One Way to Increase Vaccination Rates: Calm Discussion?

The question of declining children's vaccination rates -- and how to improve them -- exploded into the public consciousness early this year when a measles outbreak, linked to Disneyland, spread across California and to other states.

Since then, SB 277, a bill to abolish the state's vaccine "personal belief exemption," moved through the legislature amid heated and vocal opposition. It was signed by the governor last month. Under the law, all school children must be vaccinated against 10 different diseases. Only those who cannot be vaccinated for medical reasons are exempt.

A Perspective published in the journal Pediatrics offers a thoughtful breather on the rancorous debate we've seen in California. In the essay, Holly Witteman, an assistant professor of medicine at Laval University in Quebec, writes in favor of applying a "shared decision making" approach with vaccine hesitant parents. This means engaging them with a combination of information and helping people clarify their values.

"What I like about approaches like shared decision making," Witteman told me in an email, "is that they center the conversation around what matters to patients."

"We should at least be talking about these kinds of approaches when we talk about concerns about immunization rates, rather than throwing up our hands as though there is nothing that can be done to help parents overcome vaccine hesitancy."

Witteman is not a physician and when friends ask about vaccines, she advises them to talk to their doctor, but she's also an expert in medical decision-making. In the essay she describes conversations with friends and family members where she explains why she has chosen to vaccinate her own children.  She talks about the facts around vaccines -- both risks and benefits -- but she also goes beyond facts to her own values:

I explain how I am willing to accept the very small risks of vaccines because I could never live with myself if my children were injured or killed by a vaccine-preventable disease or if they passed along a virus to someone more vulnerable and I had done nothing to prevent such events.

She points to early research trials which suggest that providing shared decision-making tools helps to increase vaccination rates.  She cites an anecdote from her own experience -- a friend who pointed to the "respectful factual calm" reassurance from Witteman that contributed to the family starting vaccines for their child.

"It's such a crazy polarized topic everywhere," the friend commented to Witteman on Facebook (and Witteman shares in the Perspective with permission), "that it's really hard to have a conversation about it without feeling attacked. Thank you."

This is what I have seen as I have covered the debate around SB 277. Those who fear vaccines were called stupid, anti-scientific or selfish -- which is unlikely to help improve vaccination rates, Witteman suggests. "It may feel good to rant and rave, but people rarely change their minds because someone called them stupid and wrong."

Now it remains to be seen if requiring vaccines to attend school for all but those with a medical exemption will improve vaccination rates. Witteman says she's not opposed to the law, but in an email said she "wonder(s) if it might backfire by increasing polarization, entrenching views, and driving parents who are vaccine hesitant further toward vaccine refusal."

Now a former Assemblyman has filed paperwork with the Office of the Attorney General for a referendum to overturn SB 277. Backers of the law's repeal have until late September to gather 365,880 signatures to qualify for the Nov. 2016 ballot. If they are successful, the law will be put on hold until after the election.