How Pharmacists Should Talk So Vaccine-Hesitant Parents Listen

Drug Topics JournalDrug Topics April 2023
Volume 167
Issue 04

Vaccine hesitancy exists on a spectrum, but with the right tools, pharmacists can provide education and reassurance to parents and caregivers.

Child vaccination coverage dropped again during the 2021-2022 school year in the United States, according to a January 2023 Morbidity and Mortality Weekly Report.1 In previous years, 94% of children were up-to-date with the CDC vaccination schedule; during 2020-2021, that rate dropped to 93% for children entering kindergarten.1 And although 2.6% of those children had an exemption from vaccination, 3.9% did not—and were not current with the MMR vaccine.1

Although vaccination rates in toddlers remained high, there were disparities among children living in rural and underserved areas.2 According to the CDC, addressing parental hesitancy toward vaccines is, among other methods, “warranted to reduce disparities so all children can be protected from vaccine-preventable diseases.”2 Pharmacists can help combat parental vaccine hesitancy directly by engaging caregivers, listening compassionately, asking the right questions, and offering information and guidance.

Understand that vaccine hesitancy is caused by several factors and exists in varying degrees. A 2016 study published in the Journal of Pediatric Pharmacology and Therapeutics described 4 main causes of caregiver vaccine hesitancy: safety concerns, religious reasons, personal beliefs or philosophical reasons, and wanting more information from health care providers.3 These reasons, investigators explained, cultivate a spectrum of hesitancy, from flat-out refusal to delayed vaccination.

“A large subset of parents admit to having concerns and questions about childhood vaccinations. For this reason, it can be helpful for pharmacists and other health care providers to understand the cited reasons for hesitancy so they are better prepared to educate their patients’ families,” the investigators wrote.3 Other issues that add to caregiver hesitancy include mis-or disinformation on social media, the growing antivaccination movement, and concerns about the newness of messenger RNA COVID-19 vaccines.4

Be prepared for caregiver questions. Caregivers often have questions about the number of vaccinations children need, as well as the timing of those vaccinations.5 Therefore, reassuring parents of the safety of receiving multiple vaccines at once is crucial.5

Parents and caregivers may have questions about vaccine safety and whether vaccines are more dangerous than the diseases themselves. They may also have questions about natural immunity vs immunity conferred via vaccination. Parents want to know about adverse effects or may be afraid of unknown serious, long-term effects,5 and they may have questions about ingredients or the relationship between vaccines and autism.5

No matter their concerns, parents should be persuaded not to delay vaccination. “Remind parents that they must start each vaccine series on time to protect their child as soon as possible, and their child must complete each multidose series for the best protection. There are no data to support that spacing out vaccines offers safe or effective protection from these diseases,” the CDC reported. The CDC provides resources for health care providers5 to help prepare answers to common questions and sample scripts of what to say to vaccine-hesitant parents and caregivers. It is important to have handouts available that contain information about both vaccines and the diseases they prevent.

How to speak and what to say. The way pharmacists speak to caregivers is just as important as giving accurate information to questions. The American Academy of Pediatrics (AAP) stressed the importance of first listening to parents in a nonconfrontational and nonjudgmental manner. “Allowing parents to express their concerns will increase their willingness to listen to your views,” the AAP noted.6 The AAP encourages health care providers to develop personalized relationships with parents and promote vaccine decision-making as a partnership to reduce hesitancy.

Through these relationships, pharmacists can affirm parents when they present correct knowledge about vaccination and gently guide them toward the right information when they do not. Being open and honest about what is known and unknown about vaccines can go a long way, as can explaining where mis- and disinformation comes from and who benefits from it. Benefits of vaccines should be emphasized over adverse events or risks, and that vaccination is one of the greatest medical achievements in recent times.6 “Stress the number of lives saved by immunization, as a positive approach, rather than focusing on the number of deaths from not immunizing,” the AAP added.6

Educational resources can be tailored to each individual family. “Provide parents with Vaccine Information Statements, educational resources, and reliable websites. Personalize the information provided to parents based on cultural beliefs, vaccine concerns, and literacy level,” the AAP said. In addition to protecting the individual child’s health, collective benefits should also be discussed, such as protecting other vulnerable individuals. Consider explaining to hesitant parents how clinical trials work and how they provide evidence for why vaccines are so successful.6

Additional Tools to Help Address Caregiver Vaccine Hesitancy

To help pharmacists reduce vaccine hesitancy, the American Pharmacists Association has created Vaccine Confident,7 an initiative funded by the CDC to strengthen patient confidence in getting vaccinated. Vaccine Confident provides a variety of tools to assist pharmacists in reassuring patients about the safety and efficacy of vaccinations The project’s goal is to “inform, educate, influence, and motivate pharmacists and the pharmacy care team” to develop confidence around vaccines for themselves and their communities.

“Along with doctors and nurses, pharmacists are one of the most trusted sources of health information,” said Sachiko Ozawa, PhD, MHS, associate professor of the Division of Practice Advancement and Clinical Education at the University of North Carolina Eshelman School of Pharmacy in Chapel Hill. “It is important that pharmacists carefully listen to [patients’] specific concerns without judgment and make gentle suggestions to those who are weakly hesitant to vaccination When pharmacists are faced with misinformation, Ozawa said they could also describe the deceptive techniques used to spread misinformation so patients can learn to identify these methods and protect against future misinformation when they see it.

Knowing what to say and how to say it, in addition to educational resources, is essential for pharmacists to help parents and caregivers overcome vaccine hesitancy. Fortunately, a variety of online tools are available to improve pharmacist communication skills to help raise rates of vaccination in children.

1. Seither R, Calhoun K, Yusuf OB, et al. Vaccination coverage with selected vaccines and exemption rates among children in kindergarten—United States, 2021-22 school year. MMWR Morb Mortal Wkly Rep. 2023;72(2):26-32. doi:10.15585/mmwr.mm7202a2
2. Hill HA, Chen M, Elam-Evans LD, Yankey D, Singleton JA. Vaccination coverage by age 24 months among children born during 2018-2019—National Immunization Survey-Child, United States, 2019-2021. MMWR Morb Mortal Wkly Rep. 2023;72(2):33-38. doi:10.15585/mmwr.mm7202a3
3. McKee C, Bohannon K. Exploring the reasons behind parental refusal of vaccines. J Pediatr Pharmacol Ther. 2016;21(2):104-109. doi:10.5863/1551-6776-21.2.104
4. Addressing the COVID-19 crisis: an open forum webinar series for pharmacists - 9/9/21. American Pharmacist Association. YouTube. September 9, 2021. Accessed March 5, 2023.
Preparing for questions parents may ask about vaccines. CDC. Updated April 11, 2018. Accessed March 7, 2023.
Talking with vaccine hesitant parents. American Academy of Pediatrics. Updated July 30, 2021. Accessed March 23, 2023.
Vaccine confident strategy. American Pharmacists Association. Accessed March 7, 2023.
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