From Vaccine Hesitant to Vaccine Confident: A Mother’s Journey and Recommendations for Public Health

At first, I had no hesitation about vaccinations. My parents did it for me and it seemed safe enough. So as a new mom making hundreds of daily decisions, I vaccinated my firstborn without worry.

Four years and four kids later, something had changed. Doubts had been sown in my mind from various sources – from conversations with new moms during play dates who expressed concerns or even chose to delay and/or opt out of vaccination all together to the information influx on the internet. Most powerful were the emotionally gripping personal stories blaming vaccines for horrible (even deadly) reactions in young children. For me personally, the documented ethical history of certain vaccines was disturbing. 

I wasn’t so sure anymore – all the ‘what if’s’ were swirling in my mind at every well-baby appointment building in pressure until I couldn’t stand the fear anymore. What if there was truth being suppressed by heartless pharmaceutical companies who could care less about my child over another profitable quarter? What if the ‘reports’ of far more vaccine-related injuries were true? What if even doctors were being misinformed and used to connect with the blindly trusting public? Were the virtually unseen diseases really a serious threat anyway? The narrative of suspicion and distrust was easy to accept in our age of information overload. 

After years of visiting drop-in clinic doctors, we had been assigned to a new young family doctor. I dutifully yet begrudgingly went to the well-baby appointments (which was a feat to do year round with 4 kids ages 5 and under). I’d see the doctor for a few minutes at most, and then he’d tell me what I already knew about my baby: he was healthy and growing well.

When baby #4 was born, I steeled myself to tell this new-to-me doctor that we would NOT be vaccinating. I was not interested in a discussion or push-back, and this clearly showed in my tone and manner. My new doctor looked at me for the first time (rather than his laptop or the baby), blinked a few times, slowly said, “Okay”, and that was that.

We never spoke of it again.

Life passed quickly with a bustling growing family. Seven years sped by in a flash, our kids continued to thrive and vaccine-preventable diseases were the last thing on my mind. I went to the doctor when something was wrong, like an ear infection or other minor concerns.

In early 2015, I came across a vaccine-related news article. Scrolling down to the comment feed, I found hundreds of fellow Canadians had lodged their opinions about people just like me – ‘anti-vaxxers’ (anyone who didn’t vaccinate for anything less than a medical reason). It was profoundly disturbing to read everyday people, my virtual neighbours, speak in such scathing, hateful terms. Some openly called for anti-vaxxer parents to be stripped of their parental rights, be prosecuted and have their children taken into custody for child abuse.

This derision and open hostility did not make me want to talk to ANY ‘pro-vax’ person. Quite the opposite. I turned to my anti-vaxxer friends, online groups, websites, blogs etc., where I found warmth, welcome, compassion, understanding and respect. 

The ‘cultural conversation’ was heating up everywhere, so I decided to settle the matter once and for all by PROVING that I was right NOT to vaccinate. I set out to personally review the ‘best’ each ‘side’ had to support their position (and undermine the opposition) in my evenings after our then 7 children were in bed. I was certain I would find the rock-solid proof I needed to tell my family, friends and the angry mob in society to leave me alone.

Long story short (you can read it here: Learning the Hard Way: My Journey From Anti-Vax to Science), I did not find what I was looking for.  A pro-vax friend of a friend reached out via Facebook to offer her assistance in my search. I was highly skeptical, but she disarmed me in our first chat by saying I was a good parent and it’s OK to ask questions about vaccines. She treated me with basic dignity and respect by acknowledging that it’s hard to make so many critical decisions on behalf of our kids ‒ especially concerning health matters with so much media attention and information overload.

She disarmed me by treating me with dignity as a person and parent.

She validated that it’s actually responsible parenting to ask questions about an invasive procedure.

She re-directed me by encouraging me to get answers – BUT to carefully check the sources.

I did. It only took 2 evenings for me to do a total 180. There was no longer any doubt in my mind that vaccines were reasonably safe and effective. Morally, it was still a very difficult choice to be caught between our consciences and our kids’ safety. I completely understand how hard that choice is for parents to work through. Ultimately, we did call our doctor’s office in good conscience, and they very graciously booked us to start catching everyone up for a month later. 

For the next few weeks, life went on. But things were about to take a serious turn. The spring cold running through the kids the last several weeks wasn’t really going away. In my 8-month-old, it was actually getting worse, and was soon confirmed as the paroxysmal stage of whooping cough.

The next few weeks were crazy. I don’t like to recall it. I didn’t want anyone else to go through this if I could help them avoid it. So, from our 5-day isolation during antibiotic treatment, I chose to share my story, hoping to connect with other moms like me who had been caught up in doubt and fear: caring, intelligent, everyday parents who genuinely loved their kids and wanted to protect them from harm as best as they knew how. They weren’t hard-core anti-vaxxers – they were stuck somewhere in the middle for more than one reason.

The story got picked up by the CBC and went internationally viral.  It. Was. Crazy.

To my surprise, during the intense personal and media storm, many deeply caring health care professionals contacted me privately.  They shared from their hearts their struggles to help patients like myself who were not vaccinating.  They all asked me earnestly, how could they help parents be VACCINE CONFIDENT?

I don’t have a silver bullet answer for this excellent question.  It’s my hope that in sharing my personal story others might gain some insight, and then apply what works best in their situation.

My best advice:

It’s not for lack of information.  The solid weight of evidence is on your side.  A large part of this is a TRUST issue.  And you can help (or hinder) parents who are struggling to make this critical choice.

1. Treat people like PEOPLE – not specimens. Make eye contact and smile more. You have minutes to make or break a human connection with a likely frazzled overtired mom. A little human warmth goes a long way in the cold sterility of an exam room. 
2. Validate it’s OKAY to have QUESTIONS – it’s actually a reasonable and responsible parental action. Relax and don’t overreact to their concerns. Again, eye contact and smile. It sets people at ease. Nurses are great at this. Warmly offer to be a resource in hearing their questions and directing them to solid, well-backed research, so they can make an INFORMED DECISION.
3. Take the TIME or make the time – our conveyor-belt socialized-medicine approach has its cons. If time is not available in the appointment, connect them in a friendly no-pressure way to the nurse (who actually performs the vaccines anyway – nurses are GOLDMINES of people skills, information and support for parents). Introduce nurses by their first names and talk glowingly about them as you hand off your patient into their care. Again – it encourages trust, which in turn encourages productive positive dialogue.

These might seem ridiculously oversimplified but sometimes that’s all it takes to build trust. And trust is one of the most significant factors in this health crisis. You can help vaccine-hesitant parents become confident – it might not happen in one visit, but don’t underestimate the power you have to influence them toward or away from a solid, informed, confident decision.

A Message from CANVax:

Health care providers continue to be the most trusted source for vaccination information and advice, playing a key role in building and maintaining public confidence in vaccines and the health system that delivers them. Below are examples of practical tips that can be used to address vaccine hesitancy and concerns with patients and parents:

1. Techniques to discuss vaccination
Conversations with parents and patients who may be vaccine-hesitant can be emotional for all parties involved (1). When talking to parents and patients, consider:

a.     Introducing immunization in a manner that is presumptive rather than in a participatory manner:
Research has shown that it is more effective in introducing immunization in a presumptive manner to promote vaccine acceptance than in a participatory manner (2).

Presumptive: ‘Sarah is due for her routine vaccinations today.’
Participatory: ‘Would you like to do Sarah’s vaccinations today?’

b.    Using motivational interviewing:
Motivational interviewing is a helpful client-centred technique for dissecting and exploring concerns that vaccine-hesitant patients and parents may have towards vaccines (3). This type of interviewing focuses on working with the patient and parent rather than talking to them.

Example of a motivational interview path (4):

• Open-ended questions: What are your concerns?
• Affirmation: I understand
• Reflective listening: Your concerns are…
• Summarize: To summarize…

2. Health care provider recommendation
Health care providers continue to be the most trusted source for vaccination information and advice among the public. As such, provider recommendations are not only important in building confidence in vaccines but also in driving vaccine acceptance and uptake (5-6).

Research has shown that people are generally more positive, trusting and receptive toward the information received when it is something that they have heard before or if it is repeated, clear, and easy to understand in both format and language (7).  

When talking to parents and patients, it is important to (4):

• Avoid jargon that could be misconstrued, e.g., using the term “community immunity” instead of “herd immunity”, which may be off-putting for some.
• Avoid being technical.
• Deliver the message in a language and a context that fits the needs of the parent and patient.
• Use common denominators when comparing rates of an event.
• Explain single-event probability.
• Use visuals to help convey the information.

When presenting data, consider (4):

• Presenting data in absolute numbers (1 in 10 children) instead of relative risk (10% of children).
• Frame the message. Framing messages as a loss appear more concerning than framing them as a gain.
• Using stories.
• Using nudges to encourage vaccine acceptance. For example, noting that the majority of parents choose to accept routine vaccinations because they want to protect their children can nudge them to accept vaccines. Be careful not to plant fear, as this can backfire.
• Summarizing by providing the gist of the message (i.e., “And the reason this is important…”).

3. Reinforcing Vaccine Acceptance
Health care providers can reinforce vaccine acceptance behaviours by valuing the decisions of parents and patients who accept vaccines, as recommended, on time and on schedule. Further, emphasizing that choosing to vaccinate is a social norm that not only benefits the vaccine recipient but also their family and community (8).

For more resources, see "Addressing vaccine hesitancy – Clinical guidance for primary care physicians working with parents."

References

1. When parents won’t vaccinate their children: a qualitative investigation of Australian primary care providers’ experiences. Berry NJ, Henry A, Danchin M, et al. 19, s.l.: BMC Pediatrics, 2017, Vol. 17.
2. Clinician-parent discussions about influenza vaccination of children and their association with vaccine acceptance. Hofstetter AM, Robinson JD, Lepere K, Cunningham M, Etsekson N, Opel DJ. 20, s.l.: Vaccine, 2017, Vol. 35, pp. 2709-2715.
3. Improving Provider Communication about HPV Vaccines for Vaccine-Hesitant Parents Through the Use of Motivational Interviewing. Reno JE, O'Leary S, Garrett K, Pyrzanowski J, Lockhart S, Campagna E, Barnard J, Dempsey AF. 4, s.l.: J Health Commun, 2018, Vol. 23, pp. 313-320.
4. MacDonald NE, Dubé E. Canadian Guidance on Addressing Vaccine Hesitancy to Help Foster Vaccine Demand and Acceptance: Building Resilient Pro-Vaccine Communities. s.l.: [unpublished guidance report], 2019.
5. Vaccine acceptance, hesitancy and refusal in Canada: Challenges and potential approaches. Dubé E, Bettinger JA, Fisher WA, Hilderman T. 12, s.l.: Can Commun Dis Rep, 2016, Vol. 42, pp. 246-51.
6. Vaccine hesitancy: an overview. Dubé E, Laberge C, Guay M, Bramadat P, Roy R, Bettinger JA. 8, s.l.: Hum Vaccin Immunother, 2013, Vol. 9, pp. 1763-73.
7. Uniting the tribes of fluency to form a metacognitive nation. Alter AL, Oppenheimer DM. 13, s.l.: Pers Soc Psychol Rev, 2009, pp. 219-35.
8. Vaccination resilience: Building and sustaining confidence in and demand for vaccination. Dubé E, MacDonald NE. 32, s.l.: Vaccine, 2017, Vol. 35, pp. 3907-3909.