Vaccines are never a fun conversation with your kids. For many years, before every doctor’s visit, my kids would ask, “Are there shots?” I never wanted to commit to a no, even when I thought there were not, so I always hedged, “Oh, I’m not sure. Ask the doctor.” Which led to all visits starting with the kids accosting our lovely pediatrician, “Are there shots today?!” as soon as she came into the room. Even if you are enthusiastic about vaccines, the experience of holding your kids as they get them is not usually a high point of parenting. And in the present moment, the conversation about vaccines is increasingly fraught, and not just because our kids are sometimes afraid of needles.
We’re living in a moment where vaccines, long one of the most trusted and studied preventative medical treatments in existence, are suddenly being viewed with skepticism. Debunked theories about the relationship between vaccines and autism, for example, are taking center stage on Instagram and Facebook but also in congressional hearings. I think that part of the problem we’re facing is a lack of understanding. People don’t know quite how vaccines work or why there are more now than in the past or how we can know that they are safe.
My guest today is Dr. Adam Davis. A pediatrician in the Bay Area, Adam was my medical editor for the book Cribsheet, and he has a lot to say about vaccines from the perspective of someone who gives them.
In the conversation, we talk about our theories on why the COVID vaccine sped up a slow-growing movement around vaccine skepticism. We talk about the role that vaccines play in public health and how to explain that. We talk about what it’s like for doctors to deal with vaccine skeptics in their own practice and what people can and can’t be talked into or out of and, because it’s a parenting podcast, some hacks for getting your kids through vaccines without too much drama. Adam is here to help cut through some of the noise and generate some real understanding.
Here are three highlights from the conversation:
Why are vaccines for diseases that have been eradicated, like polio, still important to get?
How can you make getting vaccines slightly more tolerable for your child?
I find that attention’s the most important thing, just getting the attention away from it. And some kids you can’t do that with. They have panic attacks while they’re getting vaccines, and then it’s hold tight, hold fast, and go fast. Don’t take time.
Why is there a warning about egg allergies with some vaccines?
Full transcript
This transcript was automatically generated and may contain small errors.
It relieved some of the tension for me because one of the nice things about ambulatory medicine versus inpatient medicine is often you have that longer time period. In acute medicine, you need to figure out what’s going wrong and correct it shortly, but a rash you can say, “Well, let’s do this for a week. And if it’s getting much worse, we can call a friend or we can…” And that’s true for a number of things that can happen in the ambulatory world.
And over the years, now it’s been seven years that I’ve been doing this, I feel that every day. It’s a really special honor to have a family identify you as their child’s pediatrician. It’s a huge amount of trust. It’s a very unique relationship. It’s really special and a lot different times in the child life, like when they’re born obviously, but also those teen years when you’re transitioning from being mostly talking to the parents to mostly talking to the kid and you’re trying to preserve that relationship with the parents but also know that the kid can be in some rebellion, and you want to be on their side as well. And so it’s humbling that way and it’s really special.
A lot of the questions that people can ask me, there’s not a wealth of literature to go to to answer it, but vaccines is the exception there. Vaccines are really well studied and the effects, what we call the effect size, how many people you have to do something to to protect one person is quite small with vaccines. Honestly, even if you go outside of doctors, if you just think about what’s improved health over the last century or more, it’s hygiene and vaccines are number one and number two. Probably hygiene first and vaccines second. But vaccines has been life-changing for public health. And so I’m a strong believer, so much so that our practice… And not every practice has the benefit of being able to do this, but we have limited capacity to keep patients in our practice who truly refuse vaccines. We won’t do that for the long haul. And in our state, they’re required for schools.
Before that, I think that most parents mindlessly went to their doc and said, “Oh, it’s vaccine time. Cool, tell me what I need to get.” And then they got in the habit of doing their own analysis on it, which led to more and more questions, which leads to longer conversations, which led to some resistance in some areas. And specifically with the COVID vaccine, I think there’s also this almost… It’s somewhat illogical, but there’s almost this thing, “I want to be done with the pandemic.” And one day being way of being done with the pandemic is just, I’m not doing the vaccine anymore either because that’s part of the pandemic.
And the other thing that happened, which I think has a portion of fault to some extent of public health, and I’ve talked about this before, is after that initial vaccine wave, when we then got into the current state of boosters, I think that people are feeling attacked when they are raising concerns that they view as very valid, and some of which I think are reasonable. For example, there are a lot of people who would say now, “I don’t know why my seven-year-old needs a fourth booster. They’ve had COVID four times. They’ve had all of the shots. Europe doesn’t give boosters. Why is the CDC saying this is so important?” And then they feel like, “Well, I don’t really agree with this, it doesn’t seem reasonable. And then let me think about it. Why do I need the measles vaccine?” And I think for me, that’s a little bit of a failure because I actually think it should be totally reasonable to say, “Your kid gets a measles vaccine, but also, they don’t need a fourth booster because the value of that for a healthy kid is small.”
One, they make you a little bit less likely to get the disease, but not a ton less likely. And it depends a little bit on the timing, it depends on each individual booster and whether that particular booster matched the particular strain that happens to be around during the next bump. But it does. And we know that from data. Two, it attenuates the disease. And again, that means to lessen the strength of it. And I’ll give you a great example that I have just from two weeks ago. And this is from flu, but I had a 13-year-old and a 20-year-old. And flu has been brutal the last few weeks.
And the same thing can be a said of COVID. Now COVID seems to be right now a more mild disease than flu A for kids in general. I don’t see the high fevers and the really ill. You do see really tired and a lot of cough. And the tired is out of proportion often with the height of the fever, which with fluids seems more aligned. But again, I think it’s hard to measure these things in studies because they’re not the outcome studies they’re looking at. The second thing, besides lowering the risk of getting the disease and attenuating the disease itself if you get it… And part of the attenuation is just knocking off that tail of the bell curve too of this-
But the third thing, and this is incredibly important and the main reason that I vaccinate is we know from studies prior to the pandemic that the more kids who are vaccinated with flu vaccine in a community under 18, the less elderly people die in that community that season. And we know from COVID studies in the prisons where they can look at spread really nicely between prisoners, that even if a prisoner got COVID, they were less likely to give it to their cellmate if they had the vaccine because the viral load that they were coughing out was lower.
And so I do believe, and some… Again, we’ll get more data on COVID over time as these… But I do believe, first of all, more COVID deaths still today than flu deaths over the course of a year. We have more COVID deaths in this country. And so I do think that we can protect our elderly and our immunocompromised by continuing to have universal vaccination programs.
And so I really stress to families just, “Look, I don’t give any of the kids’ polio vaccine because I’m worried they’re going to get polio. There hasn’t been a case of polio in California. Maybe there will be now since New York’s had a case last year. But we haven’t had a case since the ’70s. It’s very unlikely that they’re going to be exposed to polio, but they’re part of a larger project, and that project is to rid the world of polio. And COVID and flu we’re probably not going to rid the world of, they’re going to be endemic until technology changes dramatically, but if everybody vaccinate themselves, we will have less of a bump every year, we will have less deaths every year. And I think that matters.” That’s how I explain it to them and then I let them make the decision they want to make.
But what I will say there is that we have doctor practices in the area, both in the city itself and surrounding the city that are very open to alternative vaccine or no vaccine families. And what I say to families is actually not, “Hey, you’re an horrible person because you’re not going to vaccinate your kid,” or even your pain in the ass. What I say to them is, “Look, we’re building a relationship of trust here, and I want you guys to trust that I’m going to give you the best information I can and that you trust me as a shepherd to help you through this. And if on the thing that I think is most evidence-based, you guys are like, ‘No,’ then there might just be a better match for you locally.” That’s what I offer up to them. I’m never like, “You’re bad people,” I’m just like, “I have a system of beliefs about medicine that you guys don’t believe, and so why wouldn’t you see somebody who matched that better?” I also don’t do crystal medicine in my practice. If they really wanted that, they should seek that out with somebody else.
But it’s funny, I do think that in our world right now, just where the culture is, people feel that they need to protect themselves and protect what they have a little bit more than they did before. And it’s a coarser environment. But I think within that, when you actually say, “Hey, no, this is actually a community thing,” and they weren’t thinking of it that way, it opens up something for them. For a lot of my patients, anyhow. My front staff, they have a big joke because I do a lot more vaccinations than a lot of my partners. I just do. We will vaccinate parents for COVID and flu. I ask every parent every visit, which is not what-
But actually, this is a place where I say to them, “Look, I actually think… One, there is some evidence about this. And there’s some evidence that you have increased level of febrile seizures if you split your vaccines.” And I think that data is most likely just fever’s a potential side effect of any vaccine, so if you have fevers more time, you’re more likely to have a febrile seizure. But I don’t know.
But it’s not the thing I lead with. I don’t usually talk about that. What I usually talk about is the child’s experience. And what I usually say to them is, “Look, the day you get vaccines sucks and the next day sucks. And I don’t want so many of those days for your child. If we split this day into three days, then three days suck getting the shots, and that’s more of a negative stimuli for them, for this office, and for everything. Once they get their first shot, while they’re crying for their second shot, it’s not that big of a deal to them. They’re still going to be okay five minutes later. And yes, there might get a fever tomorrow, but I don’t think it’s additive. I don’t think if you give five vaccines, the fever will be three times as high. And it means if we split it that there’s another day they might get fever.”
And actually, the other part of it is really trying to help the patient take the vaccine calmly. And we can do a lot of things about that. For the little babies, please feed your baby while they’re getting the vaccines. Nurse them if you’re breastfeeding, give them a bottle if you’re not. It makes a huge difference. For the little bit older kids, distract them. Put them over your shoulder. Put a screen or a bright moving thing behind your shoulder that they can watch. Often, kids won’t even know they’re getting vaccines. With older kids, like anybody four to five and above, I play categories while I’m giving vaccines. I don’t give the vaccines, my medical assistants do, but I hold their hands, they look me eye to eye, and we go through a favorite thing, animals for the younger kids, sometimes sports players for the older kids. And honestly, they sometimes ask me if they’ve got their vaccines yet. It depends a little bit if they want to concentrate.
Some people do the EMLA. I think it’s a little bit placebo. I don’t think it matters if you numb the skin a little bit before the vaccine. But the vibration thing, like the buzzy bee or the ice, those things all work, but I find that attention’s the most important thing, just getting the attention away from it. And some kids you can’t do that. They have panic attacks while they’re getting vaccines, and then it’s hold tight, hold fast and go fast. Don’t take time.
But it’s funny, I have families that after they get the vaccines, the kids will be like, “Oh, the worst part was thinking about the vaccine beforehand.” Or the parents will be like, “Oh my god, that wasn’t nearly as bad as I thought it would be.” So many parents come in with their own needle phobia that they project it down to their kids. If you can take a moment and think of a strategy to keep your kid distracted during vaccines, I think that everybody ends up not hating vaccines as much.
Again, on a public health basis, like worldwide, giving it at day zero absolutely makes sense. And Vietnam is where the major studies in hepatitis B have been. We’ve cut down on liver cancer in a single generation. Hepatitis B over time puts you at high risk of liver cancer. We’ve been able to cut down on that significantly, 80%, 90% from a previous generation because of hepatitis B vaccine.
On the other hand, most of my families, the reason they say no is they’re like, “Oh, this baby’s so tiny. I’m so worried about them getting a shot.” And then they come to my office because… And they also don’t trust the hospital system, but they’ve already decided they trust me, so they’ll just get it a few days later. And again, the likelihood that they got hepatitis B and either tested negative for it or got it in between the time they got tested and the time they delivered is so low that it’s not one I put a ton of energy in fighting.
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