to list her various tactics, everything from infomercial-style science to cajoling to arguing to demanding. Nothing was working. The baby had passed the time for its 2-month shots. The mother had even changed providers in order to find one that agreed to see her child without vaccinations.

What do we do as nurses? What is the best way to convince reluctant parents of the benefits of vaccination for all children? How do you talk to someone who is completely against vaccination and who believes the false news stories condemning their use?

Our tendency is to want to assign blame for the situation we find ourselves in as a society. How did we get where we are? What caused this sudden shift in vaccination usage? The causes would involve a long exploration of lots of studies and literature, but ultimately, parents have given birth to children in a time of deep distrust of the established way of doing things. That coupled with sensationalized stories of supposed harm from vaccinations may have led to drop in the numbers of children being vaccinated and to dangerous outbreaks of diseases like measles-once a rarity, now distressingly more common. Another factor pointed out by researchers is the fact that these childhood diseases, once common and dreaded passages of childhood, are now so uncommon that many parents have never witnessed the true misery they can inflict on a child and the potential sequelae. In their efforts to protect their child from harm, they mistakenly think that they are doing the best thing by not vaccinating.

The CDC does an impressive job with their easily accessible information on vaccination (Facts for Parents: For Parents of Infants and Young Children (birth through 6 years old) | CDC). Listing the 14 diseases that vaccines prevent before age 2, the CDC goes on to provide all the science and detail that parents might be interested in regarding those once common scourges: Chickenpox (Varicella), Diphtheria, Flu (Influenza), Hepatitis A, Hepatitis B, Hib, Measles, Mumps, Polio, Pneumococcal, Rotavirus, Rubella, Tetorifice, Whooping Cough (Pertussis).

So what's a nurse to do to counter this tsunami of non-compliance? How can we help our patients/parents understand the risks and benefits of vaccinations in a comprehensive way that promotes health for all children?

Stay respectful

Shaming and blaming are not great tools in our teaching toolkit. We have to acknowledge that just about every parent out there only wants what is ultimately best for their child. When we are less than professional we break the tenuous bridges of communication and miss out on an opportunity to offer that particular parent the benefit of our knowledge and expertise.

Listen with compassion to the parents' reasoning and motivation

Having open-ended conversations that allow for questions and answers has a chance of producing the desired outcome. When we listen, we build trust. When we build trust, we maximize the opportunity for success in being able to have our instruction received in a positive manner. This is easier to do when we remember that one of the contributing factors to the drop in level of inoculation may be the distrust between young parents and the established medical community.

Learn a few facts that can make an impression

One that I used several times this past flu season was the fact that children who were vaccinated for influenza got less sick than children who were not vaccinated and of those children who died, 74% had not had the vaccine (Influenza Vaccine Effectiveness Against Pediatric Deaths: 21-214 | Articles | Pediatrics). The number of statistics and the complexity of their interpretation can make our arguments seem like so much white noise to parents who are already overwhelmed. If we keep our advice on topic, our information to the point, it is possible that we will avoid turning the parents' attention setting to "off" before we get started. Sometimes it seems like we can be our own worst enemies as we try to cover every possible scenario, every single number, every potential complication-all in an effort to be complete. Is it possible that this is one of those times when less is actually more?

Lay down the law

After California laid down laws making it tougher for parents to get exemptions, vaccination rates rose among incoming school-age children (Vaccination rate jumps in California after tougher inoculation law). As professional nurses, we can all speak to our state officials and our representatives about the need for stricter vaccination standards.

Make it clear

Zach Horne, a graduate student in psychology at the University of Illinois at Urbana-Champaign researched the link between information and change in behavior related to vaccinations: "What's going on with anti-vaccination parents, we think, is because they haven't seen kids with measles and mumps, those consequences aren't that real to them." (There's a surprisingly simple way to convince vaccine skeptics to reconsider - The Washington Post) Is it possible that because parents had never seen the devastating effects of the "Big 14" listed above, they were less likely to inoculate? Horne and others emphasize that more work needs to be done. Meanwhile, could it help to show some pictures? It is unclear but may be helpful.

As nurses, we are ambassadors for accurate scientific information. As we help spread the good news that vaccinations really do help kids, may we do it with kindness, respect and also thoroughness. My friend's grandchild remains unvaccinated, but the conversation continues and has really only just begun.

Joy Eastridge

[VivaLasViejas, ASN, RN]

Excellent post. I have a friend---and she's a nurse!---who refused to vaccinate her kids until they reached seventh grade, at which point they were forced to be vaccinated or they would be excluded from school. I have had multiple discussions with her since she also refuses to get the flu shot (and gets deathly ill every flu season). She doesn't listen to reason. Thank you for some ideas on how to reach people like her. I love her and can't understand why, with her education, she won't accept vaccination as a necessary part of life.

[Here.I.Stand, BSN, RN]

She doesn't listen to reason[/Quote]

It's very difficult to reason with the unreasonable.

One thing that really gets me is clinging to the mythical belief about autism. First off, the sample size in no-longer-Dr.-Wakefield's "study" would be laughable if it wasn't so scary... Really. As a 3rd grader, I had a bigger sample size for my poll re: participants' favorite Thanksgiving pie.

BUT even if it were true, really? Why in hades would you risk DEATH before you risk autism???

[holisticallyminded]

Just WOW. Arrogant nurses who know NOTHING about the immune system (because the level of education in nursing school is sub par in this area), know nothing about vaccine adjuvants, nothing about developing immune systems and can't answer basic questions about WHY parents should be wary of vaccination HAVE NO RIGHT to help with informed decision making, let alone moralize about the safety of vaccines. I am often very embarrassed that my profession would use their license as a political tool.

Ever heard of the Cochrane Review? The verdict is more than out on vaccines. You don't know what you're talking about. My patients will be provided INFORMED CONSENT.

[Elfriede]

There is no vaccine against stupidity or ignorance.

I know enough nurses without tetorifice or polio protection.

I schools refuse to take unvaccinated children,

we are one step further.

[cmefford]

THIS!!!!!

I have such a hard time with this exact "reasoning" for not vaccinating. No matter how many times it is pointed out that the "study" was a fraud, people still cling to the autism argument!!!!

[OldDude]

I've given up on trying to change the mind of an anti-vaccine parents. In Texas there are two ways for children to attend public school without being compliant with state immunization laws; medical exemption from a doctor or "Exemption from immunizations for Reasons of Conscious" affidavit - which replaced the religious exemption and lumped any objection imaginable into the heap. The affidavit numbers are increasing every year. It's alarming and once the herd immunity is breached it's gonna be an ugly and sad sight to see.

[Emergent, RN]

Here's the Cochrane review results for influenza vaccine on healthy adults. They exclude data from the many biased, industry funded studies out there.

CD001269/ARI_vaccines-prevent-influenza-healthy-adults

Authors' conclusions:

Healthy adults who receive inactivated parenteral influenza vaccine rather than no vaccine probably experience less influenza, from just over 2% to just under 1% (moderate-certainty evidence). They also probably experience less ILI following vaccination, but the degree of benefit when expressed in absolute terms varied across different settings. Variation in protection against ILI may be due in part to inconsistent symptom classification. Certainty of evidence for the small reductions in hospitalisations and time off work is low. Protection against influenza and ILI in mothers and newborns was smaller than the effects seen in other populations considered in this review.

Vaccines increase the risk of a number of adverse events, including a small increase in fever, but rates of nausea and vomiting are uncertain. The protective effect of vaccination in pregnant women and newborns is also very modest. We did not find any evidence of an association between influenza vaccination and serious adverse events in the comparative studies considered in this review. Fifteen included RCTs were industry funded (29%).

[Horseshoe, BSN, RN]

I've given up on trying to change the mind of an anti-vaccine parents. In Texas there are two ways for children to attend public school without being compliant with state immunization laws; medical exemption from a doctor or "Exemption from immunizations for Reasons of Conscious" affidavit - which replaced the religious exemption and lumped any objection imaginable into the heap. The affidavit numbers are increasing every year. It's alarming and once the herd immunity is breached it's gonna be an ugly and sad sight to see.

Do you realize that you "liked" an anti-vaxx post above? Seems at odds with your post.

[OldDude]

Do you realize that you "liked" an anti-vaxx post above? Seems at odds with your post.

No I didn't - thank you!

[Horseshoe, BSN, RN]

No I didn't - thank you!

Lest anyone be confused by where that poster stands:

Feb 18, '15 by holisticallyminded

I'm one of the few folks I know who actually read the MMR/autism study YEARS AGO before it was banned because it did not jive with healthcare propaganda. The link that was found between autism and MMR was that EVERY CHILD WHO DEVELOPED AUTISM AFTER VACCINATION HAD GUT INFLAMMATION AT THE TIME OF VACCINATION. A correlation was drawn and it was speculated that susceptible children needed to be identified and more research done. It did not make the claims that so many people later speculated it did; it merely pointed out that there was more room for study. If you have also read the amount of independent PUBLISHED (yes) research done on GMOs and gut inflammation, especially in children, you might think again before you propagandize to others.

No one has the right to push MEDICINE on anyone else.

Co-incidentally, an independent local study was done in my area, showing that in a population on Vashon island of unvaccinated children (very high population of highly educated parents and high population of unvaccinated children), NOT ONE had a peanut allergy, while their vaccinated counterparts showed significant increase in the allergy. Again, no one claims vaccines are directly related, but could they be linked?

Shall I go on?

Please read my earlier post about vaccination bypassing the cellular response mechanism in favor of a humeral response only, which is why we gain temporary, partial (or are sometimes completely unresponsive) long-term immunity after vaccination. Cellular response in a healthy person is typically able to knock out virus before it invades, sending messengers back to make long-term antibody, all without the individual's knowledge. Herd immunity is not achieved by vaccination at all, which is why the flu shot argument never holds water. Herd immunity is far more likely when populations contract and fight disease, developing antibody that is then faster to replicate when similar disease breaks out in a community. This goes all the back to smallpox, and certainly works for the flu. Did you know that each and every blood type has natural antibody for specific flu types?

The list of adjuvants in vaccines is very, very long and highly toxic. Aluminum (does not leave the brain once it passes the blood-brain barrier) is linked to Alzheimer's and other neurological deficits, latex (another common ingredient) is linked to increased allergy, formaldehyde (yes, also in many beauty products, including topical creams, lotions and makeup found at your local Sephora) is a carcinogen, etc, etc, etc. There are sooooooo many. Why would you want these items injected into your body to MAYBE gain immunity to something that DOESN'T KILL YOU ANYWAY???? And exactly how am I here at all if my family all had measles, mumps, etc, if it's so damn deadly?

Oh, that's right...we're only worried about babies. No problem, I think we should all jeopardize our health, risking not only short-term vaccine reaction (my future daughter in law- a celiac- lost her job last year, developed a full-body skin reaction and lost all of her hair after a routine flu shot that her GP stated she "needed"), but also long-term chronic disease so that our current babies can be healthy. Gosh oh golly, I wonder if their parents will opt out of vaccination once they're out of that grey area of babyhood and thank me when my own child is damaged to the point of no return?

Should I shame each and every one of you who doesn't take care of yourself, spreading disease and wasting my tax dollars with your overweight, junk-food eating bodies? I'm sorry but you have NO IDEA what you are talking about.

-mother of a celiac, FTT child who attends private school.

[Have Nurse, ADN, RN]

"Pneumonia, bronchitis, sinus infections and ear infections are examples of flu-related complications. The flu also can make chronic health problems worse. For example, people with asthma may experience asthma attacks while they have the flu, and people with chronic congestive heart failure may experience a worsening of this condition triggered by flu. List below are the groups of people who are more likely to get serious flu-related complications if they get sick with influenza." This from the CDC website. My biggest worry is for the kids. The ear infections mentioned as a complication of flu, can turn into meningitis and can kill.

I was one of those people who once refused to vaccinate. I hadn't had a flu shot in 43 years. My reason?

It was a live virus back then and I got very sick.

Then, in 2010, I got hit with H1N1, followed by pneumonia. I was coughing up blood, thinking I had Tuberculosis, which of course I did not, but it had me scared. I dropped 11 pounds overnight and not from anything GI related.

It took me over a month to recover, as I have no spleen. I was stubborn and stupid to put myself in that situation.

We know that the virus mutates, but those who take the shot, if they end up getting sick anyway, it's because of one of two things: Either they had the virus in them already before they got the shot, or, they got the shot, got sick, but kicked it faster because they had the shot on board.

I am a child of the 50's and can tell you first hand, diseases such as Smallpox, Measles, Mumps and Rubella, Whooping cough can be deadly. There's nothing "natural" about it and you don't do your kids any favors by not vaccinating. And, there's no such thing as "herd immunity." Oh..my job? Infection Control