Crucial Conversations QA

How to Discuss Childhood Immunization with Reluctant Parents

Dear David,

With the recent rise of children getting measles and the increasing number of people who refuse to have their children vaccinated, I have become very curious about the decisions that parents are making about their children. I work in healthcare and support vaccinating children, and I know that people who refuse to vaccinate their children can put together an informed case to support their point of view. I think their case is flawed and I can identify specific flaws in their case, which makes it difficult for me to hold a conversation with them.

Do you have some suggestions about how to hold conversations with parents opposed to vaccinating their children when I really do believe that they are taking a huge and unnecessary risk with their child and, as a result, other children?

Signed,
Concerned Healthcare Professional

Dear Concerned,

Thanks for a great question. It’s not just vaccines that cause communication breakdowns. We see breakdowns across our culture, which makes your question especially relevant. I’ll outline some tips below that should help.

You Can’t Win an Argument. It’s a paradox that it becomes harder, instead of easier, to convince someone when you are supremely confident in your own point of view. It has to do with Dale Carnegie’s insight, “You can’t win an argument.” Here is how a conversation can turn into an argument:

  • I ask the parent why they don’t want to vaccinate their child.
  • The parent shares all the reasons they have against vaccination.
  • I attack their reasons and try to add reasons for vaccination.
  • They attack mine and defend theirs.
  • I attack theirs and defend mine.
  • Rinse and repeat.
  • They win, because it’s their child.
  • In trying to win an argument I’ve fallen into what’s called the Persuasion Trap. I have become the champion for my cause and pushed the parent into being champion for the opposite cause. The result is an argumentative cycle I can’t win.

    Motivational Interviewing. Motivational Interviewing is an approach that is designed to avoid the Persuasion Trap. Instead of taking sides, it helps the parent explore and resolve the ambivalence they probably feel about vaccinating their child. And it recognizes the reality that it’s the parent who will make the final judgment. The goal is to engage the parent’s own intrinsic motivation. Below are a few principles you can use:

    Ask for Permission. When the parent says they are unwilling to have their child vaccinated, don’t launch into an argument. Instead, ask permission to discuss it further. This puts the parent into the decision-making role.

    Explore their Ambivalence. Most unwilling parents have doubts. Make it safe for them to voice their concerns. This establishes your role as helper, rather than opponent. Below are how these first two elements might sound in a conversation:

    YOU: Your child is due for her measles immunization today, but I heard you declined it from the nurse. Would it be okay if we discussed it?

    PARENT: Um, okay.

    YOU: Many of my patients are concerned about the safety of vaccines and whether their child is more likely to get sick from the shot than the actual disease. Others have questions about how bad it would be if their child got the measles. Would it be like a common cold, or could it affect their heart? Could their child die? Still other parents want to spare their child the pain of one more shot. These are all valid concerns. What do you see as the pros and cons of having your child vaccinated?

    I like to draw a line down the middle of a piece of paper and write the pros on the left and cons on the right side of the line. This helps the parent turn their vague feelings and fears into a finite number of specific concerns—concerns that can be addressed.

    Paraphrase to Ensure Understanding. Summarize each concern. This makes sure you understand it and also demonstrates that you are listening. “So, correct me if I’m wrong, but you are worried the vaccine will make your child’s arm sore and that she might feel sick for a week. You’ve also heard that measles used to be considered a relatively minor childhood disease. So, you have questions about how serious a problem it is. Is that right?”

    Address Each Concern with Facts. But first, ask for permission (again), “Would you mind if I provided you with more information about the measles, so you’ll have all the facts before you decide about the vaccine?” Then provide clarifying information in a nonjudgmental way.

    Consider the Messenger. Ask yourself whether you are the right person to provide the facts. If you are a nurse, a physician, or another healthcare provider, consider yourself credible. Your profession puts you among the most trusted people in our society. If that’s you, then you might make your presentation more personal, “I’ve had all of my children vaccinated. My son, Elijah, hates shots, but none of my children had any kind of bad reaction. I feel very good about my decision.”

    If you don’t think the person sees you as a credible messenger, then use information that comes from a more credible source. Provide a handout from the American Academy of Pediatrics or a pamphlet from your local public health agency.

    Consider Multiple Influences. You asked how to have a conversation with an unwilling parent. These conversations are important, but they’re only one aspect of a comprehensive influence strategy. If it was your job to improve vaccination rates in your region, country, or hemisphere, you would want to employ a combination of strategies at the Personal, Social, and Structural levels. These would include conversations, but also involve community leaders within schools, churches, and sports teams. They would also include changes to laws, incentives, and perhaps the way the vaccines are delivered. I hope this is helpful. Try a few of these approaches and let us know how they work.

    Best,
    David

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    David Maxfield

    David Maxfield is a New York Times bestselling author, keynote speaker, and leading social scientist for organizational change. For thirty years, David has delivered engaging keynotes at prestigious venues including Stanford and Georgetown Universities. David’s work has been translated into twenty-eight languages, is available in thirty-six countries, and has generated results for three hundred of the Fortune 500.
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11 thoughts on “How to Discuss Childhood Immunization with Reluctant Parents”

  1. Anit-vaxers aren’t big on science. On Reddit there’s a story of a pediatrician who proposed to an anti-vax parent the possibility “that anti-vaccine propaganda could be an attempt by the Russians or Chinese to weaken the health of the United States population?” According to the story, this new crackpot theory was too strong to resist and the child got his vaccines.

    The thing is, some of those Russian trolls actually did pepper their divisive political posts with anti-vax propaganda.

    1. The opposite is actually true. Those in the vaccine awareness group choose not vaccinate based on science….or the lack of science and safety. Since no true placebo safety testing has ever been done and the pharmaceutical industry is no longer held liable for injuries and death when it comes to vaccines….although 4 BILLION dollars has been paid out for vaccine injuries and death though a special court funded with taxpayer money…..then parents have every right to be cautious, to question and to refuse vaccines. Parents should not to be pressured into receiving vaccines by doctors and nurses who have been trained on how to coerce parents through persuasive dialogue. I believe that parents are intelligent enough to do their own research and that they need to learn to trust their God-given instincts when it comes to making important decisions for their children and family.

      1. I appreciate your bringing up the vaccine injury fund. Most are unfamiliar.

        An individual needs only to pause a moment to consider if one is forced to have foreign material injected into their body against their will what is next? True you might be pro-vaccination but what if the next forced procedure or medication is something you do not want? Might we insist that all who have cancer submit to the recommended treatment regardless of patient preference?

    2. Mr. Maxfield laid out a very polite approach to how one might find common ground on a topic with opposing view points and you choose to begin your reply with name calling.

      Individuals concerned about vaccines come to their decision from a variety of reasonings, just as those who choose to vaccinate. In fact they are likely much more informed than the average person choosing vaccines. Thus it would be inaccurate to say they are not big on science. In fact some are scientifically trained. Additionally, opposition has been present LONG before the Russian trolls launched their war.

      As a historical point it was these concerned parents that had thimerosal removed from many vaccines, which makes them safer for everyone. We owe them a debt of gratitude.

  2. If I were the parent and a health professional were to follow this strategy, I would appreciate the chance to discuss pros and cons of both the disease and the vaccine.

    I would also strongly encourage the person seeking to influence me to question the authorities they are appealing to. This arena is filled with bias.

    Vaccines are a multi billion $ enterprise. Vaccine manufacturers are not liable in any way for any vaccine once it is added to the CDC recommended schedule.

    Over $4 billion has been paid out to victims of vaccine injury since 1988 through a tax payer funded compensation program (VICP). These cases are becoming increasingly difficult to receive compensation because the injured party is confined to a close court arguing against the full force of the Department of Justice lawyers, and full discovery is not allowed. Studies and reports held by the manufacturers on their own safety testing data cannot be requested as in a regular court of law.

    Further, there is a time limit to apply and most parents and doctors are not even aware of the existence of the VICP.

    Further, health care providers routinely deny all vaccine injuries and insist there is no connection between the vaccine and reactions that occur in the days following.

    Vaccines are a unique item in the FDA and are not subject to the same rigorous safety testing of other drugs. I would ask the health care provider to supply me with just one study of one vaccine which compared the vaccine to a true placebo to track the safety.

    When approaching this topic with parents, health care professionals would do well to be more skeptical of their own view and spend more time listening to parents who are first hand eye witnesses to the harm that vaccines can cause to some children. All public health officials agree that vaccines will harm some who receive them. The disagreement is over how many are harmed. We would do well to seek valid answers to the rate of injury rather than believe those who are profiting from the distribution and blind faith in these products. There is a lot of valid science that attests to the harms. Recent papers by Dr Aaby, Dr Theresa Deisher, Dr Chris Exley, and others should be examined.

    1. Yes, be more skeptical. Imagine the difference if providers had been more skeptical when they were sold a bill of goods related to oxycontin. It is my opinion that a similar story will be played out with vaccines.

  3. My children are grown, but if I had children today I would be skeptical of vaccinating them due to the HIGH incidence of autism. I applaud my children who are not having their children get vaccines. One of my grandson’s screamed for 48 hours after the measles vaccine at 2 yrs of age. That was enough for them to make the decision about future vaccines.

    1. My unvaccinated children are 29 and 25, which is why I can offer a bit of perspective. This is not a new phenomena. When my children were young and the chicken pox vaccine came out I told them to mark my words, this common disease will be made into a horrible disease in no time to influence parents. First, it was voluntary and the selling point was that parents would not need to miss work if their child contracted it. I also knew the voluntary option would not last.

  4. I appreciate the article’s suggestions on having a dialogue and wanting to understand the person’s point of view. It truly helps to approach tough topics with the attitude that you are not seeking to win an argument versus understand the other person’s point of view.

    For the suggested verbiage, I have one suggestion. I do not recommend using the phrase, would you mind? As it is a yes/ no question, it could lead the person to think yes – I do mind which leads your conversation in a negative direction. Instead perhaps asking, “Would you like to hear more information about the measles, so you’ll have all the facts before you decide about the vaccine?” is a better option.

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