Where you are:
You are an FY2 working in the paediatric department.Who the student is:
Mike James, a final year medical student in clinical rotation in your department wants to learn about what to do when someone refuses vaccination.What you must do:
Teach him and address his concerns.
Approach
- Smile
- Introduce yourself and explain your role ‘Hey, you must be Mike if I am not wrong. I am X working in this department’.
- ID check: Done with the introduction part above.
- Build rapport: Ask about work/ How is his first day going… etc.
- Main concern: Copy the concern from the notes ‘I understand you are here today to learn about what do if someone refuses vaccination, am I right?’
Yes, definitely I would love to show you how to do it. I appreciate that you are already filled with so much enthusiasm’. - Assess knowledge (4 W):
- So, before we start could you tell me What you know about vaccination in particular?
- Why do you want to know about it? The student might tell you that they have seen their senior handling a vaccination refusal and what to know how they can handle the situation.
Teach:
We should give the parents a good reason to get their child vaccinated. At the same time, we should be transparent about vaccinations side effects as well.
Advantages of vaccines:
- Individual level: Help to protect them and their child from many serious and potentially deadly diseases.
- Community level: herd immunity through vaccination to protect other people in their family and community by helping to stop diseases spreading to people who cannot have vaccines, such as babies too young to be vaccinated and those who are too ill to be vaccinated
- Sometimes reduce or even get rid of some diseases – if enough people are vaccinated. Eg: polio and smallpox have been eradicated in the UK
Vaccines side effects:
- Local side effects: pain, swelling, redness.
- Systemic side effects: fever, lymph gland enlargements. Of course, we will have to tell the parents that they are temporary side effects and if they usually resolve in a few days and offer paracetamol in case they persist and cause trouble.
- Rare side effect: anaphylaxis. Of course, we will have to tell the parents that we have a team of healthcare professionals, who will be watching over their child for a certain period after vaccination to make sure that nothing happens and they will be ready to take action in case something rare as anaphylaxis happens
Concerns by parents:
- MMR and Autism: “Parents do have concerns about MMR being related to autism, do you know how we should address the concern?”. We tell the parents that the MMR vaccine is given around the time autism is diagnosed, so parents tend to make false connections to it but it has been proven that there is no foundation or link to the connection. We will have to make sure
that they understand that. Vaccines have undergone rigorous safety testing before being introduced they’re also constantly monitored for side effects after being introduced.
You can give examples of recent evidence demonstrating importance of vaccines such as:
- The effect vaccines had on reducing mortality following COVID infection.
- The recent outbreak of Measles in the UK due to the loss of herd immunity
due to reduced vaccination uptake by the community.
Parents might have a reason to decline vaccination for their child despite explaining advantages, and disadvantages. We have to:
- Respect their decision.
- They have the right to decide what is best for their child.
- We should not force them.
- Welcome them back in case they have a change of mind
- We need the parents to sign the Immunisation Refusal Form.
As vaccination is not mandatory in the UK, it is not usually required to inform
the school about vaccination status. However individual school policies may vary
with the school.