Vaccine Communication Skills: How to Speak with Vaccine-Hesitant Parents & the Media

1. Vaccine Communication Skills: How to Speak with Vaccine-Hesitant Parents & the Media Kris Calvin CEO, AAP-CA

2. Objectives • Understand changing concerns of vaccine-hesitant families • Gain skills & best practices for effective communication with vaccine hesitant families • Become more comfortable skills engaging the media on vaccine issues. • Understand how these skills translate in the advocacy arena (example of AB 2109).

3. Vaccination is the top Public Health achievement of the 20th Century MMWR 1999; 48:241

4. 2010: Practicing Pediatricians: Top Vaccine Safety Concerns of Patients/Families • Autism • Thimerosal • Aluminum • Pain of so many shots • Why so many shots at once/so early? Concern about overwhelming • the immune system. • Have not seen these diseases so do not see the value that outweighs any risk

5. 2012 Vaccine-”educated” parents • May be “pro-vaccine” for themselves, but object to it for infants/children • May no longer believe in a vaccine-autism connection (or at least will not say so) • Want “green” vaccines—pure, natural (no additives) • Overwhelming the young immune system = #1 concern, many want alternative schedule

6. More 2012 Parent Concerns • General mistrust of scientific research/systems of care—funding, motives (per shot payment) • My unvaccinated baby is “healthier” than vaccinated children (rosy cheeks) • I am fine not caring about “public health”—my responsibility is MY child only • Highly influenced by non-MD providers—chiropractors, nurses, midwives/doulas

7. Kindergarten PBEs by County 2000 2008 Lee et al NVIC 2010

8. Do you matter?

9. Do practicing MDs consider it important to have effective vaccine communication skills? • Many spoke to what a huge part of practice vaccines have become. • Numerous spoke about the importance of these skills for both general pediatricians and subspecialists. • Importance of subspecialist supporting need for vaccines, even in cases where they do not give the vaccines themselves. • Also for many children with special health care needs, the subspecialist is the medical home.

10. Why Parents Who Planned To Delay/Refuse Vaccine Changed Their Minds Gust et al Pediatr 2009;122:718

11. How can you respond?

13. From FFrom Practicing Pediatricians: Best Practices

14. Practicing Pediatricians: What I didn’t think I would do or see! • Nearly all have learned to “negotiate” vaccines for some families, using slightly modified “alternate schedules” as part of routine practice. (This requires diligence, documentation and clear communication about what is acceptable and what is not. This is NOT about substituting a Sears-type schedule for science.) • Many parents feel it is now “due diligence” to at least question one or more vaccines, even if they will readily accept them. • MD must deal with own anger/rejection at not being trusted over vaccines.

15. Listen first Ask each family/parent what, if any, are their concerns about vaccines. “Having a prepared spiel and spouting lots of science without knowing what someone’s specific concerns are wastes time and does not build trust.”

16. Assess depth of concern • First tier: Parents who want to “exercise due diligence”. • Second tier: One or more specific fears based on myths in the media or from friends, that if listened to and carefully responded, will set aside. • Third tier: those who are fearful of vaccines either due to a close personal experience (a sibling whose child had autism after a vaccine, or had what they perceived as a bad adverse reaction) or who refuse vaccines as part of a larger life philosophy.

17. Be ready for your own negative emotions. • Doctors need to recognize that they need to come to terms with emotions of anger or disappointment in parents who listen to celebrities or media rather than trained MDs, who feel that they know what is best for the child. Those emotions; move beyond judgment to help the patients.

19. Pre-empt resistance • Begin at the first visit letting the family know proactively their position as a doctor in strong support of vaccines for their child. Give websites you trust about vaccines. • Share if you vaccinate your own child/ your niece, your nephew.

20. Use “stories” rather than theories • Focus on those diseases that are still seen and they can understand, and tell stories about children who did not get vaccines.

21. Other Lessons Learned • Maximize benefits to their child • not a public health discussion • vaccines provide protection • risk of disease for omitted vaccines

22. BOTTOM LINE: This is not a debate, it is a conversation. It doesn’t matter if you are “right” ; it matters what they want and decide to do.

23. Working With the Media Improving the Value of Medical Journalism <Media slides courtesy of Val Ulene, LA Times health columnist>

24. Why Engage the Media As a major source of medical information, the media can be particularly important in educating the general public, the medical community and policy makers.

25. Most news articles on medically related topics fail to discuss important issues such as evidence quality, costs, and risks versus benefits

27. Barriers to Good Medical Reporting • Lack of time • Lack of space • Lack of knowledge

28. Overcoming Barriers: What Can Doctors Do to Help • Make yourself available • Provide accurate, up-to-date information about health-related topics • Be professional • Tell a good story

29. Should I Do the Interview? • Find out what the reporter wants to know and what their attitude toward the subject might be • Get to know the media outlet • Determine if you’re the right person to do the interview • Decide whether it’s worth your time and energy

30. DON’T BE AFRAID TO TURN DOWN AN INTERVIEW!

31. Where Do People Get Their News?

32. Use Social Media About a quarter (27%) of adults say they regularly or sometimes get news or news headlines through Facebook, Twitter or other social networking sites. This rises to 38% of people younger than 30, but now spans a notable share of older Americans (12% of those 65 and older) as well.

33. Preparing for interviews • Bring the journalist up to speed • Get yourself up to speed • Prepare and practice key message points • Review facts and figures • Identify questions (easy, hard and terrible) and formulate responses

34. The Interview • Answer their questions in clear, concise, simple language • Stick to what you know • Take charge • Take a stance • Be enthusiastic!

35. Avoid Getting Trapped • Stay calm and positive • Don’t pretend to know something you don’t know • Correct inaccurate information • If you make an error, correct yourself as soon as possible • There’s no such thing as “off the record”

36. Follow-up After an Interview • Ask if you’ll have the opportunity to review and correct the piece • Make yourself available for follow-up questions

37. Don’t Wait for Them to Call You! • Send press releases • Invite to press conferences • Provide them with information kits • Reach out to personal contacts • Submit letters to the editors • Write spec articles

38. Not for today--AB 2109 (PAN) PBES • REQUIRES HEALTH CARE PROVIDER SIGNATURE FOR PBE • INTENDED TO DECREASE CONVENIENCE PBES WHILE STILL PERMITTING PARENTAL CHOICE • BASED ON WASHINGTON STATE LAW SHOWING RESULTS • LOW BURDEN TO MD PRACTICES—FAX/EMAIL OK; FEW PATIENTS PER PRACTICE

39. THANK YOU!