Approximately 250,000 American kindergartners are unvaccinated against measles.* That’s a shocking, embarrassing, dangerous statistic. But here’s the good news: Only a small percentage of those kids have parents who are Twitter trolls, anti-science extremists, or nutty celebrities. Surveys rarely capture this fact. They tell us that so-called anti-vaxxers are politically diverse, generally conspiratorial, and sometimes belong to fundamentalist religious sects, but surveys haven’t effectively quantified the hardness of their views. The best way to get this kind of information is by talking to pediatricians.
So I did. I sent out this informal two-question survey to a small subset of doctors who belong to the American Academy of Pediatrics, and asked pediatricians I know to disseminate it to their colleagues:
- How do you deal with parents who refuse to vaccinate their children?
- What would you like to say to them, if you weren’t limited by the boundaries of professionalism?
I guaranteed the pediatricians anonymity because I expected some colorful language. But that’s not what I got. Among the dozens of doctors who responded, I didn’t get a single angry remark, even when I pushed for one. (I’ll admit I was hoping at least one pediatrician would work blue. Weren’t you?)
About one-half of the respondents turn away children who have not been vaccinated by a certain age. When they cut kids loose, the doctors blame themselves more than the parents or the media. (The phrase “I failed them,” or something similar, came up often.) There were two explanations for turning children away. No. 1: The doctors worried about exposing their other patients to an unvaccinated child. No. 2: Since they were unable to convince the parent to make the right decision about vaccines, they felt they hadn’t formed an effective doctor-patient relationship. Those parents might be better off with a different doctor—not one who doubts the safety of vaccines, but one who can win their trust. (One doctor has a page on his website explaining his views on vaccination and providing a list of local pediatricians who accept his non-vaccinated patients.)
The pediatricians who continue to see unvaccinated children never give up the fight. One doctor begins each appointment with the following questions: “Can we talk about vaccines today? Is there anything I can tell you that would help you feel more comfortable?” If the parent says “no,” he simply moves on with the visit and tries again next time.
Very few of the pediatricians admit to having pent-up rage. Some would like to tell parents that they think their decision represents a form of child abuse. Many more feel the urge to explain the terrible things infectious diseases still do to children worldwide, but instead hold their tongues. That decision is probably wise. As Jamelle Bouie explained on Monday in Slate, research suggests that horror stories and explicit images of disease-ravaged children only tend to harden a parent’s resistance to vaccination.
Many of the doctors who responded to the survey were proud of their persuasiveness. They have collectively seen thousands of patients who initially expressed resistance, discomfort, or outright opposition to vaccinating their children. The overwhelming majority of those parents—even the most obstinate—eventually vaccinate.
There is sometimes frustration among doctors. Wendy Sue Swanson, a pediatrician at Seattle Children’s who writes the blog Seattle Mama Doc (who was one of my survey participants but declined the offer of anonymity), recently wrote about her anger at an anti-vax mother who laughed off her passion about vaccination. But those moments seem to be rare.
What’s the most effective approach? Besides persistence, many doctors believe that appeals based on personal experience are the most effective. Many pediatricians tell parents that they vaccinate their own children, and some of them even show pictures of their adorable kids to emphasize that vaccinated children are healthy children. One of the doctors tells patients that two of her grandparents suffered through measles. They are thrilled that their children, grandchildren, and great-grandchildren will never have that experience. (If you don’t have a personal story, consider pointing skeptics to author Roald Dahl’s moving essay about his daughter’s death of measles.)
These strategies are intriguing, but sadly there’s little hard data to say whether they are the best approaches. The literature on how to persuade American parents who resist vaccination is extremely thin and inconclusive. There hasn’t been enough research funding directed toward the problem, even though vaccination rates have been falling in some places for several years. One half-excuse is that pediatrics doesn’t attract many research-focused doctors. It’s one of the lowest-paid specialties, and research doctors generally make less money than clinicians. Nevertheless, vaccine communication strategies should be a national research priority.
This exercise has convinced me we ought to reserve the phrase “anti-vaxxer” for that small group of committed, loud-mouthed ignoramuses who try to spread their pernicious, conspiratorial nonsense to innocent parents and children. The vast majority of those who don’t vaccinate their children, however, represent a collective social failure. Somehow, we’re slowly losing a debate to a group of people who are spectacularly, demonstrably wrong. If we can’t beat them, we should blame ourselves. I know pediatricians already are.
Correction, Feb. 5, 2015: This article originally misstated that approximately 1 million American kindergartners are unvaccinated against measles. Approximately 250,000 American kindergartners are unvaccinated against measles. (Return.)