How to Respond When Patients Ask about Vaccines

by G. Richard Holt, MD, MSE, MPH, MABE, D Bioethics •

The CDC has developed a number of excellent publications related to “common vaccine safety concerns,” and “why immunize your child,” to which parents can be directed for thoughtful consideration. The American Academy of Pediatrics also has numerous resources for parents and physicians with regard to vaccination hesitancy (Pediatrics. 2016 Sep;138(3). pii: e20162146).

Some parents may be considering not immunizing their children at all. Others may voice concerns that the immunization schedule is too intense or concentrated, and are seeking the option to spread out the immunizations over a longer period of time. In response to those parents who may plan not to immunize, physicians are encouraged to explain the notion of a “social contract,” wherein families who do not immunize benefit from the “herd effect” of other children’s vaccinations, while not having to bear the slight risks. Additionally, if the children do contract a virus-specific infection, they could potentially infect babies and immunocompromised individuals who are not immunized for medical reasons.

It is important for physicians to emphasize the often terrible outcomes of infections in the non-immunized, and to help parents realize that these diseases are to be avoided for good reasons. And although it is a difficult ethical dilemma for physicians who are tasked with immunizing their patients to refuse to accept or maintain children in their practices whose parents will not allow them to be immunized, it does occur. The decision appears to be one of individual professional conscience.

Some pediatricians and family physicians are becoming increasingly amenable to discussing modifications of the vaccination schedule for children of parents with strong concerns about the density of immunizations. However, any acquiescence to a modified schedule must be accompanied by a very strong informed consent acknowledging that the child may well be at higher risk for contracting one of the infections in question, owing to decreased immunity at a given point in time. Given a choice between no immunizations and a modified schedule of immunizations, the latter is preferable. At this time, regulatory agencies in this country offer no specific guidelines regarding modifying the recommended schedule of immunization.

The Role of Otolaryngologists

Otolaryngologists are not tasked with the responsibility of immunizing children; however, the fact that vaccines currently in clinical use have greatly reduced the severity of many diseases common to the history of this specialty means that otolaryngologists do have a stake in the discussion.

The appropriate responses we can give to parents wishing to discuss their vaccine hesitancy may include:

  • Listening carefully and with empathy;
  • Educating the parents about the diseases that vaccines prevent or reduce;
  • Helping them to better understand the science of immunization and herd immunity; and
  • Emphasizing the importance of the social contract for community public health to which we all are obligated.

These are delicate discussions, and a balance must be maintained between affirming the parents’ right to make decisions for their children, and stressing their responsibility to understand the facts as we know them about the salutary effects of immunization. Information gathering and sharing between the parents and the otolaryngologist should occur in a respectful, interactive environment, with the best interests of the child/children always at the forefront.