How to respond to non-vaccinating parents

Listening and engaging is a much better strategy than shouting the facts, Adam Hofmann says.

I was completing my notes on a patient’s chart in the hospital one morning when I overheard two nurses discussing vaccinations. They had got into an increasingly heated disagreement about vaccinating their children. Notwithstanding my guilty feelings at being an eavesdropper, I found myself drawn into the discussion.

One stated that she had refused to vaccinate her last child. The other nurse was clearly surprised. I was too; this nurse, after all, was a medical professional. She administered vaccines fairly routinely to our patients. That she could have anti-vaccine sentiments seemed, to me, rather incongruous.

I am firmly in favour of vaccines. They are right up there with antibiotics, anaesthetics and public hygiene as the innovations that doctors agree have saved the most lives in the past two centuries. But, history and science aside, I am firmly in favour of vaccines, because I have come face to face with the consequences of not having access to them.

I still recall with intense clarity an experience I had as a visiting doctor in a hospital in Kampala, Uganda. There, I met a young man bound by ragged cloth restraints to his iron bed frame. His body was arched unnaturally, and his face was a rictus of pain. Disturbed, I walked over to his chart. He had tetanus. In Canada, vaccination has made the condition so rare — 0.2 cases per million inhabitants — as to be something that most doctors won’t see in their entire careers.

Back in the here and now, I realized that the non-vaccinating nurse had likely never seen a case of tetanus. So I decided I needed to find out which of her experiences had led her to this decision. I started by asking her, simply, why? I followed up with question after question, avoiding confrontation. I genuinely tried to understand her point of view. It led to a real and open discussion.

What I learned was that she felt that the rise in allergy and ADHD was due to vaccines. Her last child was the only one of four who didn’t suffer from these, and he was the only child she hadn’t vaccinated. For her, this was as powerful anecdotal proof as my experiences in Uganda. She had cast about for a root cause, as we all do when confronted with difficult life challenges, and she had concluded vaccination was it.

I also understood something I never had before: In a life full of stress and parenting difficulties, her decision to not vaccinate had given her a new sense of control over the fate of herself and her family.

By the end of our conversation, after a reciprocation of openness on her part and a brief discussion of the history and science behind vaccines, she grudgingly conceded that at least some vaccines were probably essential and not related to the problems faced by her other children. She even said she would reconsider getting her son vaccinated. I think she meant it.

I was humbled by this experience, and have taken from it that we have failed as scientists and as a society to comprehend and address the underlying causes of what the World Health Organization terms “vaccine hesitancy,” a major threat to our well-being. Merely shouting facts in a louder voice at those who refuse to vaccinate is a failing strategy. The painstaking work of trying to understand the people who make these decisions is of fundamental importance.

When all is said and done, sometimes our ability to heal as physicians lies well beyond our medical training. As individuals, we cannot possibly counter the major technological and cultural changes in society, now compounded by fake news or inaccurate sources of medical information. As compassionate health professionals, we must never forget to step up and engage our patients, our peers and our neighbours on a human level.