There is an art to vaccine counseling. I suspect it varies based on geography, community, and personality of the counselor and the parent.
I will say the singular insurmountable obstacle is the dissenting parent not present at the visit. “Well, I think it’s a good idea but my (spouse/partner etc)!is very opposed, so not today.”
I have almost never seen that person accept an invitation to come to a visit, speak on the phone, or otherwise participate in the child’s medical visits. If I cannot counsel, educate, I am stuck.
I suspect occasionally it’s a way to deflect as well.
I still offer education even when they decline. “Ok, well we will not be doing that today then, but is it ok if I just provide you with some background information that you can think about in the meantime?” Every once in a while they even change their mind on the spot… sometimes…
Separating and layering recommendations help- well, your 6 month old has a much greater need for the flu shot than your healthy teen, but let’s look at why you might consider for each of them… it’s different, we have to acknowledge that. It improves discussion and uptake. It’s time consuming. But it’s worth it.
But we are fielding more aggressive calls from anti vaccine families in the last few weeks. It’s going to be bad. Without a doubt.
I truly hope that no generation needs to see the results of lack of vaccination. I am someone who saw both. 1st grade no vaccinations, 2nd grade vaccinations. My best friend in 1st grade contracted polio, within a week he was in an iron lung, within a month he had died (from an infection?). I hope that this does not become common. I hope that no one has to go through this again.
I can remember my mother crying with relief when I received my first polio vaccination. I think people in many areas of the country discounted COVID because most of the deaths occurred in the older population. They have no memory of the devastation many of the infectious diseases caused in children and I hope they never have to experience it.
One small suggestion: include the URL for the excellent Frequently Asked Questions PDF file at the bottom of each page, so that if people share hardcopies then anybody who gets a hardcopy can easily find the online version.
Do you have the cases/death per disease prior to vaccine availability as tabulated numeric data?
What might be helpful is to project forward-- "without a vaccine, and with changes in population, we would be seeing approximately 3M cases of measles annually along with 30k deaths; with vaccines, we're seeing 3k cases and 4 deaths"-- or whatever the actual data is.
That might help people better understand the benefits of the vaccine. To be transparent, some adjustment may need to be made for improved treatment options.
It is very tricky to estimate what might happen in the future because there are so many unknowns. One thing that we do know is that around half a million US deaths in the past five years could have been prevented, because Excess Deaths were so much higher among the unvaccinated.
"However, the patterns of excess mortality changed substantially over time. The entire reduction occurred in states with relatively high vaccination rates, with excess deaths increasing in less-vaccinated states. This probably reflected a direct protective effect of the vaccines and possibly reductions in delayed or foregone medical care among vaccinated individuals."
I am also rather recently retired, but what you write (Sarahb) below is in line with how I approached this for many years. Most of the folks alive were not around when the Polio problem was faced by every parent every summer. I can remember my own parent's fears as the news came out about more and more cases of poliomyelitis in the community. Unfortunately, it may take a resurgence in the devastation of decades in the past for this seriously harmful disinformation to finally be quashed.
Once again, the issue isn't a binary for or against that it's made out to be. Yes, vaccines have been a godsend that prevents many dreadful diseases. However, this doesn't translate into trust of the current schedules, which are vastly different from decades past and call for infants and children to get many more shots with the concoctions combined. How much research and testing has been put into the combination approach? Two that may be safe, given separately at different times might be a problem when combined. I know people in the medical field who refuse the current govt. schedules and instead spaced them out as well as deciding against certain ones like hepatitis for an infant that has little to no risk of exposure.
The name calling, labeling, etc. that is rampant in this leftist echo chamber is not helpful. Neither is making it a binary for or against argument.
I think a major challenge is "when the science changes the recommendations change". This is not the view of many of my associates. Flexible beliefs are considered unreliable. Your previous post about lessons from the handling of COVID mention several.examples. Humility I think necessary but will be considered weakness by many. Ours is a fallen world. Arrogance has pitfalls, too.
This is definitely related to a point I often make about the weakness of our science education and how research builds greater understanding over time. I am constantly pushing this message, using an analogy (“adding planks to a pier one at a time, that is reaching into previously unknown waters”). People are not very good at adapting their way of thinking and they are not comfortable with unknowns.
I would like to see more attention given to the HIB vaccine, which is a more recent success story. When I completed my medical training in the early 80's HIB disease accounted for significant mortality, and the majority of cases of pediatric meningitis. Any children's hospital of size had a dozen kids on the floor in various stages of treatment (which required 10 days of IV therapy). When routine vaccination was adopted, these diseases essentially disappeared. It became something of a problem in family practice and pediatrics residencies, since meningitis became rare enough that many trainees never saw a case. Remarkable, and since it occurred more recently, this success story may add something to the dialogue.
The video is very nice with important info, however the white lettering on black is difficult to read, and wording is at a very high level. The video moves a little fast for average readers. I love it, but I am an MD. The average parent cannot compute that fast or at that level. Do you have someone on your team who adjusts your info graphics and pdfs to the 8th grade level (where all health info is necessary to be)? This is a tall order, and thanks so much for all of your hard work. Susan@susanlandersmd.com
Hello, YLE team! The video on the polio vaccine is terrific. This is just the type of messaging we need on social media. Thank you for creating this.
I do feel the video could benefit from a voice over that reads the text. I personally know people that will not engage with the video if they have to read. Some are poor readers, others are simply averse to reading much. Is this possible? I do believe you could reach more people this way.
Thank you for this! I have packets to hand out at my clinic to vaccine hesitant parents- this handout you made will be added to the pile of info showing vaccine safety! Cheers!
The lack of societal memory is another large factor in vaccine hesitancy. I remember people in my community who had contracted polio, or who were sick with measles or chickenpox .We have a hard time telling the stories of these children ( or ourselves with these diseases). After hours and years ( I retired after 43 years of practice) of counseling and dispensing information I do agree there are sporadic wins. I can't help but think that if we showed people examples of some of these diseases, e.g. a coughing distressed 6 month old, with pertussis, that they would be more inclined to vaccinate their children. Providers could keep videos on the laptops we use for our EMR's. " A picture is worth a thousand words..."
You do not mention Pneumococcal or H. Flu vaccines. As a resident, I cared for a number of children with serious complications of these illness, e.g. meningitis. These illnesses killed children in very dramatic ways and serve as reminders to me of our health system's ability to reduce severe diseases over a very short period of time.
One final note, ivaccinate is an organization with information that is very easy for parents to digest. i recommend it highly, https://ivaccinate.org/.
Yes we need trusted messengers for vaccines! I wish you would say the same about masks for Covid… people still get and die or are disabled from covid! Physicians often refuse to mask and ridicule their patients that do. Spend one day taking care of a long covid patient and walk in our shoes.
YLE: The ethics of a placebo-based trial in the era of rampant polio struck a chord with me. That lack of large RCT’s for polio vaccine could also translate into the scenario of no drug therapies for the novel SARS-Cov2 pandemic in the early weeks of 2020. That’s what our post-acute COVID19 recovery hospital Hospitalists faced when the usual & customary supportive care in the area ICU’s failed and subsequently created a terrible conundrum about what to do with these post-acute COVID19 victims. It was simply unethical and unacceptable for us to wring our hands and do nothing or add misery and potential morbidity by extending pre-existing efforts with steroids, ineffective anti-virals etc. Our team dug deep and chose a protocol capitalizing on a repurposed drug with unique targeted pharmacodynamics that addressed the same pathophysiological issues as a well-studied proxy disorder. This repurposing proved consistently beneficial for acute and advanced post-acute COVID19 through every variant for inpatients and outpatients over 4+ years while demonstrating its 4 decades of well-established safety.
Summary of pertinent refs: clarifying our clinical concepts and experiences coupled with our focus on critical immune concepts and neuroreceptors:
2. Ref: Foster, M.R.B., Hijazi, A.A., Opoku, R., Varghese, P., Li, C. (2021). The Use of Hydroxyurea in the Treatment of COVID-19. J. Crit. Care Med. (Targu Mures). 7(4), 312-317. doi: 10.2478/jccm-2021-0019.
3. Ref: Lykhmus O, Kalashnyk O, Sullivan R Jr, Skok M. Hydroxyurea interaction with α7 nicotinic acetylcholine receptor can underlie its therapeutic efficacy upon COVID-19. J Neuroimmunol. 2023 Dec 15;385:578244. doi: 10.1016
4. Ref: Skok M. The role of α7 nicotinic acetylcholine receptors in post-acute sequelae of covid-19. Int J Biochem Cell Biol. 2024 Jan 11;168:106519
FWIW here's an editorial I submitted to a local paper:
How would you like it if half your children died of preventable diseases before reaching high school?
This was the norm up until a century or so ago when vaccines for common, highly contagious, deadly
childhood diseases began to be available. In those days, parents gave thanks for such a merciful
development and rushed to the doctors' offices to get their children these precious shots. These days,
not so much. How soon we forget!
Just a quick reminder of the real villains in this story: (1) Measles vaccine was licensed in 1963; prior
to that, we lost around 500 children a year to this nasty disease, and tens of thousands were
hospitalized. Two doses are 97% effective in preventing symptoms, but we need 95% coverage to
prevent an outbreak. Some communities have fallen well below this level. (2) Diphtheria infected
100,000 American kids annually as recently as a century ago. About 10% died of suffocation from this
nasty problem. Thanks to vaccines, there is now fewer than one case a year in the U.S. (3) Tetanus
germs are found in the soil and need only a skin cut to enter a person's blood. Without immediate
treatment, up to 20% of infected people die in agony. The tetanus vaccine came out about 80 years ago
and lowered the U.S. case rate from more than 500 annually to fewer than 50. (4) Mumps is especially
nasty because you can be without symptoms for a month while spreading your infection to lots of
family, friends, and neighbors. We got our first mumps vaccine in 1967 and the rate of infection
dropped 99%, though case rates have recently gone up ten-fold. Mumps is no joke because even when
it doesn't kill you, it can leave you with deafness, sterility, seizures, and strokes. (5) Rubella can
devastate a fetus if the mom gets it. Some 32,000 babies are born each year with Rubella and about a
third of them die before their first birthday. There's no good treatment for this problem, but the vaccine
licensed in 1969 cut the U.S. rate from 47,000 to six cases each year. Fortunately, there's now a single
shot that protects against measles, mumps, and rubella! (6) Polio killed or paralyzed 21,000 people in
the U.S. in 1952, but the vaccines eliminated it here, though it still spreads in poorer countries. If you
doubt any of these figures, please have a chat with a licensed medical professional.
We're more vulnerable now because vaccination rates have gone down for all the diseases on this list.
This problem apparently relates to fears of vaccination side-effects. It is possible that diseases could be
virtually eliminated through universal vaccination so that vaccine side-effects become a bigger problem
than the diseases... for a while. The problem with this reasoning is that these diseases spread very
rapidly among unvaccinated people. That leaves us at risk for massive outbreaks that could very
quickly dwarf any possible problems from the vaccines.
I suppose the risks and benefits are like those facing a person who chooses to drive while drunk.
Chances are you'll get away with it, but your risk of a serious accident goes way up. You may not care
if you live or die, but don't you owe something to all the other drivers who might suffer from your
careless behavior?
Please consider carefully the fact that some people, through no fault of their own, are more likely than
others to die or suffer crippling after-effects from the diseases listed above. These include the young,
the old, and anybody already weakened by a chronic illness. Grown-ups, especially those who follow
Christian teachings or those of most other religions, understand that they have a responsibility to
protect those who are less fortunate, even at some cost to ourselves.
Finally, we need to carefully consider the reasons why some celebrity-wannabes exaggerate the harms
of vaccination while minimizing its benefits. Some of these folks care only about their own fame and
fortune. Some are actually working for our national enemies and are getting paid to weaken us. Many
are so uneducated that the history of preventable childhood diseases is unknown to them. Please don't
you be one of these!
This is excellent; thank you for the work of putting it together!
Really well written. Thanks for your efforts!
There is an art to vaccine counseling. I suspect it varies based on geography, community, and personality of the counselor and the parent.
I will say the singular insurmountable obstacle is the dissenting parent not present at the visit. “Well, I think it’s a good idea but my (spouse/partner etc)!is very opposed, so not today.”
I have almost never seen that person accept an invitation to come to a visit, speak on the phone, or otherwise participate in the child’s medical visits. If I cannot counsel, educate, I am stuck.
I suspect occasionally it’s a way to deflect as well.
I still offer education even when they decline. “Ok, well we will not be doing that today then, but is it ok if I just provide you with some background information that you can think about in the meantime?” Every once in a while they even change their mind on the spot… sometimes…
Separating and layering recommendations help- well, your 6 month old has a much greater need for the flu shot than your healthy teen, but let’s look at why you might consider for each of them… it’s different, we have to acknowledge that. It improves discussion and uptake. It’s time consuming. But it’s worth it.
But we are fielding more aggressive calls from anti vaccine families in the last few weeks. It’s going to be bad. Without a doubt.
>>Great<< post! I'm retired now but everything you say resonates with my experiences.
I truly hope that no generation needs to see the results of lack of vaccination. I am someone who saw both. 1st grade no vaccinations, 2nd grade vaccinations. My best friend in 1st grade contracted polio, within a week he was in an iron lung, within a month he had died (from an infection?). I hope that this does not become common. I hope that no one has to go through this again.
I can remember my mother crying with relief when I received my first polio vaccination. I think people in many areas of the country discounted COVID because most of the deaths occurred in the older population. They have no memory of the devastation many of the infectious diseases caused in children and I hope they never have to experience it.
I can remember the scare of polio. Partly why RFK JR'S attitude is incomprehensible. Guess the brain worm did a number on him🪱 .
One small suggestion: include the URL for the excellent Frequently Asked Questions PDF file at the bottom of each page, so that if people share hardcopies then anybody who gets a hardcopy can easily find the online version.
Do you have the cases/death per disease prior to vaccine availability as tabulated numeric data?
What might be helpful is to project forward-- "without a vaccine, and with changes in population, we would be seeing approximately 3M cases of measles annually along with 30k deaths; with vaccines, we're seeing 3k cases and 4 deaths"-- or whatever the actual data is.
That might help people better understand the benefits of the vaccine. To be transparent, some adjustment may need to be made for improved treatment options.
It is very tricky to estimate what might happen in the future because there are so many unknowns. One thing that we do know is that around half a million US deaths in the past five years could have been prevented, because Excess Deaths were so much higher among the unvaccinated.
https://pubmed.ncbi.nlm.nih.gov/37486680/
https://ajph.aphapublications.org/doi/10.2105/AJPH.2024.307731
https://pmc.ncbi.nlm.nih.gov/articles/PMC10289647/
https://pmc.ncbi.nlm.nih.gov/articles/PMC10988222/
Quote from the last of these papers:
"However, the patterns of excess mortality changed substantially over time. The entire reduction occurred in states with relatively high vaccination rates, with excess deaths increasing in less-vaccinated states. This probably reflected a direct protective effect of the vaccines and possibly reductions in delayed or foregone medical care among vaccinated individuals."
I am also rather recently retired, but what you write (Sarahb) below is in line with how I approached this for many years. Most of the folks alive were not around when the Polio problem was faced by every parent every summer. I can remember my own parent's fears as the news came out about more and more cases of poliomyelitis in the community. Unfortunately, it may take a resurgence in the devastation of decades in the past for this seriously harmful disinformation to finally be quashed.
Once again, the issue isn't a binary for or against that it's made out to be. Yes, vaccines have been a godsend that prevents many dreadful diseases. However, this doesn't translate into trust of the current schedules, which are vastly different from decades past and call for infants and children to get many more shots with the concoctions combined. How much research and testing has been put into the combination approach? Two that may be safe, given separately at different times might be a problem when combined. I know people in the medical field who refuse the current govt. schedules and instead spaced them out as well as deciding against certain ones like hepatitis for an infant that has little to no risk of exposure.
The name calling, labeling, etc. that is rampant in this leftist echo chamber is not helpful. Neither is making it a binary for or against argument.
I have friends in the medical field who have followed the childhood schedules from other countries.
I think a major challenge is "when the science changes the recommendations change". This is not the view of many of my associates. Flexible beliefs are considered unreliable. Your previous post about lessons from the handling of COVID mention several.examples. Humility I think necessary but will be considered weakness by many. Ours is a fallen world. Arrogance has pitfalls, too.
This is definitely related to a point I often make about the weakness of our science education and how research builds greater understanding over time. I am constantly pushing this message, using an analogy (“adding planks to a pier one at a time, that is reaching into previously unknown waters”). People are not very good at adapting their way of thinking and they are not comfortable with unknowns.
I would like to see more attention given to the HIB vaccine, which is a more recent success story. When I completed my medical training in the early 80's HIB disease accounted for significant mortality, and the majority of cases of pediatric meningitis. Any children's hospital of size had a dozen kids on the floor in various stages of treatment (which required 10 days of IV therapy). When routine vaccination was adopted, these diseases essentially disappeared. It became something of a problem in family practice and pediatrics residencies, since meningitis became rare enough that many trainees never saw a case. Remarkable, and since it occurred more recently, this success story may add something to the dialogue.
The video is very nice with important info, however the white lettering on black is difficult to read, and wording is at a very high level. The video moves a little fast for average readers. I love it, but I am an MD. The average parent cannot compute that fast or at that level. Do you have someone on your team who adjusts your info graphics and pdfs to the 8th grade level (where all health info is necessary to be)? This is a tall order, and thanks so much for all of your hard work. Susan@susanlandersmd.com
Hello, YLE team! The video on the polio vaccine is terrific. This is just the type of messaging we need on social media. Thank you for creating this.
I do feel the video could benefit from a voice over that reads the text. I personally know people that will not engage with the video if they have to read. Some are poor readers, others are simply averse to reading much. Is this possible? I do believe you could reach more people this way.
Thank you!
Thank you for this! I have packets to hand out at my clinic to vaccine hesitant parents- this handout you made will be added to the pile of info showing vaccine safety! Cheers!
The lack of societal memory is another large factor in vaccine hesitancy. I remember people in my community who had contracted polio, or who were sick with measles or chickenpox .We have a hard time telling the stories of these children ( or ourselves with these diseases). After hours and years ( I retired after 43 years of practice) of counseling and dispensing information I do agree there are sporadic wins. I can't help but think that if we showed people examples of some of these diseases, e.g. a coughing distressed 6 month old, with pertussis, that they would be more inclined to vaccinate their children. Providers could keep videos on the laptops we use for our EMR's. " A picture is worth a thousand words..."
You do not mention Pneumococcal or H. Flu vaccines. As a resident, I cared for a number of children with serious complications of these illness, e.g. meningitis. These illnesses killed children in very dramatic ways and serve as reminders to me of our health system's ability to reduce severe diseases over a very short period of time.
One final note, ivaccinate is an organization with information that is very easy for parents to digest. i recommend it highly, https://ivaccinate.org/.
Great response to the noise. We need to promote the science in ways it will be heard. Love the video approach.
Yes we need trusted messengers for vaccines! I wish you would say the same about masks for Covid… people still get and die or are disabled from covid! Physicians often refuse to mask and ridicule their patients that do. Spend one day taking care of a long covid patient and walk in our shoes.
YLE: The ethics of a placebo-based trial in the era of rampant polio struck a chord with me. That lack of large RCT’s for polio vaccine could also translate into the scenario of no drug therapies for the novel SARS-Cov2 pandemic in the early weeks of 2020. That’s what our post-acute COVID19 recovery hospital Hospitalists faced when the usual & customary supportive care in the area ICU’s failed and subsequently created a terrible conundrum about what to do with these post-acute COVID19 victims. It was simply unethical and unacceptable for us to wring our hands and do nothing or add misery and potential morbidity by extending pre-existing efforts with steroids, ineffective anti-virals etc. Our team dug deep and chose a protocol capitalizing on a repurposed drug with unique targeted pharmacodynamics that addressed the same pathophysiological issues as a well-studied proxy disorder. This repurposing proved consistently beneficial for acute and advanced post-acute COVID19 through every variant for inpatients and outpatients over 4+ years while demonstrating its 4 decades of well-established safety.
Summary of pertinent refs: clarifying our clinical concepts and experiences coupled with our focus on critical immune concepts and neuroreceptors:
1. Ref: Nature Scientific Reports (2019) 9:14829 | https://doi.org/10.1038/s41598-019-51339-x
2. Ref: Foster, M.R.B., Hijazi, A.A., Opoku, R., Varghese, P., Li, C. (2021). The Use of Hydroxyurea in the Treatment of COVID-19. J. Crit. Care Med. (Targu Mures). 7(4), 312-317. doi: 10.2478/jccm-2021-0019.
3. Ref: Lykhmus O, Kalashnyk O, Sullivan R Jr, Skok M. Hydroxyurea interaction with α7 nicotinic acetylcholine receptor can underlie its therapeutic efficacy upon COVID-19. J Neuroimmunol. 2023 Dec 15;385:578244. doi: 10.1016
4. Ref: Skok M. The role of α7 nicotinic acetylcholine receptors in post-acute sequelae of covid-19. Int J Biochem Cell Biol. 2024 Jan 11;168:106519