SEPTEMBER 7 2019 LISTENER 35
are happy to vaccinate, those who are
hesitant – they have concerns but could go
either way – and those who are staunchly
anti-vaccination.
Hard-line anti-vaxxers are just 1-3% of
the community at most, says Turner, but
it’s hard to change their minds. “They’ve
often had bad experiences and they’ve got
deeply embedded mistrust – they just will
not in any way accept the science.”
VALID CONCERNS
Some US paediatricians take a tough stance
on vaccine refusers, telling them to find
another doctor. It’s not a tactic Turner advo-
cates. Leave the conversation open and keep
asking about vaccination, she suggests.
With parents who are on the fence, it’s
a matter of teasing out their concerns and
addressing them. “Recognise that people’s
worries are valid and that it’s okay to have
concerns,” she says. “A lot of people are
needle-phobic, and we miss that one.” Or
they may think their baby is too young to
cope with immunisation or be worried about
what’s in vaccines.
Though listening is the first step,
healthcare providers should confidently
recommend vaccination, Turner says.
“Sometimes I don’t think we express the
importance enough of why we believe in
vaccinating.”
Julie Leask, a professor and social scientist
in the University of Sydney’s nursing school,
who researches attitudes to vaccination and
chairs a WHO immunisation group, agrees.
“We recorded conversations between hesi-
tant parents and clinicians and sometimes
we felt the clinicians were content to follow
the parents. We felt sometimes those parents
wanted to actually have a recommendation
to vaccinate after they’d discussed all the
issues. In some ways, it takes the agony of
that decision out of their hands.”
However, not everyone will be receptive.
“If they’re really resistant and you get too
heavy-handed, the discussion can end up
degenerating into a conflict or a game of
scientific ping-pong,” says Leask.
That can entrench anti-vaccination views.Scientists call it the “world-view backfire
effect”. Defending themselves forces people
to explain the rationale for their beliefs and
that cements their view. Care is also needed
when debunking common myths about vac-
cines, as people have been shown to forget
what is myth and what is fact. Lead with
positive information, not the myth, Leask
recommends.NORMALISING VACCINATION
Tailoring messages to values that are
important to people can also help
sway them towards vaccination.
If they’re big on personal liberty,
present the options clearly and
work through the pros and cons of
each with them. If they’re worried
about putting foreign substances
in their newborn’s body, talk about
how vaccination builds on natural
immunity.
As for the social-media mine-
field, it can be best to stay away
from Facebook, as responding
means posts get shown to more
people. Don’t give anti-vaxxers
extra oxygen, Leask says. Austral-
ian boxer Anthony Mundine was
slammed for an anti-vaccination
tweet, but outraged media reports
just gave him more exposure.
What about in a face-to-face set-
ting, such as an antenatal group? If
someone says they’re not vaccinat-
ing, ask why, share your own views
and move on. “You don’t want
the vaccination debate to drive a
wedge into relationships, and it
can, because people feel strongly.”
Auckland paediatrician Margue-
rite Dalton says she’s had some of
her most useful vaccination discussions
with other parents at the school gate. At a
school fundraiser, mothers with girls were
discussing the human papillomavirus (HPV)
vaccine. Dalton mentioned that her son had
it. “They both looked at me and said, ‘But
he’s a boy,’ and we got into a discussion
about why I thought it was really important
that even my son had it.”
She’s chatted with parents on the side of
a hockey field, saying her son had a sore
arm from his flu shot. “It lets other parents
know that’s what you’ve done with your
son, who’s the same age as their child – and
that you think it’s really important.”
Those conversations are valuable, Dalton
says, because it normalises vaccination –
“that it’s what we all do, that it’s part of
normal life”. lA
bout a third of first-time
parents at Auckland GP
Marcus Bishop’s Te Atatū
practice worry about their
baby’s first jabs at six weeks,
particularly if there is a family history
of an adverse reaction or
autism. “That’s the key time
in terms of education and
dispelling myths, and it’s
often when people are quite
emotional, tired and fearful.”
Building trust and spending
as much time as it takes helps
parents feel comfortable about
immunising, Bishop says.
His practice has 20-minute
appointment times, instead
of the standard 15 minutes.
“But I’ve certainly had several
vaccine chats that go on for 40
minutes.”
Some parents want to delay
the first vaccinations, but letting
them know about local cases
of whooping cough, which is
included in the six-week shots,
can change their minds.
If patients know their GP
doesn’t just unthinkingly toe
the traditional line, they’re
more likely to trust what they
say about vaccination, says
Bishop, particularly if they
suspect doctors are being brain-
washed by drug companies.
“For a long time I’ve looked critically
at the traditional approach of using
antibiotics to manage ear pain,” he says.
Evidence shows that antibiotics reduce
the average
length of earache
only from eight
days to seven.
When exactly
what is pre-
dicted happens,
and the child’s
ear returns to
normal without
antibiotics,
“they can see
we know what
we’re talking
about”.‘Tired & tearful’
“In some ways, it takes
the agony of that decision
out of their hands.”
GE
TTY (^) I
MA
GE
S
From top, Nikki
Turner, Julie
Leask and Marcus
Bishop.