One: Remember that even now, anti-vaxxers are not actually the biggest reason for missed vaccines. Poverty is. From Mother Jones: “an astonishing 49 percent of toddlers born from 2004 through 2008 hadn’t had all their shots by their second birthday, but only about 2 percent had parents who refused to have them vaccinated.” This is a fixable problem.
Two: Improve trust in the medical community and the public health community by stopping the ridiculous misinforming of parents about other subjects having to do pregnancy and early child-rearing. End the scare tactics about home birth and co-sleeping (there are ways to do it safely, and equally dangerous ways to avoid it). Get your act together about what it takes to appropriately support early breastfeeding. Stop making people labor on their backs, and insisting on unnecessary episiotomies. I could go on and on and on. The point being: if you want new parents to trust your word about vaccines, you have to have not cried wolf a million times before that. And right now, that ain’t happening.
Three: Improve trust in the public health community by, er, how can, I put this . . . telling the truth? Don’t exaggerate or mislead in order to scare people into short term gains. This goes for sex, it goes for drugs (if you tell teens pot will kill them and make them crazy and it doesn’t, why are you surprised that they don’t listen to you about heroin?). It also goes for vaccines. For the most part I know it’s just frustrating that you are telling the truth and people don’t believe it. But there’s also the point that a 1 in 10,000 chance of dying and high risk of blindness other complications should be bad enough—you don’t need to increase it to 1 in 1,000, especially when you know a bevy of skeptics will jump on any inconsistency.
Four: For fuck’s sake, don’t use public health officials doing vaccinations as cover for CIA operations against Bin Laden and then brag about it. Who cares if polio is coming back in Pakistan and public health workers are being murdered? After all, we’re all busy being mad at some anti-vaxxers in California.
Five: Don’t encourage all pediatricians to draw a hard line about 100 percent vaccination 100 percent on time. I know this is controversial and really up to doctors themselves, but berating and belittling parents—directly to their faces, or in public forums—and sending them away will only drive them into the arms of doctors who will just sign off on skipping vaccines all together.
Six: Don’t believe the line that no parents fall in a gray area on vaccines. This is one of the most dangerous and offensive ideas out there right now. Now, there are true believers who will not be convinced. And then there’s that study that showed that (a) refuting the bogus autism link and (b) employing scare tactics like pictures of sick kids didn’t change reluctant parents’ minds. The over hasty and unscientific conclusion I see many people leaping to from this is, “It’s hopeless. Once someone has questioned/delayed/skipped a vaccine it’s all over. They will never change.” This couldn’t be further from the truth. Yes, don’t try to convince people they are wrong to be concerned. Yes, don’t guilt trip them. Confirmation bias will kick in, and merely make them dig in.
But I would suggest, from fairly extensive conversations with people who have in fact traveled this road, that doctors who acknowledge their concerns, ask them what they are actually worried about, address the ones they can address (e.g. preservative free vaccines; allergy testing to make sure the reaction their kid had last time wasn’t related to vaccine components, spread out schedule), and have a respectful conversation about which vaccines they consider to be the most important and why, actually end up with pretty high eventual vaccination rates with people who came in skeptical.
Seven: Chill with the shaming. All of this shrill, mean, dismissive vitriol aimed at people who haven’t vaccinated is a great way to screw up the delicate work of those doctors I just described. (See my previous column “How (Not) to Talk About Vaccines” for more on why the superior attitude is not only not productive, but not necessarily warranted.) Venting may feel good, but if your actual goal is Saving the Children™ instead of demonstrating how you are So On the Side of Science, you might want to take it down a notch.
(This column was originally published in Metroland, the Capital Region of New York’s former alt-weekly, on Feb 12, 2015, under the title “How to Increase Vaccination Rates”.)