As the article points out, the parents who are extremely against vaccines are often mislead by information that they may have read (more likely what they heard). Our jobs as physicians and arguably our most important job is patient education (parent education in this scenario). At the end of the day, the patient/parent has the final say in the medical care we provide to them. In this particular scenario, we must educate the parents so that they can make the best decision for their child. While we all know the importance of getting vaccinated, it is also important to not push the issue so much that the parent feels like we are forcing anything upon their child. I think the article said it best by saying a victory for physicians may not mean the child gets all the vaccinations, but that the parent becomes more open to having discussions about them.

• Tyler Johnson

Despite the fact that, as medical professionals, we view anti-vaccination parents as the bad guys we need to remember that in most cases they are sincerely doing what they feel is best for their children. Not everyone is a doctor, or a scientist, or even aware as to want constitutes as evidence in an argument. It is important to keep this in mind when talking to parents about vaccinating their children. Even though their logic might be flawed and outright dangerous to their children health, they are not endangering them purposefully. To susceptible people, the internet is filled with all kinds of anti-vaccine propaganda, and rumors such as vaccines cause autism along with many others are presented as peer reviewed scientific findings. I have looked into several of these websites and, apart from finding no data supporting any of their findings, they seem, by in large, to be anti-government smear campaigns. A couple of the so called “research papers” that these websites presented had no connection to any peer reviewed journal, and not one of their citations was to a credible source. One article even cited itself.

• Timothy Cox

When speaking to parents about vaccines, I think it's important to meet parents where they are at. If they have a positive attitude toward vaccines, it may be a good idea to make sure they understand how vaccines work and reiterate the benefits, and warn of the rare side effects.

A greater issue occurs in discussing vaccines with patients that are not very acquainted with science, or that have bought into the anti-vaccine pseudoscience. Explain how vaccines work in a way that patients understand, make sure the parents understand the drawbacks of not vaccinating children, and not antagonize the parents while also expressing concern for the children's well-being. The greatest fear of vaccines currently is the misconception that they cause autism, and the best argument against that is the paper was retracted by the journal that initially published it. However, many parents are skeptical of mainstream medicine and may hold strongly to false beliefs propagated by alternative medicine sources, in which case the physician's best hope is to see if the parents may change their minds eventually.

• Michael Pajor

With all this anecdotal information floating around displaying vaccinations in a negative light, as a future physician it is imperative that we help dispel these myths in order to generate herd immunity and keep devastating diseases from causing havoc in our societies. Often times parents use their own experience in proving that all these vaccinations are not necessary. For example, they might say that they did not get all these vaccinations when they were born and they turned out perfectly healthy. This is a very common misconception I've come across in recent years. Well the fact is not that long ago, devastating illnesses such polio completely decimated the lives of many people. One striking image that always comes to mind is a picture of a hospital in the early 1900's with an entire ward dedicated to housing patients in iron lungs because they were unable to breathe on their own. In the context of the total amount of time humans have existed on Earth, we have only been able to eradicate many devastating illnesses in the past 100+ years. Many parents and people lose sight of this. Entire populations had been wiped out by plagues through out history. This is why when certain viruses like Ebola pop up, the entire world's medical community takes this very serious and rightfully so.

As a physician it is our duty to uphold the Hippocratic Oath, however there are limits to what we can do when parents refuse to vaccinate their children. As the saying goes, the proof is in the pudding. The physician must explain to the parents the decades of arduous clinical evaluation and scientific evidence doctors have, vaccines have been shown to be very safe and help the baby get off to a great start for a long healthy life. Providing the parents with take home material and directing them to reliable immunization websites is also a great way to help quell any worries that they may have.

• Ismail Hassan

I think it will be important to start a dialogue with a parent and ask them what makes them think vaccinations may be dangerous with their child. This should be done in a respectful and genuinely inquisitive manner in order to understand their perspective. It also affords an opportunity to evaluate their healthcare literacy and possibly the type of counseling that would be most effective in getting them to understand a physician's point of view. If they are the type of people who have combed the internet for research that denounces vaccinations, then evaluate the research with them, perhaps pointing out flaws in their methodology and giving the parents access to the many convincing studies that show the benefits of vaccination. If they are the type of parents who base their feelings on anecdotes or other stories, then it may be more helpful to tell more stories of your own. By relaying experiences you've had with preventable diseases in children or by explaining that you would vaccinate your own children, perhaps you could appeal to their emotional side. I do think that the most important piece to all of this will be engaging the parents in a respectful dialogue, eager to hear their concerns.

• Spencer Printen

The first thing that comes to my mind after reading this article is how I will handle parents in the future who may not want to vaccinate their child. I am typically not a very confrontational person and it can hard for me to continue insisting that someone else take a certain course of action. I feel as though autonomy over one's health is an important component of health. However, since the child is not the one making the decision regarding their health, this dynamic leads to medical professionals serving as advocates for them. I do not believe that vaccination conversations should be aggressive or that a healthcare provider should dominate the conversation. The conversation really should be one of respect and honesty. I know that for me personally, I will want to pursue the conversation for a longer period of time than if I were trying to convince someone to do something else. At the end of such a conversation, if a parent still does not want to vaccinate their child, then at least this respectful dialogue demonstrated the care that the physician has for the child and can perhaps lead to vaccination in the future.

• Robbie George

This article puts forth a well-thought out plan to create a dialogue with parents and society that tells the truth about vaccines. The parents' questions and concerns stem from fear for their child's health. When dealing with an emotion like fear, it is important, as the physician, to be understanding and show that you truly care for the child's health as well. I think it is important to understand there is a difference between people who are completely anti-vaccinations and those who just have questions. I agree with @Lochan Bellamkonda, that people do have legitimate concerns about vaccines. There are a lot of anti-vaccination supporters and many of them are very vocal about their opinions. When people hear something negative about vaccines a few times, it can be understandable they would have questions for their doctor. Showing your patients that your number one concern is the health of their child is an important step in building the foundation of trust that is needed between the parent and physician.

I was surprised that the concern for others was not a bigger topic in this article. I have heard many anti-vaccination supporters with the belief that if everyone else is vaccinated, than I do not have to be. This follows the idea of herd immunity. However, vaccines do not work 100% of the time and people who are immunocompromised are at risk, regardless if they have had the vaccine.

One more thing I would like to mention here, I was reading an anti-vaxx article and the author stated that children do not make any antibodies before the age of 1, so vaccinating before then is pointless (and the only reason to vaccinate that young is for big vaccine companies to make money). I remember learning in Immuno that a child relies on their mother's antibodies before the age of 1, so in that case, why do we vaccinate that early? According to this research article, http://pediatrics.aappublications.org/content/109/1/124.full, even neonates are able to respond to foreign antigens and produce antigen specific receptors.

• Brian Didier

I think all of you have done an excellent job driving home a few key points:

1. Both logic and emotion are necessary to help a parent understand a need for vaccination. As Chip and Dan Heath said in Switch, the key to behavior change is in engaging the Rider (logical direction), Elephant (emotional ambition), and Path (the activation energy of a change).
2. Establishing and cultivating a relationship based on trust is essential to all good healthcare delivery.
3. Herd immunity insists that we be good stewards of vaccination and advocate strongly that our patients receive them.

I think one crucial thing I did not encounter in most arguments is this: are we, as providers, aware enough of the economic and structural hurdles to vaccination? We need to make ourselves aware that parents might also be hesitant to vaccinate their children because of perceived cost, because other parents in their community are non-adherent to recommended vaccinations, or because they might not be able to take time off to return for boosters or subsequent vaccinations in a series. Can we recognize when there is significant social impedance to vaccination, beyond the 'anti-vaxxer' mindset, and do we know how to help those families? Physicians are among the best-empowered advocates for the poor and marginalized, something we should also be taking into consideration when it comes to vaccination.

• Alex Matelski

If I were to come across parents who were unsure about vaccinating their children I would first ask them what concerns they had about the vaccines. Hopefully during this time the parents would present information that they had found, not because it is wrong and I can disprove them but because it shows that they care about the well-being of their child. I would then address each of the concerns that the parents had about the vaccines. I believe that an open and respectful discussion with the parents will help the trust that the parents have in me as a physician. I would also attempt to gain a strong relationship with every family so that I can better understand the source of their concerns about vaccines. When it comes to supporting why I believe every child should be vaccinated, I would begin by talking about the major benefits of vaccinating children against the diseases the vaccines protect against. With there being scientific evidence that a healthy child is very unlikely to have a severe response to any vaccination, and diseases such as autism having no correlation to being caused by vaccines it is important to discuss this topic because many parents may have not known how insignificant the risks of vaccines are. Through these discussions I would look to educate more families about the true nature of vaccines so that more children are vaccinated and hopefully in the future more diseases can be eradicated like small pox has been thanks to vaccines.

• Adam Bernardi

I believe it’s absolutely critical to keep an open and honest discussion going with parents in order to involve the parents as partners in their child’s care and to express to them that the physician also views their child’s health as their top priority.

I also like the idea of using a mix of science and medical anecdotes (depending on what is most appropriate for each set of parents) in order to communicate effectively and build trust. Most importantly, the information should be tailored to the parent’s specific concerns and discussed in a simple way. I really like the analogy @Colin Stone used above and would consider using it with my future patients when discussing vaccines.

If a parent refuses to vaccinate their child, I appreciate that the pamphlet suggested continuing care for this patient because, like many others mentioned above, it is ultimately the parent's decision. However, I think it is critical to emphasize the additional responsibility the parents will have and potential harm this could cause to others around them. By maintaining care with the patient and an open dialogue, the physician may have a chance to help the parents make decisions about vaccinations and other preventive health measures in the future.

• Brittany Lala