In our April print edition, pediatric PA Chris Barry, PA-C, MMSc, wrote about parents who hesitate or even refuse to have their children vaccinated because of the fear of adverse events, including autism. Editor Michael Gerchufsky also spoke with Barry for this week's online audio Webcast.
For an online-exclusive Q&A ADVANCE spoke with several other PAs about their strategies for dealing with vaccine-reluctant parents. Here are their responses.
Q: How do you handle parents who are reluctant to vaccinate their children?
Charlene Morris, PA-C, MPAS
A: Immunizations are often considered a personal decision by our patients or their parents and this attitude adds challenges and dismay to our everyday practice.
We know medical history. Before the polio vaccine, up to 50,000 children a year contracted poliomyelitis. Many of them are now as adults succumbing to post-polio syndrome of weakness and loss of function from a disease contracted in youth. Sugar-cube vaccines many of us received in school gymnasiums virtually eradicated polio. The last reported case--post immunization--was in 1979, before many PAs were even born.
Still, we encounter parents who fear that vaccines cause autism or a young women fearing pain from an HPV vaccine. How do we surmount these objections? When people refuse vaccines for religious reasons, how do we persuade them to get immunizations?
Professionally, I continue to mention the benefits of vaccines. When literature is released refuting one malady or another, I offer this to parents and patients. I also point out how pertussis has again emerged and that to be responsible members of society we must participate in disease prevention and community health.
Sometimes, we do not immediately make headway, but when meningitis strikes a college student or another young woman dies from cervical cancer--otherwise vaccine-preventable diseases--that is when our best opportunity may arise to champion immunizations for our patients.
Charlene Morris is a PA at Pamlico Medical Center in Bayboro, N.C., and a member of the ADVANCE editorial advisory board.
Rod Moser, PA, PhD
A: In a free society, parents basically have the right to decide what illnesses their children will get. I simply look parents in the eyes, and say, "How will you feel if your child contracts one of these serious, preventable diseases, becomes deaf or disabled, or dies? Are you prepared to keep your child quarantined in your home forever, to not play with other children, not go to the park, not attend birthday parties or go to Disneyland? Are you prepared to homeschool your children? If not, I think you should seriously consider vaccinating your children. Perhaps it is not your unimmunized child that should worry you, it is all of the other unimmunized children."
I remain pro-vaccination and assertive, but I allow parents to express the reasons for their stance. If it is one of the vaccinations-cause-autism parents or the vaccines-contain-mercury parents, I am well-prepared with resources to review with them. If they are the alternative-vaccination-schedule parents, I work with them and allow them to decelerate. Some vaccines are better than no vaccines. For religious or culturally biased parents, I am well-prepared with a counterargument, too. I have heard all of the reasons and all of the stories, and I am not shy about respectfully defending my position. For the fringe parents who believe that vaccines are part of a government plot to control us, I give them a list of other practices to join. I have no defense for idiocy.
I talk about relative risks. The risk of being struck by lightning or being killed as a passenger in a motor vehicle is considerably higher than the risk of any potentially serious, proven vaccine risk. I tell them about my cousin who had polio, about my patients who became deaf from mumps or about a child I knew who died of measles. I know they have not experienced these terrible illnesses firsthand, but I have, and I freely share those stories. Parents have to realize that these diseases are real and that they are kid-killers.
Before anyone vaccinates, they must first educate. Misinformation about the risks of immunizations is rampant and getting worse every day. Physician assistants have a continuing responsibility to change behaviors and that includes changing false beliefs and attitudes about essential preventative services. Immunizations have saved more lives than any other public health effort in the last hundred years. I would like to keep it that way.
Rod Moser is a PA at Sutter Roseville Pediatrics in Roseville, Calif., and a member of the ADVANCE editorial advisory board.
Maggie Krejci, PA-C
A: Most importantly, I listen to and acknowledge parents' concerns and find out their specific reasons for vaccine refusal. Parental fears about vaccines, especially anxiety about an autism-vaccine link, usually stem from misinformation or lack of information.
I engage in proactive discussions and address misconceptions by presenting reputable and up-to-date information. It is also my responsibility to educate parents about the dangers of vaccine-preventable diseases, and to stress how vaccines protect their child's health as well as the safety of our community.
Maggie Krejci is a PA in the department of pediatric infectious diseases at the University of Nebraska Medical Center in Omaha.