Taking the sting out

The nation’s public health departments are on high alert following warnings that Australia could be stripped of its measles elimination status within 12 months if the number of cases continues to rise at its current rate.

As of 9 May, there had been 109 measles cases reported – compared to 103 for the whole of 2018 and 81 for 2017.

The immunisation rate among young children is just below the 95% mark in Australia – which is the magic number needed to achieve herd immunity.

A drop in vaccination rates makes us vulnerable to the spread of diseases such as measles – thus the current outbreak has given rise to public health campaigns on the necessity of immunisation.

But immunisation tends to polarise people, and occasionally this messaging attracts online vitriol against those who decide not to vaccinate, and those who do. We see this almost every day on AMA (NSW)’s Facebook page.

It’s unlikely that hurling insults at anti-vaxxers is going to change their minds, any more than insulting comments from that movement would deter firm proponents of immunisation. However, there is an opportunity to encourage people who are vaccine hesitant by establishing a relationship that is built on trust and respect.

AMA (NSW) Vice President and general practitioner, Dr Danielle McMullen, often faces patients who are concerned about vaccinations.

“I hope that by having a therapeutic relationship with my patients that is ongoing and comprehensive, I open the door to discussion around vaccination. I certainly see some examples of that. A few times per year I have patients come in and ask questions specifically around the safety of vaccines for their children.”

She recently had a patient indicate she was nervous about vaccinating her teenage boys with the HPV vaccine.

“We explored her concerns in a non-judgmental way, validated her concerns and presented evidence as it stands. I still don’t know what she chose to do with the information, but hopefully walked away more likely to vaccinate.”

Dr McMullen described another case, where the young parents of a baby expressed their anxiety about vaccination and resentment of pressure to vaccinate by the ‘no jab, no play’ policy and family tax benefit legislation.

“It takes time to manage these cases, explain common and rare side effects, and to make sure that parents are giving informed consent. It’s important to try and help them understand the difference between financial pressures and medical risks. Ultimately, they decided to vaccinate but hearing things like ‘my baby had better not get any adverse reaction or I’ll be really mad’ made me anxious and I took a long time to make sure I had discussed things with them to the point that they understood the decision they were making.”

She adds that time can be a luxury for busy general practices, and some patients choose to do their research elsewhere.

“And science isn’t always sexy. For some reason at the moment people seem to love the pseudoscience space – people using big long ‘sciency’ sounding words which promote the counter-position.”

The World Health Organisation (WHO) suggests health professionals have a vital role in addressing vaccine hesitancy.

“In the face of emerging hesitancy, health workers remain the most trusted advisor and influencer of vaccination decisions. The capacity and confidence of health workers are often stretched, though, as they are faced with time constraints, limited resources, and inadequate information and/or training to respond to any questions and discuss the risks and benefits.”

According to the WHO, several factors contribute to vaccine hesitancy including complacency, lack of convenience, and low levels of trust.

If patients are hesitant, health professionals are urged to use a motivational interviewing method, which creates a conversation around change without attempting to convince the person of the need to change or instructing them about how to change.

Health professionals are encouraged to answer open-ended questions, such as ‘what do you think…’ ‘what did you understand…’?

Another tool to use is reflection. By repeating what the patient says, or repeating what you think the patient means, you are acknowledging their concerns. For example, is a patient says ‘I know vaccinating will help me but I am afraid of side effects,’ the doctor could respond, “I understand you want to make the best choice for yourself. What side effects are you concerned about?’

It’s important that health professionals affirm the strength of discussion (“It’s great that you are starting to think about vaccines”) and validate the patient’s concerns (“The health of your children is important to you.”)

These are just a few techniques suggested by the World Health Organisation. For more information, visit who.int.