Clinical Challenges: Discussing Childhood Vaccination With Hesitant Parents

“Nearly all pediatricians encounter parents who want to do what is best for their child — even though it may mean they have questions about vaccines,” the American Academy of Pediatrics (AAP) notes in its advice to physicians on how to talk to vaccine-hesitant parents.

Addressing hesitancy can be complex, but communication is key, experts told MedPage Today.

“The factors that influence it are so broad,” infectious disease physician Lori Handy, MD, MSCE, of the Vaccine Education Center at Children’s Hospital of Philadelphia, told MedPage Today, and these factors can range from a lack of confidence or trust in the medical system or pharmaceutical companies to convenience issues.

Accordingly, it’s important to “make sure providers are very knowledgeable about the vaccine they’re providing,” she said, and that they “encourage questions from anyone who has some level of hesitancy.”

The Message Is Benefit

As the season for respiratory pathogens heats up, Ashlesha Kaushik, MD, a pediatrician, infectious disease specialist, and national spokesperson for the AAP, reiterated that viruses like influenza and respiratory syncytial virus (RSV) can lead to plenty of sickness and hospitalizations among kids.

Though parents are familiar with annual recommendations for the flu shot, there are now new options designed to protect infants against severe disease from RSV. CDC advisors recently recommended the monoclonal antibody nirsevimab (Beyfortus) for infants and a maternal RSV vaccine (Abrysvo) designed to pass on protection from mother to infant at birth. In most cases, just one or the other is recommended.

It will be important for providers to discuss both new options with parents, Kaushik said.

Aside from flu and RSV, Kaushik said it’s also essential to address the benefits of COVID vaccination in children. Kids, especially those who are immunocompromised, can develop severe complications from COVID, she noted.

Yet, parental hesitancy persists.

Recent polling from KFF found that while nearly half of U.S. adults expect to get the new COVID vaccine this fall, most parents don’t expect to get it for their children.

The poll also indicated that there are partisan gaps related to the issue of vaccine hesitancy, but partisans agree their personal doctors, including their children’s pediatricians, are “their most trusted sources of vaccine information,” KFF noted.

Several suggestions aimed at helping pediatricians have these conversations include listening to parents’ concerns and acknowledging them in a non-confrontational way, promoting partnerships in decision-making, and being open regarding what is known about vaccination and what is not known, according to the AAP. Other tips include personalizing information for parents based on cultural beliefs, specific concerns, and literacy level, as well as explaining what clinical trials are and how they work.

‘Victims of Our Own Success?’

And it’s not just newer vaccines parents are hesitant about.

A little more than 20 years ago, measles was eliminated in the U.S. following the success of the measles, mumps, and rubella (MMR) vaccine. More recently though, there have been a number of measles outbreaks, largely affecting unvaccinated kids.

“It is highly concerning to see outbreaks of measles in the U.S.,” Handy said. “We had decades of measles eradication in the country.”

Ultimately, she said, “We may be victims of our own success,” as these days, parents may not even know what measles is.

But the risks are very real.

MMR is such an effective and safe vaccine that offers lifetime protection, Kaushik said, and measles “can be very devastating.”

“It’s not a simple rash,” Kaushik explained. It can affect the brain and can lead to a condition called subacute sclerosing panencephalitis (SSPE). Advanced stages of the progressive neurological condition are characterized by patient deterioration to a comatose state, and then to a persistent vegetative state. “I’ve seen children get very, very sick,” she added. “We should not take these outbreaks lightly.”

Measles is just one example of the risks posed by vaccine hesitancy. Kaushik also pointed to another vaccine-preventable disease: polio.

History has shown how detrimental polio can be long-term if a child contracts it, she said. And, “for decades now, so many millions of children have been protected” through vaccination. She worries about the outcome for an unvaccinated child should we see a large outbreak in the future.

“We need to pick what’s best for our children,” Kaushik said. Contracting a disease that could have been prevented by a vaccine “might not be a passing event.”

She added that children in other parts of the world continue to lose their lives from vaccine-preventable diseases due to a lack of access. In the U.S., “we have had the privilege,” of having vaccines available. “My heart really goes out to those children,” who cannot get the vaccines they need, she said.

In reiterating the importance of vaccines, new and old, to parents, Handy said it’s critical to explain why they have been developed in the first place: “Vaccines are only designed for those infectious diseases that are really consequential pathogens.”

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