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By Anna Almendrala
When Theresa Ward had her first child 14 years ago, Pittsburgh's mother followed the pediatrician's recommendations and fully vaccinated her son on time.
But when the boy turned 3 years old, Ward began to worry about risks associated with vaccines, such as fever or rare but serious allergic reactions. She was also afraid of autism. Ward, who is now 30 years old, started to refuse booster injections for the toddler and when she had two other children, they are not vaccinated.
"I was in no hurry to choose to have them vaccinated because of the environment we live in," said Ward. "We are in the United States and we live in Pittsburgh where we have access to the best hospitals in case of illness."
Because she refused the vaccination, several pediatricians in the region rejected it, worried about the risk that this could present for their other very young patients. Ward finally landed at a pediatrician in East Pittsburgh who did not impose a vaccination on the patients. Instead, for several years, the doctor maintained an open dialogue with Ward.
The patience of this doctor has borne fruit.
In 2016, after a 10-day trip to India, Ward's perspective on vaccines began to change again. Seeing how people were suffering from preventable diseases, as well as lack of access to basic health care, Ward realized that his internal conflict about vaccines was egocentric.
"We have the responsibility for the greatest good in the world," said Ward. Upon her return from India, she went directly to her pediatrician to inform her three children about the situation. When her fourth child was born, she vaccinated him on time.
While the vast majority of Americans choose to have their children vaccinated, the number of unvaccinated children is increasing. The latest estimate from the US Centers for Disease Control and Prevention shows that in 2017, 1.3% of toddlers had only one stroke, more than quadruple the 0.3% recorded in 2001.
Ward's story alludes to the time and intensity of care needed to counsel a reluctant parent about vaccines. But as measles outbreaks continue in the United States, doctors and public health experts realize that they largely ignore the most effective methods of combating the anti-vaccine movement.
We do not have a consistent communication program on vaccines.
The safety and efficacy of vaccines have been studied for decades, but research on how to talk about vaccines and how to increase vaccine acceptance is still in its infancy. In the midst of measles in the United States, doctors and public health officials are quickly learning what works and what does not work when it comes to communicating with parents and communities who are reluctant to get vaccinated.
"These outbreaks show us that we are late," said John Wiesman, secretary of the Washington Department of Health. "There is no reason that people get sick of a preventable disease through vaccination."
And the little that is available has not yet been "expanded", nor extended to all local doctors' offices and public health services, said Dr. Saad Omer, epidemiologist, expert on vaccines and infectious diseases at Emory University in Atlanta. "We have no consistent vaccine communication program," said Omer.
Omer and Wiesman both testified at a Senate committee hearing held on March 5 to request additional funding for vaccine communication research to combat the spread of messages. anti-vaccine.
The lack of a standard operating procedure for vaccine communication is reflected in the way each municipality chooses to respond to the measles outbreak.
After a measles outbreak in Rockland County, New York State, local authorities temporarily banned unvaccinated children attending public assembly sites for 30 days. The controversial policy was considered aggressive, but resulted in at least 700 more vaccinations against mumps, measles and rubella in free clinics, according to the Rockland County Health Department. The decision provoked widespread public outcry among the region's Orthodox and Hasidic Jewish community, and a state judge issued a preliminary injunction against the ban on April 5th.
It's too early to know if public bans like Rockland's are effective in increasing vaccination rates, Omer said. Wiesman declined to specifically comment on the Rockland ban, but said that if public health was adequately funded in the United States, such orders would not be necessary.
"If we vaccinate people, we do not need to focus on those kinds of efforts that disrupt people's lives and really do not serve anyone," Wiesman told NBC News.
Empathy, active listening
An effective technique, called motivational interview, requires an experienced facilitator who uses empathy and active listening to get in touch with parents who may be angry or afraid of vaccines. That's what Siman Nuurali, the health care coordinator at the Minnesota Children's Hospital, used at the height of the Minnesota measles outbreak in 2017.
The Somali community of Minnesota had high vaccination rates, on par with the general population. But in the early 2000s, these figures dropped from 91% in 2004 to 54% in 2010. The experts attributed the decline for a decade to anti-vaccine groups claiming that childhood vaccines caused their children to develop of autism.
Nuurali and Somali-speaking colleagues attended community meetings in mosques to denounce anti-vaccination groups that had infiltrated the Somali community of Minneapolis. Nuurali has also actively tried to reach families of unvaccinated children.
Nuurali learned which statements ended a conversation and which led to an appointment for immunizations. She found that, from "MMR's photo does not cause autism," derailed the discussion.
"It seemed superior and condescending, as if we were not interested in anything other than a vaccination program," Nuurali told NBC News. "What worked for us was when we listened."
Thanks to the efforts of the Minnesota Ministry of Health, the Minnesota Children's Hospital, Nuurali and others, Somali children under the age of 6 have experienced a 262% increase in the number of April RMOs to August 2017 – the duration of the measles epidemic – compared to the previous year.
Omer is not surprised by Nuurali's experience.
"Motivational interviewing techniques go after motivation, but they do not reaffirm the wrong facts," Omer said. "If you try to correct incorrect information, they can actually turn against you."
There is already evidence that streamlining the process can make a difference.
Stop demonizing parents
Research shows that, in a patient's file, there is a standing order for vaccines that allows nurses, midwives, pharmacists or medical assistants to give the vaccine;
Initial research also suggests that when doctors use language with patients who assume that they will receive vaccines ("We need to do some injections"), as opposed to language that seems to require participation ("What do you do about injections? "?"), More families are accepting vaccines, Omer said.
To reach parents reluctant to vaccinate, public health professionals and researchers must first stop demonizing them, said Melissa Carrion, assistant professor of technical communication at Georgia Southern University. The next step is to sit one-on-one with the parents, a difficult task given that doctors are not reimbursed for vaccine counseling, she said.
In a study conducted in 2017, Carrion conducted 50 in-depth interviews with mothers like Ward, who chose not to vaccinate their children. Some were completely caught off guard, but Carrion discovered that most of them were simply looking to find health care providers to address their concerns.
"Nobody on the vaccine advocacy side wanted to spend that time recognizing their issues, but the anti-vaccine community gave them a lot," Carrion said. "These are the people who said," Yes, I will send you studies, yes, I will send you sites. "
This corresponds to Ward's experience. She spoke with a pediatrician whom she had trusted for years and who had taken the time to answer her questions.
"We found a pediatrician who would not be [mandate shots] and just gave me the freedom to treat him and have an open conversation about immunization, "she said. "He was very patient and happy to do it, and that really put my trust in him."
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