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
Slides 3-10 provide an introduction to the topic by summarizing the success of vaccines and acknowledging the rising concern about vaccine safety in the community.
At the end of the 20th century the Surgeon General, David Satcher declared vaccination one of the top public health achievements of the 20th century. Some would say it is the top achievement because of the number of lives saved and the cost-effectiveness of immunization.
MMWR 1999; 48:241

4. Why so many shots at once/so early? Concern about overwhelming
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 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
This map shows the rate of personal belief exemptions (PBEs) that parents have exerted on behalf of there children to avoid school immunization entry requirements in California. The distribution of underimmunized children is not even across the state of California. In 2000, only one county indicated in red, had more than 5% of its kindergarten students taking a personal beliefs exemption. By 2008 that number had increased substantially.
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
It is important to note that parents trust their doctors more than any other source. Doctors need to be able to discuss vaccine safety concerns and provide accurate information.
Gust et al Pediatr 2009;122:718

11. How can you respond?
We’re in a period of time now where we’ve got an array of controversies that focus on vaccine safety. The most explosive one right now seems to be the fear that vaccines, vaccine preservatives, or other vaccine components are associated with the rise in autism rates in the US. We also commonly hear the concern that children receiving several vaccinations at once will overwhelm their immune systems. We hear that diseases like polio, measles, and diphtheria don’t exist anymore. So why bother vaccinating against them. Some parents, and with the support of the naturopathic community, believe that such diseases are not particularly dangerous for kids and that getting the disease builds a natural immunity. And of course, thanks to the success of vaccines, fewer and fewer parents have ever experienced many of the once-common vaccine-preventable disease first hand. Some people, when asked about vaccination mandates don’t necessarily disagree that vaccines are helpful. But they do take objection to being told by the government that they have to do it. This can become more contentious as parents fear that some vaccines may be less than safe. Lastly, some parents point to big pharmaceutical companies who profit from distributing vaccines. 11

12. The concern over vaccine safety led to the development of Vaccine Information Statements which are available for every vaccine and should be given to parents and patients every time they are to receive a vaccine. The VIS provides information about the adverse events associated with each vaccine. It is important to inform patients about both the benefits and risks of vaccines. However, VIS statements may raise concerns with parents and patients.

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. Share if you vaccinate your own child/ your niece, your nephew.
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

26. This ad from Jenny McCarthy’s organization, Generation Rescue, appeared in USA Today. It may not be accurate, but it’s got great visual impact, the message is provocative yet clear, and it appears uncontested in the popular media with a website address people can go to for more information. And by the way, I did. Their site has a very sophisticated look, using citations from professionals who disagree with the mainstream. Remember, there are always some of those. This is intended to go directly to parents.

27. Barriers to Good Medical Reporting
Lack of time
Lack of space
Lack of knowledge
Based on interviews with medical journalists.

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
IT’S BETTER NOT TO DO AN INTERVIEW THAN TO DO A BAD INTERVIEW.
TRY TO UNDERSTAND THEIR GOALS. ARE THEY COMPATIBLE WITH YOURS?
Will the interview offer you the chance to make positive points or provide helpful information about your topic/issue/organization?
What type of publication or program is it? Is it reputable? Is it one you want to be associated with? Who is their audience? Is it one you want to reach?

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

31. Where Do People Get Their News?
The public’s top two sources of news remain television and the internet. Two-thirds of Americans (66%) say television is where they get most of their news, while 43% say they turn to the internet. About three-in-ten Americans (31%) say they get most of their news from newspapers. Radio was a distant fourth choice, with 19% saying they turned to it.

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.
Social networking has expanded the ways in which the public gets news and information.

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
Provide the journalist with pertinent background information.
Identify what the journalist is reporting on: Ask for specifics. Consider whether you’re the best person to speak with them about that topic. Would you/they be better off referring them to someone with more expertise in the field. Examples: anxiety column.
Inquire about their angle: Journalists approach most stories with a preconceived bias. Examples: infant toilet training, baby sign language, spanking
Provide them with information up front: They’ll come to the interview better prepared. You may be able to influence their bias.
Vet the journalist: They’ve vetted you. You should do the same in turn. Take a few minutes to look at what they’ve written. Specifically what they’ve written about the topic you’re discussing with them. Is their writing accurate? Is their writing credible? What is their bias?
Identify questions: Ask for the interviewer’s questions in advance. Anticipate other questions that may be asked.

34. The Interview
Answer their questions in clear, concise, simple language
Stick to what you know
Take charge
Take a stance
Be enthusiastic!
Keep your answers short—3 or 4 sentences tends to be ideal. Speak in complete sentences and avoid using medical jargon or technical language. Simplify, simplify, simplify. Break a technical subject down into something everyone can digest and understand. Use a metaphor, a personal story, an example or an analogy to explain your points/
Take charge: Don’t be led blindly along by the interviewer. Answer their questions but always try to bridge back to your key points. Don’t be afraid to disagree with assertions that a reporter makes or correct any misinformation that they may site.
Take a stand: Have a strong point of view about what you’re discussing. Try to change attitudes or inspire someone with what you say
Be enthusiastic: View this as an opportunity to share you knowledge and insights with the public. If you care about what you say, so will others!
Stick to what you know: Don’t comment on areas outside your expertise. Offer to refer them to colleagues who may be more knowledge in a particular area. If you don’t know the answer to a question, say so. For print media, offer to get the journalist the answer to their question before their deadline if possible.

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”
Don’t become defensive when asked a negative question or when an interviewer becomes confrontational. Stick to the facts

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
Offer to vet the piece: Rare with visual media like television. May have some luck with print media. Position it as ‘reviewing for inaccuracies’. You will not be granted an opportunity to ‘approve’ the piece.
Forge a good relationship with the journalist. It will not only improve the quality of the piece they’re working on….it will increase the chances they’ll reach out to you the next time they need help.

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/ OK; FEW PATIENTS PER PRACTICE

39. THANK YOU!