For decades, vaccinations were a given. And why wouldn't they be? The Centers for Disease Control and Prevention considers vaccines one of the great public health achievements of the 20th century.
That was the case when Dr. Lisa Stern trained to be a pediatrician two decades ago. At that time, she says, there was no need to learn how to talk to parents about the benefits of vaccination.
"We just told them what they were going to get, … and that was the end of the conversation," she says.
But these days, it's not always that easy.
Tactics for the talk
When families come see her at Tenth Street Pediatric Medical Group in Santa Monica, Stern says she leaves a lot of time at checkups to talk about vaccines.
She says just a handful of the families she sees at are completely opposed to vaccinating their kids, while she estimates that about 20 percent have other concerns, including the number of shots and their ingredients.
Some are interested in bucking the recommended vaccination schedule developed by the Advisory Committee on Immunization Practices, and instead following an alternative — and untested — schedule, developed by Orange County doctor Bob Sears.
Stern says she explains that Sears' schedule is "not based on science, and it leaves their kids at risk. I always want to work with parents and educate them, but I think that has definitely been something that has made my job a little more challenging."
Here's one tactic Stern says she's employed: She'll agree to give a baby one of the five or six shots he needs at his two-month check up. It's a way, she says, for parents to dip their toes into the vaccine waters.
“That way, it’s sort of dipping their toe in the water," she says. "And then they walk away, and they’re like, 'OK, the baby was fine.'"
And that, says Stern, creates an opportunity to bring the family back to give the baby the rest of his shots.
A few doctors have gotten so frustrated that they won’t treat families who refuse to vaccinate their kids. The American Academy of Pediatrics discourages doctors from doing that – but says if they feel like they're at their wit's end, they might encourage a family to seek out a different provider.
"The more times they come in, the more you can try to convince them that vaccines are good, and we do recommend vaccines," says Dr. Marshall Sachs, an associate professor of pediatrics at UCLA. He has been practicing medicine for more than 50 years, and says he agrees with the academy's approach.
Sachs says he's convinced some parents to vaccinate by sharing his memories of treating kids who had diseases that are now vaccine-preventable.
"I give them some personal experiences, because when I first started practice, we used to have wards of children with meningitis, whooping cough," he recalls. "I haven't seen a child with bacterial meningitis in years.”
Though, he notes, whooping cough has re-emerged, hitting epidemic proportions this year. According to the California Department of Public Health, about 10 percent of kids sickened this year were never vaccinated against the disease.
Practicing the vaccine talk
The difficult vaccination conversation has become so common that Mattel Children's Hospital UCLA recently held a workshop, where pediatricians could practice responding to parents' questions. It was led by Dr. Paul Offit, a nationally-known vaccines expert and director of the Vaccine Education Center at Children's Hospital of Philadelphia.
Offit uses levity, as he pretends to be a vaccine opponent.
"I live a healthy, natural lifestyle," he says. "Why do I need these vaccines, these unnatural things injected into my arm, when I've been able to have strawberry smoothies, to the point I have?" The doctors in the lecture hall break into laughter as he adds, "Sorry, this is an east coaster talking."
In a more serious tone, Offit suggests a response grounded in science: It doesn't matter how well nourished you are. The only way to develop specific immunity is to be exposed to the antigen – the substance that causes the body to produce antibodies.
Offit says that sort of reasoning often works – but not always.
In Santa Monica, Dr. Stern says sometimes the best approach is to put the risk in perspective.
"The whole process of how vaccines are manufactured, and the prelicensing studies that they go through, it's more [rigorous] than any foods that we eat, any other drugs that we use," she tells parents.
"So I say to people, 'I worry more about your child tripping and hitting their head, or splitting their chin, then having a severe vaccine reaction,'" Stern adds.
Stern hopes parents trust her on that. After all, she says, her job is to advocate for children's health – and that includes vaccination.