Counseling the vaccine-hesitant patient

What’s at the root of most morbidity and mortality from influenza and other vaccine-preventable diseases? Under-immunization. Retail clinicians (i.e., nurse practioners, physician assistants and doctors) are in a unique position to influence immunization rates by educating patients on the benefits of appropriate vaccines. While myths surrounding vaccines — like the idea that the flu shot leads to contracting influenza and misguided information that vaccines lead to autism or mental retardation — have been dispelled by rigorous scientific investigation, people of all ages appear to be “skipping out” on vaccines.

With the current influenza season in full swing, retail clinicians should remain vigilant about offering the vaccine through March. Of those children who died of influenza last year, 90% had not received a flu vaccine. In contrast to previous flu seasons, the current flu strain has proven especially harmful to young adults who have not received the vaccine.

In counseling the vaccine-hesitant parent or patient, it is important to understand the basis for their stance against vaccines. Parental fears and concerns regarding vaccines often stem from misconceptions, including the belief that vaccine-preventable diseases no longer pose a risk, doubts about vaccine safety and beliefs that certain ingredients in vaccines are dangerous.

Vaccine-hesitant patients or parents can be categorized into five categories:

1. Uninformed, but educable and seeks information to counter anti-vaccine information;


2. Misinformed, but correctable and not fully aware of vaccine benefits;


3. Well-read and open-minded, willing to discuss the issues with consideration of pros and cons;


4. Strongly vaccine-resistant, willing to listen to both sides of the argument, but unlikely to change viewpoints soon; or


5. Strong-willed and committed, attempts to convince provider to agree with the argument against vaccines. Parents in this last group are difficult to counsel.

Remembering that the goal is increased adherence (i.e., decreased morbidity and mortality from vaccine-preventable diseases), non-judgmental communication is the key to counseling around vaccines. As with any emotionally charged issue, clinician attitude can help or hinder shared decision-making. Vaccine Information Sheets, or VIS, given early in the exam can help parents or patients formulate questions. Clinicians should take time to solicit questions, acknowledging both benefits and risks. Respectful listening requires eye contact and refrains from patronizing behaviors. It is most important that clinicians not get offended, nor offend the patients, around issues of disagreement. Use of clear, simple language is of utmost importance.

With practice, clinicians can develop an attitude that is respectful of the parent or patient’s authority while encouraging vaccine adherence.

For resources, visit CDC.gov/Flu/Professionals/Vaccination/ and Immunize.org.