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Johns Hopkins Bloomberg School of Public Health


Graduate students in JHSPH’s Vaccine Policy Issues class examine current national and international policy issues across the spectrum of vaccine work. As a part of the course, students selected topics for analysis. Selected entries will appear in a series on the IVAC blog. This is the final of the series.

Guest post by Shreya Patel, MPH

More often than not, these are dreaded words for significant others, employees, and teenagers everywhere. I, however, am not your significant other, boss, or parent. For this discussion, you can call me Switzerland and I am going to be metaphorically sitting directly between parents and pediatricians (ironically, that is often also my physical location as the slightly awkward fourth-year medical student). I am here to tell both parties that we need to talk. For one minute, let’s pretend that we are not warring factions. We will not (figuratively) stick our fingers in our ears and say “la la la, I can’t hear you” while the other party speaks. We will not mumble confusing jargon or excuses or insults. We will not storm out of the office. Ground rules clear? Now for the topic: vaccinations.

Vaccines protect a society from diseases through herd immunity. The more vaccinated people, the less likely a disease will spread. In today’s global society, infectious diseases can jump between continents with a boarding pass and unvaccinated children are suffering. Studies have shown that unvaccinated children are 35 times more likely to contract measles, 6 times more likely to have had pertussis, and 23 times more likely to get whooping cough compared to their vaccinated counterparts. Between January and April 2008 in the US, there were five measles outbreaks and 64 cases; all but one of the cases were either unvaccinated or did not have evidence of immunization. US vaccine exemption rates have been on the rise in the last five years with ten states increasing more than 1.5% and Alaska winning the unfortunate prize of the highest exemption rate in 2011 with 9% of its children currently unvaccinated. Vaccines have all but eradicated diseases that plagued our society in the past; but like any medicine, they only work when taken. So let’s start the discussion.

JHSPH Student Blog Shreya Patel

The author, Shreya Patel.

Parents, I sympathize. Aside from the physical and emotional stress of 2 AM feedings, tantrums over dinner, and your child’s first day of preschool, you are in a twenty-first century world bombarded by more information and opinions on how to raise your child than the average parent from the fifties received in a year. You rightfully worry about everything from what your child is watching on television to what they will be when they grow up. However, first and foremost, you value your children’s health. A physician offering to stick a needle into your child’s arm full of inactivated diseases and other components is certainly a scary thought. Many of you agree that vaccinations are helpful, but worry about their safety. Granted, the risks of being unimmunized in a well-immunized community are low (albeit not as low as an immunized child). So this is where it becomes vital to have a conversation with the only other person as invested in your child’s health as you, your pediatrician. The Internet is an extremely valuable resource for anything from news to celebrity gossip, but is also an open arena for anyone’s opinions, sometimes reading like a sequel to the Rocky Horror Picture Show. Making a decision about vaccinations without talking to your pediatrician is akin to determining how big the universe is without talking to your local expert physicist.

Pediatricians, I sympathize about your job, too. A seemingly endless stream of cranky children coughing in your face, all who must be seen, evaluated, and treated almost immediately in order to move on to the next. Comparatively underpaid and overworked, amazingly, you still know exactly what tricks make even the most terrified child smile. Then, in the middle of your busy day, comes a parent staunchly refusing a medical intervention you and every major medical society in the world recommends. It is often too easy to quickly dismiss them as uneducated, ignore their fears completely, or worst, immediately surrender to their medical opinion over your own. However, while it may seem like you are going to battle with the parent, in reality, you are protecting the health of the child. Refusing to address parental concerns in a calm, respectful manner is not in the best interests of your patient, their parents, the medical profession, and even public health in general.

Conflict resolution specialists use a concept called perceived or enlightened self-interest. To maximize one’s own self-interest in a disagreement, it is generally necessary to recognize the self-interest of the other party and understand that there are solutions where both parties will be satisfied. Instead of parents and pediatricians approaching the conflict from opposite ends of a football field, what if instead, they started on the middle ground where the both agree? Both primarily want to ensure children are healthy and safe. They want children to avoid disease, grow and develop properly, and become productive adults. With so many fundamental, common self-interests, why are so many not even willing to start the conversation?

While my personal opinions on the matter have been revealed, I still consider myself in the middle of this argument and too often watch as both parties give up on the health of their children before any discussion. Parents, make a separate appointment to discuss your concerns and choose a new pediatrician if they refuse to talk with you. Your pediatrician has your child’s best interest in mind, years of education and experience, and hopefully, would like to work with you to come to a decision you are both comfortable with. You have a personal expert at your fingertips. Why resort to celebrities for your medical advice? Pediatricians, do your own homework on the evidence behind vaccine safety or rates of vaccine-preventable diseases. Remember that parents may be misinformed or scared and would like a forum to discuss their concerns. In the end, there will always be a minority who will still refuse vaccines. As someone about to enter the field of medicine and public health, my hope is simply that all parents make their decision with a full understanding of the risks and benefits after an informed discussion with their medical provider.

Shreya Patel completed her MPH at Johns Hopkins Bloomberg School of Public Health in May, 2012, focusing on international health, vaccine policy issues, and epidemiology. She is currently a fourth-year medical student at the University of Arizona College of Medicine and plans to enter the field of Internal Medicine for residency in 2013.

Posted by Kathryn Graczyk