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...
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...
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.
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.
Find out what parents' concerns are and address them.
Well certainly the nurse that I've spoken, that I spoke to was very informed and that always helps make a decision is, is having trust in the person that you're talking to that they actually do know what they're talking about, there's nothing worse than talking to someone and you think “This person actually hasn't got a clue,” and they don't instil any confidence in you whatsoever. So she may have been talking complete rubbish but she sounded like she knew what she was talking about, so I believed her.
And I think on my six week check-up when I spoke to the doctor then about them and she sort of said you know in your little red book it asks about immunisation and she asked if I had any, you know she raised the subject, was I thinking of having him done, did I have any questions about them and I think just the fact that she was very open and you know inviting questions. And I didn't have many because I'd always thought that I would have it done, it was before the onset. But I think doctors can, you know they raise, if they raise the issue and ask if there's any questions, anything that they're unsure about at that stage rather than the parent at the six week check, rather than the parent just getting this form through. I think that was explained to me as well, that was explained to me by either the health visitor or the doctor that, you know how it worked because I didn't know whether I had to make all these appointments myself or whatever.
So it was explained that I would get an appointment through and then you just turn up or you cancel it or, and re-book, whenever. So I think that helped that, actually having the process explained that you didn't have to do anything. I think as long as they talk to you like an adult and don't “Oh you just must have them done,” as long as they sit down and actually find out what your concerns are rather than dismissing you like you're silly, then I think that helps a lot of people.
Recognise that the MMR decision is a difficult one for many parents.
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.
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...
- 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.
Would have preferred the doctor not to have dismissed out of hand his concern that his daughter...
There was one day when I went in and a doctor was talking to my wife who was in tears and was telling her that it was none of these things and that they were going to look for a sort of mystery virus. And I said, 'Well why are you looking for a mystery virus when you have a possibility that three cultivated viruses that were injected into her may well be responsible?' And he said that they weren't even going to consider it. And I said, 'Well surely that isn't logical?' I didn't question his scientific or medical knowledge, I said, 'From the point of view of logic surely these should simply be investigated.'
And in fact he and I had a stand up row, on the ward, in front of all the other parents who got upset of course. I tried to keep calm and as far as I know I was calm, at one stage he turned to my wife and said, 'You're getting very emotional about this.' And my wife had to walk away because what she of course later said she wanted to say was, 'Well, you know, if you can't get emotional about your child having what appears to be some kind of brain damage, what can you get emotional about?' And I said to the doctor, having my wits about me a little, 'Do you have children yourself?' and he said, 'No' I said, 'Well I'm sorry but you can't possibly know what it's like to have a child who appears to be brain damaged who is apparently totally healthy two weeks or so ago.
I would have just liked the doctor to have said something like, 'We understand your concern.' He may even have said at the time, 'personally I don't think that that's responsible, but of course we'll look into it.' And if he'd said just that I would have been reassured. He didn't listen and in fact he lectured me and not only that he started to argue with me.
She would have liked the health visitor to take her concerns about possible reactions to MMR...
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.
Remember the personal approach when talking to parents.
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...
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...
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.
The environment in which immunisations are given and the timing of clinics can affect parent's...
Last reviewed October 2015.
Last updated July 2013