Rethinking and “Re-feeling” Difficult Vax Conversations
(START SIDEBAR, set off with some pale color background)
JANE: There’s an old saying, ‘Behind every successful man, there’s a woman…’ But you wouldn’t know about that, Dan, because there’s no old saying about ‘what’s behind a miserable failure.”
DAN: Jane, you ignorant slut…
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The classic Saturday Night Live skit, “Point, Counter-Point,” came to mind while listening to Dr. Jennifer Reich’s presentation on dealing with parents’ concerns/questions about vaccines for children.* Why? Because Dr. Reich, a sociologist at the University of Colorado at Denver, was arguing against assuming that parents with doubts were simply ignorant people who needed to be abruptly corrected. Indeed, in her list of “Conversations that don’t help” is “correcting incorrect information.” Say what?
Dr. Reich, who’s written a book on dealing with vaccine hesitancy, Calling the Shots: Why Parents Reject Vaccines, and who has a personal connection to the topic, being a parent and being married to a pediatrician, said this in a recent presentation to the non-profit group Immunize Colorado**:
“It’s too easy to dismiss individuals who question vaccines as ignorant or anti-science and I think that’s not a useful place to start. Instead, we can think about the way these cultural threads that define what it means to be a good parent and a good health consumer are stronger and longer than this moment.”
Here she’s referring to the bigger health picture that we, as a society, have pushed hard on: the notion that we all should “take control of our health” and be informed health consumers who actively participate in healthcare decisions and who are expected to be knowledgeable advocates for their children’s care. So, when it comes to vaccines, are parents just supposed to shut up and do what they’re told, no questions allowed?
A CASE STUDY: VITAMIN K and THE GOOD MOTHER
Dr. Reich offered an example of a better approach, using doubts about the Vitamin K shot.
(A quick background on that shot from Dr. Jessica Steier of Unbiased Science: “Without enough vitamin K, a newborn’s blood can’t clot properly, and the bleeding can start without warning in the first six months of life, including in the brain. Babies who don’t get the shot are far more likely to bleed this way, and among the infants who do develop vitamin K deficiency bleeding, roughly one in five die, by the CDC’s count. The only reason most of us have never heard of this is that the shot has been routine since 1961 and has quietly prevented it for decades. We forgot the danger because the fix worked.”)
It turns out that the Vitamin K shot has become a frequent target of online anti-vaxxers, who not only argue that what it prevents is very rare, but that it’s so dangerous it comes with an FDA “black box warning.” Turns out the warning is irrelevant to childhood vaccines, but the number of babies not getting the shot has risen to over 5%. So how to handle a parent who doesn’t want their child getting Vitamin K? Dr. Reich said this of someone who is rejected the shot after having heard of the FDA’s black box warning:
The first reaction is like, ‘That’s stupid. That’s untrue.’ It feels you should dismiss it.
But it’s an interesting strategy to say, ‘You’re correct — that is a black box warning.’ And then explain it applies to adults who been given it intravenously, particularly when it’s rapidly administered to reverse anticoagulants. It has never been demonstrated in infants.
And then to highlight: “What a good mother you are that you went and read this and you found this and you’re concerned. Let’s talk.”
THE GOOD PARENT ASSUMPTION
Coming at the issue of vaccine-hesitancy from the perspective of a sociologist rather than a vaccinator gives Dr. Reich the chance to see immunization issues from the parents’ point of view. We could then argue that worrying about vaccines is evidence of a concerned parent trying to do the right thing in the face of uncertainty. Just because you, the vaccinator, are certain, doesn’t negate the existence of uncertainty.
Dr. Reich puts it this way: “You’re the expert on healthcare, but I think it’s important to acknowledge that parents are experts on their own lives. Our goal, collectively, is to empower families to make decisions — not to proselytize or convince them, but to give them the information they need to feel like they are in charge of this decision.”
In considering how to discuss vax information, meeting parents “where they are now” might be trickier than it seems, particularly when it comes to using statistical data. Dr. Reich argues that data can be less helpful than you might assume, arguing that statistics-heavy approaches, like for rates of infection or death, fail because, “Families don’t really care about rates because at the end of the day, their child is an ‘n of 1.’ They are 100% of the experience and so knowing the statistical probability doesn’t help them estimate the probability for their child.”
A DIFFERENT CONVERSATIONAL MODEL: THE VOTER
So, instead of being annoyed and dismissive, we start with this, The Good Parent Assumption…
Doubts/fears are understandable, and
having them is evidence of caring, which is therefore,
evidence of striving to be good parents.
That suggests a different conversational model, more like trying to convince someone who to vote for, instead of explaining why they are wrong. If you start with a place of “you’re wrong and here’s why,” there’s the possibility of a boomerang effect, where the parents, under attack, mentally reinforcement their belief. Rather, you seek to understand how the parents feel, not just think. This can transform a dreaded and difficult conversation into thinking and feeling together.
*Both Dr. Reich and the folks at Immunize Colorado have given us permission to pass along a link which will take you to a Vimeo recording of Dr. Reich’s presentation, including dozens of useful slides…
**IMMUNIZE COLORADO, From their website:
Immunize Colorado was first formed in 1991 in response to the alarming fact that only about 50 percent of children in our state were adequately immunized. A group of concerned physicians, insurance providers, parents, and state officials met to strategize and develop a plan to improve and sustain childhood immunization rates in Colorado. As part of that strategy, the Colorado Children’s Immunization Coalition incorporated as a 501c(3) nonprofit organization in 1999. In 2020, the Colorado Children’s Immunization Coalition changed our name to Immunize Colorado to renew and reinforce the organization’s commitment to protecting Coloradans across the lifespan from vaccine-preventable diseases.
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STATS OF THE MONTH
Time for We The People…That’s 342,621,588 (as of July 1) of us and counting!
By Bill Davenhall, Geomedicine Analyst
Another wake-up call! New U.S. population data is out this month – the US Census Bureau latest update on the population of the United States has arrived!
Gross generalizations are no longer very useful for describing the impacts and challenges for America’s immunization ecosystem. Delivering hundreds of millions of doses of vaccine is no small task – and it will get much more complicated. Immunization can start as early as within 24 hours of a birth, an event that takes place every 8 seconds of every day, somewhere in the United States. If the population clock is accurate, we will have a net gain (births minus deaths) of one person every 28 seconds – thus the job of immunizations is a massive operation.
The map/data below, prepared by the US Census Bureau this past month gives you a hint of the complexity of keeping up with immunizations – It’s maps every county (3,143) in the US and reveals the population change in every county since 2020. The counties color will tell you how much change has occurred and it is a clue to the challenges in keeping up with immunizations.
So, as you look at the colors the first thing that should startle you is the vast array of colors present and their patterns depending on where your looking. Two dominant color ramps that stand out in this mosaic of counties are the DARK colors (Violet/Blue/Green) and LIGHT colors (Green/Yellow/red/Black) – illustrating, quite convincingly, the complex challenges of immunization as a “one-size-fits-all” situation. Next, ponder the approximate number of doses of vaccines that various groups of people will need to be fully immunized – immunization experts estimate it would be close to about 350-400 million doses in 2026 alone. If a picture is worth 1,000 words, the map would be worth the value of about 350 million doses. Since no one organization generates a total number of doses of all vaccines administered annually, this figure is not verified by the CDC.
So, as we celebrate 250 years of historical democracy – ‘we the people’ is more like ‘we the peoples’! For those readers that want more detailed data a visit to the Census site will keep you updated on the data tables that are available for every county and the 6 ages groups. As you will learn when looking at the detailed data is that the Southeastern States lead the nation in seeing above average increases in every major age grouping, especially those living in counties surrounding major urban areas. This may actually be a new signal of a different national migration trend that is accelerating since Covid.
Keeping up with “immunization customers” – within households and institutions – will become a significant challenge as population shifts continue to ripple across America’s geography. I encourage immunization promoters to learn more about the United States Post Office’s Change of Address (COA) system to improve keeping up with the “immunization customer” for a lifetime, regardless of where they migrate within the United States.
As always, I appreciate 2nd opinions!
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