Vaccine hesitancy, defined as a “delay in acceptance or refusal of vaccines despite availability of vaccination services,” has been reported in more than 90% of countries in the world.1 In the United States, rates of measles have been climbing, reaching a 20-year high in 2014.2 Almost all of these were among people who had not been vaccinated, or whose vaccination status was unknown.3
The rates have continued to rise alarmingly: from January 1 to May 31, 2019, 981 individual cases of measles were confirmed in 26 states, representing an increase of 41 cases just from the previous week alone.4 This is an increase of 314 cases since 2014 and is the greatest number of cases reported in the US since 1992.4 Of the 13 outbreaks that took place in the first 4 months of 2019, six were associated with under-immunized close-knit communities and accounted for 88% of all US cases.4 Unvaccinated US residents traveling internationally are at high risk for acquiring measles and transmitting it to other unvaccinated people.4
Anti-immunization sentiment predates vaccinations used today, dating back to the process of variolation used in the early 18th century.3 However, the most current iteration of the “anti-vaccine movement” can be traced to the publication of the now-retracted 1998 paper by Andrew Wakefield linking the measles-mumps-rubella (MMR) vaccine to autism.5,6 Current drivers of the anti-vaccination movement include the modern-day availability of medical information – once accessible only to medical professionals – through digital means (eg, the Internet and social media); a shift in perspective between the doctor as the expert to shared decision-making, with the patient playing a role in guiding treatment; religious or ideological beliefs; celebrities, politicians, and public figures; and lack of trust in medical experts.7-10
Despite these concerning trends, most parents continue to receive their information about vaccines from clinicians.9 It is therefore essential for healthcare professionals to utilize effective communication strategies to address vaccine-hesitant parents.
The aim of the current article is not to comprehensively address the specific concerns raised by parents but rather to shed light on effective communication strategies. To that end, MPR interviewed two clinicians regarding their approaches to educating and discussing vaccination with parents, particularly in faith-based communities.
Blima Marcus, DNP is an oncology nurse practitioner at Memorial Sloan Kettering Cancer Center, a founder of the Vaccine Task Force, a group of Orthodox healthcare providers who operate under the umbrella of the EMES Initiative, a newly formed non-profit which brings evidence-based healthcare information to the Orthodox community, and a member of the ultra-Orthodox Jewish community in Brooklyn, NY. Some ultra-Orthodox communities have been among the communities affected by the spread of measles.11 Dr Marcus is widely involved in educating members of her own community as well as the broader Orthodox community regarding vaccinations. Dr Marcus’ work has received wide coverage in several outlets, including CNN, The New Yorker, Gothamist, and The Wall Street Journal.
Amy Givler, MD is a family physician based in Monroe, LA. An Evangelical Christian and member of the Christian Medical and Dental Associations, Dr Givler teaches widely, providing guidance to the general public and especially members of the Christian community who are opposed to vaccination on religious grounds.12,13 [Interview begins on page 2 … ]