Regular readers of this blog might feel we have an obsession about increasing vaccination rates. Guilty as charged.

Regular readers of this blog also need little or no convincing on this issue. For many years, diseases like measles were unseen, unreported, and unexpected. Measles and other vaccine-preventable illnesses became so rare they fell out of consideration when doctors formulated a differential diagnosis for a young child with fevers, malaise, rash, cough, or other symptoms. Now, regrettably, vaccine-preventable illnesses are very much back in play and have to be considered when patients come in with febrile illnesses.

We all know the reasons this is happening. While there is no single factor, one of the most common is that a growing number of parents are declining vaccines for their children. They do so based on misunderstandings and misperceptions about the risks and benefits of immunizations.

Physicians and other primary care clinicians cannot always clear up incorrect parental beliefs about vaccines, but it never hurts to try. Under the new California law AB 2109, parents who decline vaccines for their children must provide proof they have been counseled on this issue by a healthcare professional.

At the risk of oversimplification, there are two main categories of parental refusal to permit vaccination: those who are unsure about it and those who have made up their mind.

When parents voice uncertainty about vaccination, the focus can be on education. The clinician can ask the parent why they are hesitant and then address those specific concerns in a non-judgmental way. Validating parents’ questions as understandable can help the educational process. The parents may feel less defensive and will hopefully be more open to listening to the scientific reasons supporting vaccination.

When the parents have already made up their mind to refuse vaccination, the challenge is tougher. Such parents often have fixed belief systems acquired and reinforced by a community with which they identify. For these parents, education is difficult and the clinician needs to have feasible goals. While the clinician can indicate disagreement with the parents’ decision to refuse vaccination, the emphasis should be that the clinician is there for the child and the family, and is committed to the child’s health. In these situations, there is no advantage to putting the parents on the defensive.

For this second group of parents, it is reasonable to re-explore their refusal at subsequent visits, to see if there has been any movement. When re-introducing the subject of vaccination, avoid putting the parents on the defensive and reiterate your commitment to their child’s wellbeing. Even though the door may have been tightly closed the first time vaccines were discussed, the door sometimes begins to crack open as time goes by. Success will never reach 100%, but at least we will have given it our best shot.

Richard Fleming, MD