The first conversations about immunisation can set the tone for future decisions, according to an innovative research project
The weeks after the birth of a child can be stressful and tiring. Somewhere in that hazy, sleep-deprived spell, a message arrives saying it’s time for the child’s first immunisations.
Particularly after the birth of a family’s first child, the learning curve can be steep. Feeding, sleeping, bathing and dressing a new-born baby, while adapting to a whole new routine can be exhilarating and exhausting.
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It’s hardly a great time to think in detail about immunisation.
That’s why researchers at the Vienna Vaccine Safety Initiative, with the School of Design Thinking in Potsdam, Germany, have concluded that GPs, paediatricians and midwives should introduce the topic much earlier in pregnancy – when expectant parents are preparing for the arrival of their first child.
Dr Barbara Rath, co-founder and Chair of the Vienna Vaccine Safety Initiative, told Vaccines Today that by taking a ‘design thinking’ approach they sought to answer the question: How might we enable physicians to encourage parents and children to prevent infectious diseases?
“Thinking through the process of vaccine consultations in paediatric practices, we realised that vaccine questions are usually first addressed at the time when a first child has just been born into a new family,” says Dr Rath.
“This is of course also the time, when levels of stress, a lack of sleep and the need for sudden adjustments in the household may already be overwhelming to first-time parents. In other words, the first or second ‘well-child’ visit is probably the worst moment to start an in-depth conversation about preventive aspects and long-term benefits of vaccines.”
She says balanced and well-informed conversations during the first pregnancy allow parents the time to find clarity for themselves and to ask any questions they may have. “It would be best to address the topic of vaccine prevention in the greater context of safety measures and precautions when getting ready for the child to arrive,” Dr Rath adds.
The group also found by listening to parents that initial decisions set the tone for future decisions, meaning that if health professionals take the time to engage with first-time parents it can have long-term benefits on building trust in vaccines.
In addition, the researchers looked at what motivates pregnant women to be vaccinated during pregnancy against, for example flu or pertussis. They found that mothers are more likely to be vaccinated in order to protect their offspring than to do so for their own benefit.
“They would not have done it for themselves but for their children, any time,” Dr Rath recalls. This should be kept in mind when designing immunisation strategies.
Read a full transcript of our interview with Dr Barbara Rath
Why is it so important to discuss vaccination with mothers during their first pregnancy?
The idea that vaccination should be discussed during a first pregnancy is an interesting new insight, which we gained from a collaborative project of the Vienna Vaccine Safety Initiative with the School of Design Thinking in Potsdam, Germany.
Design Thinking is an innovation technique first taught Stanford University as a “method of creative action”. Design Thinking uses a radically user-centered and interdisciplinary approach to generate novel, out-of-the box ideas.
The question we studied together was: “How might we enable physicians to encourage parents and children to prevent infectious diseases?”
Thinking through the process of vaccine consultations in paediatric practices, we realised that vaccine questions are usually first addressed at the time when a first child has just been born into a new family.
This is of course also the time, when levels of stress, a lack of sleep and the need for sudden adjustments in the household may already be overwhelming to first-time parents. In other words, the first or second ‘well-child’ visit is probably the worst moment to start an in-depth conversation about preventive aspects and long-term benefits of vaccines.
Considering levels of vaccine hesitancy in the general population and the many conflicting messages and rumours that parents may have heard, it would be more proactive to start a balanced and well-informed conversation during the time of the first pregnancy, when parents feel that they have the time to find clarity for themselves and to ask questions.
It would be best to address the topic of vaccine prevention in the greater context of safety measures and precautions when getting ready for the child to arrive. As paediatricians, we should work closely with obstetricians, gynaecologists and midwives, and we should ensure that we are prepared to listen to the parents’ concerns, addressing them individually, while providing unbiased and scientifically sound information in an appropriate format and language.
Do you think parents’ first decisions about vaccines set the tone for future decisions about childhood – and even adolescent – immunisations?
Well, it is the parents who taught us that their initial decisions about vaccines often set the tone for future decisions. When thinking about ways to improve vaccine communication, we try to pay attention to the voice of the parents. Parents want to take a well-informed decision with confidence, and they would like to base this decision on a healthy dialogue around vaccines.
The parent’s decisions may certainly change direction at any time in the future, but parents told us that later changes in their decision-making would rather follow a concrete event, i.e. a positive or negative experience with a specific vaccine, or with the consequences of a prior decision to withhold immunisations.
You have said at a recent meeting in the European Parliament that pregnant women tend to vaccinate to protect their children rather than directly to protect themselves. What should this tell us about how to communicate with pregnant women about vaccination?
Yes, the tendency of mothers to get vaccinated in order to protect their offspring rather than themselves sounds counter-intuitive at first, but is not that unusual. Mothers tend to put their children first. We did hear this repeatedly during the Design Thinking project, but also during vaccine communication trainings with medical students.
To prepare future doctors, we developed a vaccine safety elective, where students learned (under supervision) to hold conversations with parents and children around the topic of vaccines.
We were astonished to hear from pregnant mothers – some of them with significant risk factors and chronic conditions – that they wished they had known earlier, that by getting vaccinated against influenza, they could have protected their children.
They would not have done it for themselves but for their children, any time. Their feedback is of particular interest considering the development of new immunization strategies. Future respiratory syncytial virus vaccines, for example, could be administered to mothers in order to protect their children during the first months of life. New immunization strategies will require new communication strategies.
You do a lot of work with migrant communities. What are the major infectious disease challenges people face in this situation?
Migrant communities have become an important focus of our work in recent months. The majority of migrants and displaced people originate from areas of the world where healthcare infrastructure has been met with all kinds of challenges, or where a functioning system has collapsed due to war or natural disasters. This, and the fact that migrants often live and travel in crowded conditions, puts them at risk of infectious diseases.
Vaccines are of enormous importance, when we wish to protect refugees and migrants, especially children and pregnant women. This also implies that we can help to keep migrants protected by keeping our own vaccination status up-to-date.
Meningococcal, pneumococcal, and rotavirus disease, measles, varicella and influenza, may all spread rapidly, especially among children. It would make a lot of sense to provide the same vaccines to migrant children as we do to the all children, and to do so swiftly.
Providing the same levels of care to all children would also be in line with the United Nations Convention on the Rights of the Child.