Feature Article — Families and Vaccines: Figuring It out when Opinions Differ

A multi-state measles outbreak is due in part to declines in vaccination with the MMR (measles-mumps-rubella) vaccine. While most parents choose to vaccinate their children, pockets of unimmunized people provide opportunities for diseases to gain a foothold in otherwise vaccinated communities.

One interesting story that has emerged from the current outbreak involves unvaccinated teenagers trying to get vaccinated against their parents’ wishes. Interviews with some of these teenagers have indicated that vaccines were not an option because of their parents’ views, and in some cases, discussion was also not an option. Now, as those teens see outbreaks of vaccine-preventable diseases, or transition to phases of life when they need to be vaccinated, they are taking matters into their own hands.

Teens are not the only ones whose positions about vaccines may differ. We periodically hear from family members frustrated with similar situations in their families. The differences occur between husbands and wives, parents and grandparents, brothers, sisters, nieces, nephews, cousins, friends and other loved ones.

Often these people contact us looking not only for reliable information but also for guidance related to keeping vaccine-preventable diseases from harming their unvaccinated family members, or for guidance when having conversations with those in their family concerned about vaccine safety.

Getting reliable information

While lots of misinformation exists about vaccines, so too does reliable information. We provide a list of organizations with reliable information on our Vaccine Websites page. The World Health Organization offers a program, called the Vaccine Safety Net, that vets vaccine-related websites around the world.

You can also check out the Vaccine Education Center (VEC) resources page at vaccine.chop.edu/resources. Click each link to see the different topics and formats for our information, including Q&A sheets and booklets as well as a large number of short videos.

Protecting unvaccinated family members

We have compiled some of the considerations for both vaccinated and unvaccinated family members in the Q&A Special Topics sheet, Vaccinated or Unvaccinated: What You Should Know.

Having conversations

Like with politics, vaccine conversations can become heated and uncomfortable. Unlike with political conversations, in some cases joint decision-making related to the health of a family member is required.

• Expectant parents — Pregnancy is a good time to gather vaccine information and discuss each other’s concerns or opinions related to vaccination. In most cases, parents agree that vaccination is an important way to protect their babies, as evidenced by the fact that most children are immunized.
  
  Some parents may consider individualizing the vaccination schedule; however, this approach is not recommended since the schedule established by the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) is tested for safety and is designed to afford children the best levels of protection. Check out these VEC resources for more information about the schedule or for an easy-to-read version of the schedule:
  • Recommended Immunization Schedule: What You Should Know (English | Spanish)
  • Easy-to-Read Immunization Schedule (English | Spanish)
  • What is the Harm in Delaying or Spacing Out Vaccines? (VIDEO)
• Parents of young children or older children who disagree with their parents’ decisions not to vaccinate when they were younger — An agreement on action is necessary. In these situations, respectful conversations and listening are an important starting point. If agreement upon next steps is not able to be reached in these conversations, consider making an appointment with the child’s healthcare provider to discuss concerns and help with making a plan that is amenable to all involved.
  
  Unfortunately, sometimes these situations end up being decided in courts — most often as part of custody disagreements. Because courts are not the best place to get accurate health information or to make health-related decisions, it is important to try to resolve differences of opinion before a situation rises to this level.
• Grandparents, aunts and uncles, or other extended family members — For generations, families have passed along advice and offered guidance about virtually every aspect of life, including parenting. The recipients of this guidance have not always opted to listen to or act on this guidance, but in most cases, they at least consider what is said or offered. So, families are natural places for vaccine conversations to occur.
  
  Because the topic of vaccines has become emotionally charged, opinions (solicited or not) are sometimes not well received. However, most new or expectant parents are just trying to do what is right for their children and welcome input from others. Often, older family members have witnessed the severity of vaccine-preventable diseases in a way that younger family members have not. They have also typically chosen to vaccinate themselves or their children without evidence of harm. Whatever a young family decides to do, they should be respected in their decision. If they are opting not to vaccinate, it may be difficult to support the choice, but try to remain respectful and share information when or if it feels appropriate. They may eventually opt to vaccinate if they do not feel like they have to constantly defend themselves or face “I told you so” as a result.
  
  If you are the sibling or cousin of someone who has opted not to vaccinate, you may decide you are not willing to have your child exposed to their unvaccinated children. These conversations can be difficult, but just as much as they have the right to make the choice not to vaccinate, you have the choice to limit interaction. The Q&A Special Topics sheet, Vaccinated or Unvaccinated: What You Should Know, offers information that may be helpful in making a plan as well as for offering support as to why you are making your decision. Regardless of how you decide to proceed, be respectful and realize that the difference of opinion and approach between yourself and the family member choosing not to vaccinate will not only affect the two of you, but will also affect the extended family. At a minimum, try to work together in a way that does not require the rest of the family to feel as though they need to pick sides.

The ongoing multi-state measles outbreaks, as well as recent outbreaks of other vaccine-preventable diseases, like pertussis and mumps, are likely to spur more of these vaccine conversations. With that in mind, remember that family relationships are more important than a single topic or issue. Hopefully, these tips and resources will help. Finally, don’t lose sight of the fact that by vaccinating your family and encouraging others to do so, you are protecting not only your family but also your community.