For anyone who thought of measles as a disease of the past, the past several weeks have come as a shock. At least 55 cases of the illness, most of them of unvaccinated children under the age of 10, have been reported in the Pacific Northwest. But an outbreak here in Oregon was almost inevitable: The state has some of the lowest inoculation rates in the country. In the past several years, more and more families with kindergarten-age children have sought nonmedical exemptions from school immunization requirements.
When I was pregnant with my first child, other parents in Portland often asked me whether I planned to vaccinate her on a delayed schedule — or at all. As a first-time mother-to-be, I thought they knew something I didn't. When I looked online, the search results were full of warnings about the supposed dangers of vaccines. Even with my training as a lawyer, a job that requires close analyses of texts, it was hard to decipher which sources were credible. Eventually, my husband and I turned to our pediatrician, who assuaged our concerns. But I knew that I couldn't be the only parent adrift in this sea of competing claims.
Between a surge in people getting shots and a corresponding surge in activism against stricter vaccine requirements, there are nervous, undecided parents in the middle, feeling besieged by the self-righteous rhetoric.
My independent nonprofit, Boost Oregon, has found a way to reach these families by giving them an opportunity to learn about vaccines directly from medical professionals. The response has been overwhelmingly positive. In exit surveys, the vast majority of people who attend our workshops say they've decided to vaccinate their children as recommended by the American Academy of Pediatrics. Our approach works, but it's time- and labor-intensive. Though we're training medical professionals to bring these workshops across the state, it's challenging to scale up quickly. After nearly four years of these efforts, I've learned that debunking misconceptions is a delicate art.
Vaccine-hesitant parents aren't stupid or anti-science. Often, they're not even opposed to vaccines; they're just scared. Anxiety leads them to postpone the decision and refuse shots at the doctor's visit, thinking they'll do more research and follow up later. Some parents recoil at the idea of sticking a needle into their perfect new baby — especially because they didn't receive as many vaccines as children do today. As a result, they wonder whether all these injections are really necessary, or if they can be spread out over time. It doesn't help that they grew up hearing from figures like actress Jenny McCarthy, or that other celebrities continue to tout vaccine misinformation. This fearmongering had decades to spread in the culture.
When our organization trains pediatricians in how to communicate with patients, we emphasize that they can't sweep all that junk science away at once. Most parents' first opportunity to ask a doctor about the inoculation schedule is during their baby's checkup two months after birth. This 20-minute appointment has to cover a plethora of important issues, from feeding to sleeping to diapering — which doesn't leave much time to ask about vaccines. If a doctor reacts with dismissal or condescension to parents' questions, the parents shut down. They turn to those they already trust, such as friends or family members, which sometimes leads to a clustering of unvaccinated people.
We allot at least two hours per workshop so that parents have ample opportunity to talk through their concerns. Some come in with notebook pages filled with handwritten questions and sheaves of online articles they've printed. First, though, we create a comfortable, welcoming environment by having everyone introduce themselves. Before so much as touching the topic of how vaccines work in the body, or how they're developed, our educators say a little about their backgrounds and hobbies, and the children in their lives. When we present the science, we don't want to come across as faceless authority figures — we want to make clear that this is a personal issue for us, too. Only then do we respond directly to parents' concerns about vaccines.
We tell doctors not to throw data at their patients. The single story that a parent hears about their cousin's classmate's niece supposedly developing a neurological disorder sticks in the mind more than the statistics about the anonymous millions who didn't suffer any side effects. We also tell them not to brandish photos of sick children. Often, fear and shaming tactics turn people off or freeze them in indecision. Choosing to vaccinate requires parents to have agency, and we want them to feel confident about their decision.
During presentations, we take care with our language. The anti-vaccine movement has made "herd immunity" seem like a nonsense term, and something about that vocabulary conjures up a mute animal, going along unthinkingly with the crowd. Instead, we use the term "community immunity."
We also encourage physicians not to kick families out of their practices: One in eight doctors report that they always dismiss patients who refuse vaccines. Often, they cite the need to protect other patients who, for health or age reasons, can't be vaccinated. But this may spur families to cluster in medical practices that exploit, and profit from, anti-vaccine rhetoric. It's also a lost opportunity: A doctor would never reject an obese patient for not losing weight, or a smoker for not quitting cigarettes. Turning away patients means losing the chance to encourage positive behaviors over time. A parent who develops a relationship with a pediatrician and sees how much that doctor cares for his or her child might be more amenable to following vaccine recommendations down the road.
We've had over 300 families participate in our workshops. Most learn about our organization from friends, social media or their obstetrician's or pediatrician's offices. So, to some extent, the attendees are self-selecting; they seek information and are open to dialogue. We want to reach the parents in the middle who are nervous and confused. We do not attempt to convince the most hard-core skeptics (who comprise a tiny minority of the population).
But occasionally, those opposed to vaccinations have sought us out. At one workshop, an anti-vaccine activist aggressively interrupted our educator and threw every possible anti-vaccine trope at him. He stayed cool and answered them point by point, which frustrated the activist and prompted her to walk out. I was nervous that this encounter would stoke fears among the expectant families in attendance, but it actually turned them against the activist's viewpoint. They wanted a deliberate, nondefensive conversation — not a screaming match.
Sometimes the sheer robustness of anti-vaccine rhetoric is discouraging. It saddens and angers me that people are putting others at risk by not vaccinating their children. But making parents feel small or selfish — or freezing them out or bossing them around — isn't the solution. We have to connect with parents using empathy to answer their questions with evidence-based information. We want them to feel empowered by this information to make the best possible health decisions for their children.
Nadine Gartner is a mother, lawyer and founding executive director of Boost Oregon in Portland. This article is presented as told to Washington Post editor Sophia Nguyen.
