“There has to be a fair amount of trust in whoever a parent is talking to” about vaccines, said Dr. Leonard Reeves, associate dean of the Northwest Clinical Campus of the Medical College of Georgia and a board member of the American Academy of Family Physicians. “I think it’s vitally important that the patient have an ongoing relationship with a physician that they can trust and that they can talk to.”
But increasing workflow demands can present challenges for clinicians in their effort to build trust.
“Some of these conversations can turn into arguments, or sort of an expert-nonexpert dynamic so that the family feels like the physician is acting like an expert, so they’re put on the defensive,” said Dr. Sean O’Leary, associate professor of pediatrics at the University of Colorado Anschutz Medical Campus and a member of the American Academy of Pediatrics committee on infectious diseases. “A lot of these families have done some of their own reading and research and they feel like they have already looked into this, so when you create this expert-nonexpert dynamic it can put people off.”
O’Leary said the average time pediatricians spend with patients during a wellness visit is about 18 minutes or less, but when a parent has concerns about vaccines, clinicians can spend more than 10 minutes discussing vaccines during that visit.
“When we’re spending more than half of the visit discussing the most evidence-based thing that we do, that’s a problem,” O’Leary said.
Overall, median vaccination coverage for the measles, mumps and rubella vaccine was more than 94% among kindergarten-age children for the 2017-18 school year, according to the Centers for Disease Control and Prevention.
But a 2018 study published in PLOS Medicine found a rising rate of nonmedical exemptions from vaccinations from 2009 to 2017 among children entering kindergarten in 12 of the 18 states that allow for exemptions from school requirements based on personal beliefs.
Nationally, the percentage of children who received exemptions rose from 2% during the 2016-17 school year to 2.2% in 2017-18, according to the CDC.
Vaccine hesitancy and refusals have been at the center of two of the largest measle outbreaks this year. As of April 8, as many as 285 cases of measles have been confirmed in the New York City boroughs of Brooklyn and Queens since October, with the majority involving members of the Orthodox Jewish community, which has historically had low vaccination coverage.
On April 9, the city took the unprecedented step of declaring a public health emergency, ordering mandatory measles vaccinations for all children in those areas over 6 months old or face a $1,000 fine.