by Daniel Salmon, PhD, MPH


Having spent the last two decades working in vaccine safety, I am often contacted by parents with concerns about vaccines for their children.

Typically, one of the parents has a lot of concerns about vaccines and the other parent is concerned about not vaccinating their child. So I guess they both have concerns, while very different.

They come to me with a wide variety of questions. Often they have specific concerns, like the number of vaccines given at one office visit, or during a short period of time, or in their first couple years of life. Dan Salmon

There usually isn’t a specific bad health outcome from so many vaccines that they are worried about. They just feel like it’s too much for their baby or infant.

Sometimes they don’t understand why their child needs a certain vaccine. For example, they don’t understand why they need to vaccinate their baby at birth if mom doesn’t have hepatitis B.

Or maybe they feel that diseases like chickenpox or measles aren’t that serious and their child may be better off getting the disease than the vaccine.

Sometimes they have really specific concerns about the safety of vaccines. Often they will talk about a family member (or many family members) who have an auto-immune disease or other disease.

They are concerned that their child may have a genetic risk to a bad vaccine reaction.

Sometimes they are very specific about a disorder or other problem they are worried the vaccine might cause, such as autism or ADHD.

Many of these parents are worried about very, very small risks to their child, including but not limited to vaccines. Often they talk about ingredients in foods and household products and what impact they may have on their child.

Often they ask about specific vaccine ingredients that they have heard are in vaccines.

I remember once commenting to a mom that, as a father, I think it would be really hard to try to eliminate so many extremely small risks. She responded that it is, but that is her job as a mom.

One thing is common among all these parents—they are really committed parents who want what is best for their children. They are trying to do what is right for their child.

They are not anti-vaccine. They are not ideologically opposed to vaccination.

I try to listen carefully to their questions, which are usually already pretty well articulated by the time they talk with me, and provide the best science to answer their questions.

I tell them what studies have been done and what they do (and don’t) tell us. I discuss the likelihood that the vaccine really causes the adverse reaction they are concerned about.

If the science indicates that the vaccine does cause the adverse reaction, I talk about the level of risk it may pose to their children. I talk about the relative increase in risk the vaccine might cause, but I try to really emphasize the absolute risk—if your child got this vaccine, what is the chance or likelihood this bad thing may happen to your child.

I also talk about what the science can’t tell us. I discuss the uncertainty in the studies that have been done and what studies that would be helpful have not yet been done.

Often these parents have already done a lot of research on their own before they talk with me. Usually they have already spoken with their doctor and family and friends about vaccines.

They are coming to me because despite all of this research and dialogue, they have remaining concerns.

I am not a clinician and I am not their child’s doctor, so I don’t make specific recommendations about what their child should do. I do talk about what is recommended for their child and why it is recommended.

Sometimes it feels like because I am focused on the science and not trying to convince them to vaccinate, they tend to believe what I am telling them.

I try to include the community and public health impact of their decision for their child. They tend to listen to what I have to say and some have questions. I usually get the sense that they have heard this before. It often feels like, while they consider the impact their child may have on others, they are going to mostly base their decision on what they believe to be in the best interests of their child.

We seldom discuss the value of vaccines. While we may talk about how serious and common some diseases are, we really don’t get into the many ways in which vaccines play an enormous role in their child’s and family’s life, or the communities they live in.

We don’t talk about the time they would need to take off of work to stay home with a sick child.

We don’t talk about the importance of schools not being a source of disease outbreaks, or having to close because so many students and teachers are sick.

We don’t talk about the economic advantages they and their employers enjoy because their child stays healthy.

We don’t talk about the savings in time their doctors and public health officials can spend preventing and treating the many diseases impacting children today because they don’t spend that time fighting once common childhood infectious diseases.

We don’t talk about the savings to our health care system because vaccines keep children healthy and are incredibly cost effective.

Why don’t we talk about the value of vaccines? I’m really not sure—maybe because they don’t have specific questions about these things? Maybe I am trying to focus on things they are concerned about and don’t want to be trying to convince them to vaccinate. Perhaps because much of this seems obvious, even though people really don’t think or talk about it very much?

We don’t think about what it took to make sure we have clean water when we turn on the faucet. We don’t think about what happens after we flush the toilet.

As parents, we don’t think about the impact of losing half our children to disease, as was the case for most of our history.

As a society, we need to do a better job of making people aware of the value of vaccines. It is so easy to take things for granted, even though they have a huge impact on our lives, because they are absent from our sight.

Many of my peers have similar conversations with parents. I think that they find the time to talk with parents, as I do, because we feel that these parents desire to get good information and make an informed decision.

I wonder sometimes if we in the medical and pubic health communities need to find better ways to inform parents about the risks and benefits of vaccines and make sure their questions are answered.

How do we talk about the value of vaccines?

As I think about the approach I use with parents, I think that it is effective. However, I also realize that there is very little science showing us what works with parents to address their hesitancy.

So I share my experience for a few reasons.

I think it is a mistake to pigeonhole parents who have concerns about vaccines as “anti-vaccine.” This is not my experience with hesitant parents and survey research shows that very, very few parents are ideologically opposed to vaccines. Labeling these parents in a negative way in not helpful.

I was once called “anti-vaccine” by a colleague because I was engaging and listening to a parent who this person considered to be “anti-vaccine.” As I have spent most of my professional life trying to optimize the prevention of vaccine preventable and vaccine induced diseases, I didn’t like being called this. I also wondered why this person felt the need to call me names. It’s fair to say that this approach didn’t lend itself to rational discussions.

Parents concerned about vaccines should be recognized as caring parents.

I believe that most parents want to base their decisions on science. Perhaps more science and sharing this information with parents would help these parents and their children.

Many of these parents didn’t trust the accuracy or credibility of the sources for vaccine information they used before talking with me. I’m not sure if my position in academia, my acknowledgment of limitations of the science, or the fact that I wasn’t trying to convince them of anything made me a more credible source of information?

As a researcher and public health practitioner, I am convinced that we need to find evidence-based approaches to meet the needs of parents who are hesitant about vaccines.

We need to find a way to talk about the value of vaccines.