I am writing in response to the article titled “Faced with vaccine refusers? Save your breath” by Dr. William G. Wilkoff.
I am a family medicine physician in Spokane, Wash., and have been in practice for the last 12 years. I take care of patients from infancy to old age and through all stages of life between. As a primary care provider, I sympathize with the concerns of Dr. Wilkoff and many others on the front lines of the vaccine debate. It takes much time and energy to talk to patients and parents about the benefits and safety of vaccination and about the sound science behind vaccines. It is exceedingly frustrating to expend so much energy and passion, only to be met with refusal – refusal of interventions that we know to be lifesaving. I take issue, however, with the assertion that it is not worth our time and breath to discuss the importance of vaccination with our questioning patients. I feel this assertion verges on being irresponsible. I worry about the impact that such a statement will have on our primary care providers who are fresh out of training and have yet to experience the positive influence that they can have on patients’ opinions regarding vaccines.
There are a multitude of reasons that people refuse vaccines. The origins of vaccine refusal go back to the beginning of vaccinations themselves, when Edward Jenner introduced the smallpox vaccine in the 1800s. Back then, the refusals most often had to do with the fact that vaccinations were made mandatory, and people felt this government requirement infringed on their personal liberties. Today, however, the most common reason for vaccine refusal, at least in my own practice, seems to stem from fear, pure and simple. Most recently, Dr. Andrew Wakefield, who published an article in the journal The Lancet in the late 1990s suggesting a causal relationship between administration of the MMR vaccine and autism, has stirred up the anti-vaccine movement. Despite the fact that his research has been debunked and he has been stripped of his medical license for falsifying and misrepresenting data, his impact persists. Our efforts are not aided by celebrity figures (actors and politicians) who have a wide-reaching public voice and use their platforms to disseminate misinformation regarding vaccines. There are also the anecdotal reasons that people refuse vaccines – they know someone who had a serious adverse reaction following vaccination or they themselves got sick following vaccination.
We, as primary care clinicians, are charged with determining the reasons behind each individual vaccine refusal so that we can clear up misunderstandings about vaccines. We are asked to do this in a limited time frame, when we have so many other issues to address in an office visit, and we often are speaking to only one or two people at a time. Does fighting this fight often feel like an uphill battle and an impossible task? Yes. Are there other things I could be doing with my time during that office visit? Absolutely! But this is our job. At our core, we are teachers. We are there to educate our patients about health and illness and prevention. Gone are the days of paternalistic medicine. Patients are more involved in their health care than ever before, and they expect to be part of the conversation and decision making process when it comes to interventions such as vaccines.
I completely disagree with the assertion that we should not waste our time discussing vaccinations with patients who initially decline them. Every single day I am able to talk patients into getting vaccines who initially refused them. Perhaps I have success because I come at the task in a nonjudgmental way. We have to remember that patients are not trying to be difficult. They are just trying to make the best decisions for themselves and for their family members. People are more open to hearing what I have to say when I acknowledge their concerns. Perhaps it is just that they respect what their doctor thinks and the fact that I am recommending it, alone, is enough to encourage them. After all, if I, as a doctor who has been through years of training, believe in vaccines, and take them myself, and give them to my own children, then why shouldn’t they feel safe about getting vaccinated? Perhaps it is because I am, as I like to tell my pleasant but challenging patients, annoyingly persistent. I will present the same message over and over again every time we see each other, and eventually they understand how important the issue is – or maybe they just get so tired of hearing me say the same thing repeatedly that they give in, just so I will stop talking. Either way, I win! Or, more seriously, perhaps it is that my patients have had some experience (someone they know had a serious outcome from a vaccine-preventable illness) that changed their minds. If we don’t offer up the topic for conversation, we will never know.