Immunisation
Messages to health professionals
In the United Kingdom, childhood immunisation has become a controversial issue, which is an ongoing challenge for health professionals. When claims were made by Wakefield et al', of a link between MMR, inflammatory bowel disease and autism, and parents' concerns were being fuelled by sensational reporting in the media, the Department of Health took the approach to firmly deny that immunisations were attached to such risks. Some parents were not convinced and some lost trust in the information given by health professionals about immunisations.
However, health professionals do now have a huge body of good research evidence available to them, which indicates the effectiveness and safety of the vaccines.
Here, the parents we interviewed talk about what helped and what didn't help them when discussing their child's immunisations with a health professional.
The overwhelming majority of parents believe in immunisation for their children. We have however included here the views of a few parents who do not believe immunisation is right for their own child based on their personal beliefs. Their views represent a small proportion of the population.
Building trust with parents
- When health professionals acknowledged and explained all the risks involved with immunisations, parents felt more able to trust them, than when concerns about potential risks were dismissed.
- When parents felt that doctors were giving their own professional opinion based on an assessment of the child's personal medical history, rather than just giving out a government line, they were more likely to trust what health professionals were saying.
- When health professionals didn't just assume that their child would be immunised but talked about the choices parents had, parents were more likely to take on board the advice that was being given.
- Parents would like health professionals to be open and honest about the reasons behind some of the advice they give.
- Parents want to feel partners in informed decision-making and not to feel coerced in to immunising their children.
- Parents would like the vaccine product insert sheets detailing the components of the vaccine, when the manufacturer states it shouldn't be given and the side effects associated with their products. Information on adverse vaccine events is not collected reliably through the 'yellow card' scheme and adverse vaccine events are under reported.
Acknowledge and explain all the risks involved with immunisations, rather than dismiss parent's concerns.
Acknowledge and explain all the risks involved with immunisations, rather than dismiss parent's concerns.
I think that they have to empathise with the difficulty of making a decision under the kind of glare of media speculation. Suffice to say I think they probably presented it as a kind of considered decision to be made rather than an inevitability. I think if they'd presented it as an inevitability I think people who maybe think they're informed and are worried will then recoil from that. So I think they should present it as something that is to do with, you know, it's a considered decision rather than a kind of inevitability. And I think probably it's probably best if they relate their own sense of dilemma and research and some of that uncertainty in it all.
I think if a doctor presents it as a certainty and is blas' and brash and confident, over-confident, that would certainly make me recoil and think twice. Because it would make me feel they're selling it to me rather than giving me the facts, which I'm sure the facts can be disputed otherwise they wouldn't have been a scare. I'm sure the facts are that actually you can't say categorically that it doesn't cause autism. So if someone were to tell me, maybe statistically this and this and this, but if they were to be very persuasive and very categorical that would make me recoil from any clarity about what I actually was going to do.
It is better to give a professional opinion and explain on what evidence the opinion has been based, rather than just give out the government line.
It is better to give a professional opinion and explain on what evidence the opinion has been based, rather than just give out the government line.
I think where you, wherever you felt they were talking from their own opinion rather than from the government line you, you were far more likely to trust what they were saying. If you felt they were regurgitating something they didn't believe, and you can kind of generally tell when people are sort of spinning out a, a line. Whereas when people were fairly adamant that it was, you know, kind of not worthy of, paying too much attention to, I was much more reassured by that. Not to encourage people just to lie about it, but it's, you did genuinely kind of want to know what they would do with their own children rather than what the government line was.
And although I know that it's very difficult in a, in a professional thing, there's a limit to how much you're allowed to say, as a parent all you want to know is that your child's going to be all right. And so it, it's not reassuring to know what the government line is. It is reassuring to know that ultimately your doctor as a professional feels that your child's going, on an overwhelming basis of evidence, is going to be fine at the end of it. And it may be that they're the same thing, but you want to have it from their personal opinion rather than from a kind of government line, that someone is going to take responsibility at the end of the day for what happens. And I think, not in that you'd want to sue them or, just that your child's, you know, basically all you want to know is that your child is going to be okay. So anything that reassures you about that is probably the best way forward.
Be honest about the reasons behind some of the advice given.
Be honest about the reasons behind some of the advice given.
So I said, 'Well, I'd rather wait for the next 10 days.' And the, and I was told that it was not possible and I was told that the reason why it was not possible was because I was putting my daughter at great risk of catching diphtheria within the next 10 days if she didn't have the vaccine. Which I think is, is not right. Because of course that's not the reason why the GP wanted her to have the vaccine. The reason was that, it was changing in 10 days and until then he had to vaccinate a number of people and he just wanted to get it done. And so I, this made me feel a little bit ill at ease and so it was not right, to wave the, the risk of disease and to try to convince me that I was being irresponsible and putting her at risk.
They wouldn't like, they wouldn't like to be told half of the, half of the truth when they have to decide what they want to do with their children. So I think it's just the same for everybody.
Respect parents' worries and listen to their concerns
- Take time to answer questions or discuss concerns and help parents to be well informed. Provide copies of the vaccine manufacturers' product insert sheets and discuss the contraindications in relation to the child's personal and family medical history. Respect parents' concerns and be open to their suggestions, volunteer information and invite parents to ask questions.
- Don't treat parents as if they are stupid.
- Don't treat the MMR decision in a flippant way. Payments have been awarded by the Government's Vaccine Damage Payment Unit for children who have been affected by vaccines.
- Don't assume that at the six-week check, parents will be having the immunisations. This may be the first time the subject of immunisation has been raised. Some parents will need time to consider the issues in relation to their child's health and medical history. They will need comprehensive information and all parents should have access to a trained health professional to talk to about the risks of catching the diseases and about the benefits and potential risks of immunisation for their own child, and the population in general.
Recognise that the MMR decision is a difficult one for many parents.
Recognise that the MMR decision is a difficult one for many parents.
They said, after they'd weighed her they said, 'She is due for her MMR'. And because I came at the end of the session the nurse was just kind of lingering around basically. And I said, 'Yes, but we're choosing to do the individual'. And then the nurse heard and she walked in and she said, she said, 'Oh, but, no, don't worry. Just the one jab, it's just quick'. 'No'. And I thought, 'I'm not going to get into this with her because I don't need to'. I said, 'No, no thanks, no we're fine'. 'But, now, look, just a, I've just got it here. Quick, come on, just come in. It'll only take a second. She'll be fine'. And I'm like, 'No, I'm really, no, we're fine'. She said, 'Oh, come on' and then she started laughing. And I thought to myself, 'It isn't just a quick thing'. And she just did not understand. It's a decision. It's not about just something quick, kind of, 'Oh, look, I've got five minutes, quick, we can get it done'. And I thought, 'That's really not the right attitude to have, and definitely not to press someone'.
Don't assume that at the six week check, parents will be having the immunisation.
Don't assume that at the six week check, parents will be having the immunisation.
- Listening to parents and being able to answer their concerns with comprehensive information can influence the decisions parents make about their child's immunisations.
Listen carefully to parents' concerns so that you can answer their questions.
Listen carefully to parents' concerns so that you can answer their questions.
The good way is listening properly to what you've got to say and to what you're asking. The impression I got when I was first given advice at the first hospital, was the fact that the registrar had, had a quick word with the consultant before, looked at my note. The consultant said, 'Well when you see the patient, well, patient's mother's, say this' and say that's what she did, so she couldn't' I mean, maybe she's still training, so she couldn't answer any more questions. Then she went and got the consultant and he wasn't listening to me either.
And I think, that when I spoke to the paediatrician immunologist, he sat quietly, he listened to everything I said and then he gave me his response to my concerns and I think that was the big difference.
It's very easy to' especially if you've come across things before, just to, and you're busy, to feel impatient and think, yes, yes, yes, I know, I don't want to know all about the details' this is what your question is. But actually if you listen to someone properly, then it might not be their question and then you might be able to reassure them about things that you didn't know that (they) would ask you. So I think it was listening properly and answering your question, rather than just telling someone what you think they should be asking you, because that then' yeah because it's almost like you had a prepared answer that you' it was almost like the consultant was getting frustrated with me for not asking the question, he wanted to answer [laughs]. And I've seen that in lawyers, a lot as well, where they say, 'No, you, what you' you don't want to ask me that question. You want to ask me another question.' And I know the reason they say that is because they don't know the answer to the question, that you have actually got. So that's what I would say.
Her questions and concerns were not answered by the health professionals she talked to which contributed to her decision not to immunise.
Her questions and concerns were not answered by the health professionals she talked to which contributed to her decision not to immunise.
I think again as in anything, particularly in parenting, you're always doubting yourself anyway. And, and I think just for somebody to have had a listening ear really and just to have had more time, just to have said, 'Well as we're discussing now, you know, 'What, exactly what's concerning you? Why are you sceptical? What, what has brought this to your mind?' You know, 'What...?' And actually listen and just say, 'Yes, I understand where you're coming from'. And then perhaps being able to give facts and figures and information from their point of view.
- When parents bring their child to see a health professional with concerns that their child may have had a reaction to MMR, be sympathetic, note the symptoms, study the vaccine manufacturers' product sheets or the Green Book and report the suspected adverse event for investigation, if appropriate.
She would have liked the health visitor to take her concerns about possible reactions to MMR seriously.
She would have liked the health visitor to take her concerns about possible reactions to MMR seriously.
I think I'd have liked her to have taken notice of what I'd said. I explained to her, I said, 'She had a really, really nasty reaction, her arms swelled up and she was on anti-histamines, antibiotics and everything, I'm just concerned that he's going to get it.' And she was just very dismissive, there were no, I think I would have liked to have said, 'Oh right, well I'll just go to speak to the doctor about it, maybe we can pull [my daughter's] file out and see what, you know, how she reacted and everything.' Maybe the GP should have done it, or he should have said, 'you know,' Or maybe there's a test they could have done, I just, I'd have liked them to have been more concerned because I were, you know. I mean, I still let them go ahead with it, I probably shouldn't, shouldn't have, thinking about it, I should have said, 'No, I want to speak to the GP about it.'
Give reassurance and try to understand what it's like from a parent's perspective
- Health professionals should be prepared to answer questions from parents about the immunisation decisions they made for their own children but should ensure that they have also balanced the risks for the individual child in front of them.
Put yourself in the frame of mind of a parent.
Put yourself in the frame of mind of a parent.
It helped her to make a decision when the health professional talked to her from one mother to another.
It helped her to make a decision when the health professional talked to her from one mother to another.
And she was just able to tell me exactly what the current sort of comment was on it and stuff and also it wasn't just her giving me the facts, she was also talking to me as a mother as well. She's got children of her own and she was talking to me from that perspective. So I kind of felt, unlike with our local doctor who other people were commenting, 'Oh they will just give you the party line,' I felt as if she was telling me exactly what all the facts were as well as the fact she was a mother and she was also being honest with me about how she felt about it.
Be well informed so that you can give parents the information they need
- Well informed health professionals, who discussed issues with confidence and were able to provide reassurance helped to instil trust in parents.
- Some parents found it more helpful to talk to a trained health professional than being given written information. But not all parents want information and the opportunity to discuss immunisations with a health professional.
She was more reassured when it was obvious that a health professional had reviewed the evidence themselves and could give an informed opinion.
She was more reassured when it was obvious that a health professional had reviewed the evidence themselves and could give an informed opinion.
I was more reassured as well when people had clearly looked at the evidence. Where people were able to say, 'Look, this is...'. I mean I, as I said before, 'This is what the research was. This is what is was based on. This is the kind of outcome of it'. And where they clearly themselves had considered what the issues were rather than just, 'It's fine. Don't worry about it. It's not worth worrying about'. Where, it's just not reassuring at all because you're not even aware of whether they really know what those issues are. It was much, yes, much more reassuring. You felt that they too had considered as a professional and weighed up on a balance of judgement whether it was likely to be detrimental or not.
The immunisation clinic
- A child friendly clinic, held at convenient times, with friendly, well informed trained health professionals can make a difference to parents' decisions to return for future immunisations.
Last reviewed October 2015.
Last updated July 2013
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