Talking to Faith-Based Parents About Vaccination: Two Experts Weigh In

Blima Marcus, DNP

How did you get involved with vaccination education?

I have a cousin who lives in Lakewood, NJ, an Orthodox community. She told me that a large percentage of her neighbors were not vaccinating their children. She suggested that I join a text-based chat group of Orthodox anti-vaccination parents to address some of their concerns.

At first, I didn’t know all the answers, but I researched them. One by one, I began to refute the concerns I was hearing. After 2 weeks, I began getting private feedback from individuals who said this was the first time someone responded to their questions and didn’t make them feel bad, incompetent, stupid, or selfish.

At the time, I was part of a large group of nurses, the Orthodox Jewish Nurses Association, and we formed the OJNA Vaccine Task Force. We decided to transfer the text-based model to a more formal, in-person round table context and have been doing so ever since.

What other forums do you use to provide education about vaccines?

Many false claims, such as the idea that vaccinations cause autism, have been introduced and circulated widely in the community through a pamphlet called the “Vaccine Safety Handbook” published by a Jewish organization called Parents Educating and Advocating for Children’s Health (PEACH). To counter the claims raised in the pamphlet, the Vaccine Task Force has published a pamphlet called “A Slice of PIE (Parents Informed and Educated),” suggesting that readers can “make PIEs out of “PEACH.”

What topics do you cover in the publication?

PIE points out certain broad concerns raised by anti-vaccine authors in the PEACH pamphlet, including outdated information, biased sources, discredited sources, selective information, false information, and irresponsible conduct on the part of the authors and their organization.

We also address specific concerns and myths, such as the belief that measles builds the child’s immune system, that it has no complications, that the vaccine itself can cause the disease, and the history of the autism concern, beginning with the now-discredited article by Wakefield.5 We review the CDC’s recommendations and provide extensive references to the safety and efficacy of the recommended vaccinations and vaccine schedule. We explain that getting sick after the flu shot doesn’t mean that the child has gotten the flu, and that research has shown that even people who get the flu because the shot doesn’t cover every strain of the virus are less likely to end up in the ICU or to have complications.

What approach do you take when you talk to parents who question vaccines or refuse to vaccinate their children?

I am nonjudgmental, I listen carefully, answer questions, and use actual science to try to dispel conspiracy theories and paranoia about financial gain by doctors, the CDC, and others involved in the vaccination process. I validate concerns as well. Many people are frightened of vaccines because they know someone whose child became ill after a vaccine. For example, one woman said her child had a seizure after having a vaccine. I said, “I don’t blame you for being worried. If it were my child, it would be scary too.”

People have responded well to this. Many found that their doctors didn’t have time or interest in going through their concerns. I’m not speaking negatively about doctors. The pediatrician’s office is not necessarily the best place for having long, in-depth discussions. There is a packed waiting room and a very limited amount of time. But what is needed for parents is more than, “No, this vaccine doesn’t cause autism.” Some parents think that doctors get bonuses for vaccinating children and I dispel that myth.

I also explain to parents how to evaluate research – for example, how to find out who funds research into vaccinations or how many children have been in a given study.

Are there any religious concerns that are specific to the Orthodox community?

Although there is a small handful of influential Orthodox rabbis who say that if there is a risk to health, one can’t be mandated to vaccinate children, the majority of rabbis do support vaccination. Some Orthodox Jews use the religious exemption to avoid vaccines, which they’re concerned about for other reasons. Some are more “new age” in their approaches and follow a less interventional lifestyle. These are parents who tend to avoid giving their kids antibiotics or give birth at home.

Some Orthodox Jews are concerned about the use of aborted fetal cell lines or animal products from unkosher animals in vaccines. I’m pretty sure that this is an excuse. Other medications contain these cell lines or products from animals. There is no Jewish law prohibiting the use of unkosher animal products, so long as they are not being ingested.

Do you think it makes a difference to Orthodox individuals that you are yourself Orthodox?

I think that being a member of the community is helpful but the most helpful part is that I’m a nurse. There are many Orthodox medical providers who are not trusted, especially about vaccines. I feel that one of the aspects of the ant-vaccine propaganda is to foster distrust of the whole medical establishment, including Orthodox providers.

However, I can also speak to some of the values I know are important to Orthodox people, such as sense of community. Certain prayers can only be recited in a quorum of 10 people. There are large families, often living in very close quarters. I explain the obligation to prevent harm to other community members by describing the impact of infectious diseases such as measles on immunocompromised children who are unable to receive vaccines and whose weakened system makes them unable to adequately fight off the disease. This awakens a sense of responsibility and provides a different angle.

Amy Givler, MD

What is your background and orientation to vaccine education?

I am a family practice doctor in Monroe, LA. I am affiliated with an indigent care hospital that services a large rural area. A good half of my patients are very rural, and the other half come from a small city.

I have always been appreciative of vaccines because I care about public health. When you look at public health advances over the centuries, probably one of the greatest ones is clean water. But if you take that out of the equation, I think that vaccines have been the most effective medical intervention. There are obviously many groundbreaking interventions that have revolutionized people’s lives, but many either benefit a small number of people or are very costly.  Vaccines are available for a large number of people and for a relatively small amount of money.

I’m an Evangelical Christian and my faith is very important to me. As one of CMDA’s regular bloggers, I have written several pieces on vaccines. Of course, I also enthusiastically educate my own patients. And I lecture in several different forums so as to more broadly disseminate this information.

Why do you think many members of the Christian community are opposed to vaccination?

One reason is that a significant segment of the Christian community tends to be less trusting of medical science and physicians than other groups. Another that is not specific to the Christian community concerns the greater availability of information in this day and age. I am 60 years old and when I started practicing medicine some 30 years ago, almost all of my patients’ medical information came from me. Now, in the Internet age, there is a great deal of medical information, both true and false, and people are coming to me with many more questions about things they’ve heard from other people.

Are there any ideological issues specific to the Christian community?

Many vaccine-hesitant Christians express concerns about the use of cell lines that came many years ago from aborted fetuses, which is a concern for Catholics as well as Evangelical Christians. Several vaccines are produced using two cell lines that originally came from the lungs of fetuses aborted in the 1960s but not aborted specifically with the intention of obtaining their tissue.14

I am not Catholic, but I respect the reasoning behind a statement issued by the Vatican in 2005 urging parents to ask their physicians to use vaccines not derived from the cell lines of the fetuses aborted in the 1960s, if such vaccines exist. If not, people should write to pharmaceutical companies urging them to develop alternative vaccines. However, if that is impossible, it is morally acceptable to use the vaccines “in the meantime, insomuch as is necessary in order to avoid a serious risk not only for one’s own children but also, and perhaps more specifically, for the health conditions of the population as a whole, especially for pregnant women.”15

An updated statement17 issued in 2017 by the Pontifical Academy for Life stated that “the cell lines currently in use are very distant from the original abortions and no longer imply that bond of moral cooperation indispensable for an ethically negative evaluation of their use” and there is no “morally relevant cooperation between those who use these vaccines today and the practice of voluntary abortion.” The statement also highlights the ”moral obligation to guarantee the vaccine coverage necessary for the safety of others.”  

This is the point of view closest to my own. I do not endorse abortion, but now that these vaccines are available, I do not believe it is wrong to use them and protecting others who are vulnerable is part of being a Christian. I explain these considerations to my patients and also have blogged about them on the CMDA site.

There are indeed alternative vaccines available, but they are not licensed in the US. The alternative hepatitis A and rubella vaccines are only available in Japan, so a patient would have to travel to Japan to obtain them.18 Although that would be a cumbersome and expensive project, it would be a way to satisfy one’s conscience while also protecting the health of oneself, one’s children, and members of the public who may be immunocompromised.

How do readers of your blog react to your viewpoints?

I started blogging, knowing full well that I might get attacked in the “comment” section, which is indeed what has happened. I can usually handle difficult, emotionally laden conversations, but personal attacks on my morality, commitment to my faith, and character are very hard, especially coming from other Christians. I have to adopt the attitude of loving them and not respond by attacking them as human beings because that is not a Christian response.

Some pro-vaccination physicians are receiving negative reviews online, even by people who were not their patients, but by anti-vaccine activists seeking to deter other parents from going to that physician.16 Has that been your experience?

My practice has not been affected by reviews, but I know several colleagues who have made pro-vaccine statements and received negative reviews and were told by their employers to stop speaking out about the subject.

How do you respond to your patients’ concerns?

When people come to me, they are often confused and they don’t know what to trust, so it begins with the patient-physician relationship and the trust they develop with me. Although a large number of patients look for information about vaccines on the Internet, over half continue to receive information from their doctors and consider healthcare providers to be the most trusted information source, despite their increased use of the Internet. In fact over two-thirds of parents believe physicians are the most reliable and trustworthy source of vaccine-related information.17

I don’t usually begin with science and information – “here’s a fact and here’s a study.” I try to create an environment where I invite and welcome their questions. I never attack them as human beings or as parents. I also don’t take their opposition, when it arises, as a personal attack. I state that I respect and affirm their concerns and the fact that they are thinking these issues through. I acknowledge that their concerns come from caring and love for their children. I use humor and validation and build on the relationship before discussion of the science. Once I have laid that groundwork, they are much more likely to listen to what I have to say about the scientific reasons for vaccination.

References

  1. Vaccine hesitancy: a generation at risk. Lancet Child Adolesc Health. 2019 May;3(5):281.
  2. Centers for Disease Control and Prevention (CDC). Measles cases in the United States reach 20-year high. Available at: https://www.cdc.gov/media/releases/2014/p0529-measles.html. Accessed: June 1, 2019.
  3. Smith TC. Vaccine Rejection and Hesitancy: A Review and Call to ActionOpen Forum Infectious Diseases, 2017;5(3): ofx146.
  4. Patel M, Lee AD, Redd SB, et al. Increase in Measles Cases—United States, January 1-April 26, 2019. MMWR Morb Mortal Wkly Rep. 201968:402-404.
  5. Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in childrenLancet. 1998;351:637–41.
  6. Rao TS, Andrade C. The MMR vaccine and autism: Sensation, refutation, retraction, and fraudIndian J Psychiatry. 2011;53(2):95–96.
  7. Hussain A, Ali S, Ahmed M, Hussain S. The Anti-vaccination Movement: A Regression in Modern MedicineCureus. 2018;10(7):e2919. Published 2018 Jul 3. doi:10.7759/cureus.2919.
  8. Baumgaertner B, Carlisle JE, Justwan F. The influence of political ideology and trust on willingness to vaccinate. PLoS One. 2018;13(1):e0191728.
  9. Zhang EJ, Chughtai AA, Heywood A, et al. Influence of political and medical leaders on parental perception of vaccination: a cross-sectional survey in Australia. BMJ Open. 2019;9:e025866.
  10. Jolley D, Douglas KM (2014) The Effects of Anti-Vaccine Conspiracy Theories on Vaccination Intentions. PLOS ONE 9(2): e89177.
  11. McDonald R, Ruppert PS, Souto M, et al. Notes from the Field: Measles Outbreaks from Imported Cases in Orthodox Jewish Communities — New York and New Jersey, 2018–2019
  12. Randall R. Not Worth a Shot: Why Some Christians Refuse Vaccinations on Moral Grounds. Christianity Today. April 26. 2019.  Available at: https://www.christianitytoday.com/ct/2019/april-web-only/why-christians-refuse-measles-vaccinations-moral-grounds.html. Accessed: May 15, 2019.
  13. Rodgers, DV, Gindler, JS, Atkinson, WL, Markowitz, LE. High attack rates and case fatality during a measles outbreak in groups with religious exemption to vaccination. Pediatr Infect Dis J. 1993;12:288-92
  14. Wadman M. Medical research: cell division. Nature. 2013;498:422-426.
  15. Catholic World News. Pontifical Academy for Life Encouraging Vaccinations? March 21, 2019. Available at: https://www.catholicculture.org/news/headlines/index.cfm?storyid=41110. Accessed: May 20, 2019.
  16. Kowalczyk L. This doctor posted online in favor of immunization. Then vaccine opponents targeted her. The Boston Globe. May 11, 2019. Available at: https://www.bostonglobe.com/metro/2019/05/11/vaccine-opponents-target-doctors-social-media-and-ratings-websites/Y8RQie1xJdr1RtKvbdR9mI/story.html. Accessed May 17, 2019.
  17. Shen SC, Dubey V. Addressing vaccine hesitancy: Clinical guidance for primary care physicians working with parentsCan Fam Physician. 2019;65(3):175–181.
  18. Pelcic G, et al. Religious exception for vaccination or religious excuses for avoiding vaccination. Croat Med J. 2016; doi: 10.3325/cmj.2016.57.516

Resources for Talking to Parents

American Academy of Pediatrics: Vaccine Hesitant Parents
https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/immunizations/Pages/vaccine-hesitant-parents.aspx

CDC: Talking to Parents about Vaccines
https://www.cdc.gov/vaccines/hcp/conversations/conv-materials.html
World Health Organization (WHO): Talking with Parents about Vaccines for Children
http://www.euro.who.int/__data/assets/pdf_file/0006/160755/Talking-with-parents_EN_WHO_WEB.pdf?ua=1

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This article originally appeared on MPR