In 1993, a young couple expecting their first child walked into my office. As the new pediatric residency director at the University of California San Diego, I was eager to help them find the right doctor for their family. With my own pediatrics career just beginning, I was especially hopeful it would be me.
During our meeting, the couple expressed concerns about recommended vaccines for their new baby. They wondered if it was too much, too soon. They wanted to know how I felt about that.
Well, I knew exactly how I felt. I was a doctor. I had spent the two years prior investigating disease outbreaks for the CDC’s Epidemic Intelligence Service. I had recently returned to the U.S. from Bangladesh, where I conducted research on polio vaccination.
So off I went. I explained how vaccines are incredibly safe and effective, and why babies should be vaccinated fully and on time. I warned that anything short of following the recommended schedule would put their child at risk of preventable illness and disease. And I said if they still felt differently than I did, they should probably find another pediatrician.
They got up and walked out. I’ve spent more than three decades as a pediatrician, so I’ve reflected a lot about that conversation over the years as routine vaccination rates have declined and outbreaks of vaccine-preventable diseases have surged. I’ve especially reflected on it in recent days, as health secretary Robert F. Kennedy Jr. and his allies have made drastic and dangerous changes to the recommended vaccine schedule that will put many more children at higher risk of preventable illness and disease.
I know I handled that moment poorly. And even though it happened a long time ago, the lessons that I learned are perhaps even more important today.
My first mistake was talking instead of listening. I should have slowed down. I should have given them the time and space to explain their thought process. I should have given myself the time to empathize with their perspective.
Instead, I immediately focused on my own. While I believe just as strongly today as I did then about the merits of vaccination, I now realize I didn’t create an atmosphere of respect and understanding. As a result, we never had a chance to develop those essential bonds of trust. Indeed, it’s that weakening of trust that anti-vaccine advocates have exploited so effectively in their crusade to turn families away from vaccines.
I also failed to account for the simple truth that every parent wants their child to grow up healthy and reach their full potential. Parents should ask tough questions about medical treatments for their children, vaccines included. If providers recoil at those questions, we become adversaries instead of allies.
Finally, I should not have so readily encouraged that couple to find a different doctor. I had important information to provide them about vaccines. But in my zeal to provide evidence and data, I didn’t realize that how I shared was just as important as what I shared.
After all, it’s only natural for new parents to feel vulnerable, uncertain, and cautious. Numbers can go only so far to assuage fear and concerns. My focus should have been our shared commitment to help their new baby grow up healthy. Recognizing and appreciating their different backgrounds and experiences could have produced a very different outcome.
Over the subsequent years — using a more collaborative, inquisitive approach — I found that some patients’ parents who were hesitant to fully vaccinate their children changed their perspective. I had a number of families change their perspective on annual flu shots. I remember a father of a young child who I took care of at a health clinic in Harlem. The first year he was under my care, he didn’t get his child vaccinated. But the following year, he did. In those kinds of moments, I could see that so much comes down to trust, and that trust is built on a willingness to listen.
A recent national poll finds that 85% of parents say they trust pediatricians on vaccines. Despite the considerable damage that Kennedy is causing to our nation’s vaccination system, that number gives me hope. The decision to vaccinate has always been a personal one, informed by quiet conversations between families and healthcare providers. Laying the groundwork for trust is the best chance we have of getting parents to say “yes” to vaccinating their children, no matter what is happening in Washington.
I never saw that couple again after they left my office. Having had years to reflect, it comes down to this: I was right about vaccines, but wrong about how to have the conversation. It is a misstep that I regret, but one I hope other doctors and medical providers can learn from as we fight so hard in this moment for the healthier future our children deserve.
Richard Besser is president and CEO of the Robert Wood Johnson Foundation and former acting director of the Centers for Disease Control and Prevention.
