For “heart moms” like Riki Graves, talking about vaccines is a matter of necessity. Her 6-year-old Juliana had a heart transplant when she was a baby. The procedure saved her life, but it also means she has to be on medications that weaken her immune system and make her vulnerable to infections.
It also means she can’t be fully vaccinated. Because of this, Graves says she has to be extra careful that everyone who spends a lot of time with Juliana is up to date on routine vaccines, including getting the flu shot every year. That can make for some nerve wracking conversations.
Graves isn’t alone. Many people can’t be fully vaccinated because of their age, allergies or medical conditions. For those families, talking about vaccines with potential caregivers, family, friends or employers is a must to protect them from serious diseases like measles or flu. But like sleep training and breastfeeding, vaccines have become something of a lightning rod for parents, despite the fact that most people in the U.S. vaccinate their kids.
But vaccine conversations don’t have to be awkward. Experts say building on your relationship, listening to core concerns and trying to find common ground can all help parents or caregivers have a respectful, productive discussion when talking to others about vaccination.
Here are some tips for ensuring vaccination conversations go as smoothly as possible, as well as what you can and can’t ask potential caregivers or child care facilities.
1. Let your relationship guide your approach
How you bring up vaccines will likely depend on the kind of relationship you have with someone, says Dr. Nathan Boonstra, a pediatrician in Des Moines, Iowa.
“You should expect that somebody who’s caring for children is up to date on their vaccines, and so I think asking in a straightforward fashion is fine,” Boonstra says. Talking to friends and relatives, however, might require a little more finesse.
How to initiate the conversation, based on who you’re talking to:
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If you’re talking to a potential nanny, babysitter or other caregiver: You could say something along the lines of, “It’s important to us that anyone caring for our baby is fully vaccinated. Are you up to date on all your vaccines?”
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If you’re bringing it up to a relative or close friend: You could say something to the effect of, “We were talking to our pediatrician, and they told us that it’s a good idea to make sure everyone who’s going to be around our son be fully vaccinated. Have you checked with your doctor to make sure you have all the recommended vaccines like flu and whooping cough?”
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If you’re feeling out a potential playdate: You could say something like, “Our daughter just went to get her shots, and she cried a little but overall did great! How did it go when your daughter got her vaccines?”
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If you’re talking to a potential employer: You could ask, “Would you tell me about your policies on vaccination?”
2. Prepare for pushback
In cases where you know that the other person is against vaccines and expect it to be an uncomfortable conversation, feel free to say that, says Karen Ernst, executive director of the parent-led nonprofit group Voices for Vaccines.
She recommends prefacing the talk with something like, “I don’t want to have conflict with you, but it’s important to have this conversation. So I’m hoping that we can do it in a respectful way.”
If you don’t think you can have a calm discussion, Ernst says it can help to enlist someone who knows both of you (ex. a mutual friend or relative) to have the conversation on your behalf. The right person could even help initiate and guide the conversation in more of a group setting.
3. Listen carefully and ask questions
It’s not uncommon for people to have questions or concerns about vaccination, Boonstra says. That doesn’t necessarily make them anti-vaccine, and it doesn’t mean you’re in for a fight.
If someone tells you they (or their kids) don’t get vaccinated, ask why not — then listen, and try to find out more. They might be more open to hearing your perspective if you show them you’re willing to listen to theirs, and asking more questions will help you get to the root of their concerns, Ernst says.
Some questions you could ask include:
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“What did your doctor say?”
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“Have you shared your concerns with your pediatrician?”
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If they’ve mentioned a new or journal article they read: “Can you send that to me so I can check it out too?”
4. Acknowledge that you’ve heard them
How you respond to a person’s questions or concerns regarding vaccines will depend on your relationship, Boonstra says. If you’re close with them, they might be OK with you responding with science-based information or resources. However, for many people, jumping straight to dispelling myths might not be the best approach as it could lead them to dig in their heels or feel defensive. A better approach is to first acknowledge you’ve heard them and try to find common ground.
In response to someone saying something like, “I don’t want to get a flu shot because I heard it’s not tested,” the experts we spoke with suggest asking, “Where did you hear that?”
Depending on what they’ve shared, experts recommend you reply with a phrase like:
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“I hear where you’re coming from.”
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“I understand why you would think that.”
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“I completely get why that would make you nervous.”
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“I had that same question.”
5. Respond to core concerns with a mix of science and stories
Once you’ve established that you’ve heard them, you can then talk about their concerns by sharing what you’ve learned. Some might respond well to facts and science while others might be more convinced by a personal story or anecdote.
A few options for responding, based on American Academy of Pediatrics (AAP) guidance on countering vaccine hesitancy:
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“People can spread diseases before they even realize they’re sick. I know about a woman who had no idea she was infected with whooping cough and passed it along to her newborn grandbaby. Can you imagine how she must have felt when that happened?”
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“Even healthy people can die from the flu. I just read about a family who lost their healthy child to flu. I can’t imagine how difficult that must have been.”
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“Vaccines go through a lot of safety testing before they can be used in the U.S., and they keep testing them even after they’ve been approved.”
6. Talk about your own experiences and beliefs
You don’t have to push back against every myth or misperception. In fact, laying the science on too thick or going into “debunking” mode could backfire, Boonstra says. It’s perfectly acceptable for you to have reached your own conclusions based on your personal experiences and health care provider’s guidance, which you can then share with others.
Some examples of things you could say, based on experts’ guidance:
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“When I talked to our pediatrician about it, she said diseases like flu can be really dangerous, even to healthy kids.”
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“Vaccines are important to us because my son is still too young to get a lot of his vaccines, and so we want to make sure the people around him are protected.”
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“Our doctor told us that it’s really important everyone around our baby be up to date on their vaccinations. I trust them and their expertise.”
7. Have an exit strategy
In case the conversation gets heated, Ernst recommends preparing a script ahead of time to wind down the discussion in a cordial way.
What to say to end a tense vaccination conversation will depend on what you discussed, but some examples include:
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“Why don’t you send me that information you referenced so that I can read through it, and then we can talk about it again later?”
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“I can see that we both feel really strongly about this. Why don’t we pause the discussion for now and talk about it again in a few days?”
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“I want you in our child’s life, and I want to keep them safe. Let’s think about how we can do that in a way that we’re both comfortable with.”
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“I appreciate you talking about this with me. As a parent, I feel like I should do everything I can to protect my child. So I hope you’ll understand that we will have to stick to video chats until he’s been vaccinated.”
Can families legally ask caregivers to get vaccinated?
Yes, families hiring an in-home caregiver, like a nanny or babysitter, can legally ask them to be vaccinated before or during their employment, says Dorit Reiss, a professor at University of California Hastings College of the Law who specializes in vaccination laws and policies. As independent employers with a small number of employees, no law prevents families from preferring vaccinated caregivers or asking them to get annual flu vaccines.
Child care centers work a little differently. While all 50 states in the U.S. require at least some vaccinations for kids attending child care facilities, only some — like Rhode Island, Washington and California — require any for child care workers themselves.
Can child care facilities tell parents their vaccination rates?
Generally, if a parent asks a child care facility what their vaccination rates are, most should be able to legally disclose the info, Reiss says. However, the better question for a center might be to ask whether they are requiring any particular vaccinations of all kids in their care.
While the Health Insurance Portability and Accountability Act of 1996 (or HIPAA) forbids health care providers from sharing individual medical records without a patient’s permission, that law doesn’t apply to child care facilities disclosing a facility-wide percentage, Reiss says.
But other considerations might keep a child care facility from being legally able to disclose vaccination rates — for example, if state law explicitly forbids it, or the day care is so small you could easily figure out who is unvaccinated based on the percentage alone.
Before asking these questions, make sure to check the state and local employment and privacy laws.
Why these tough conversations matter
While talking about vaccines can get tricky, Boonstra says it would help if more parents who vaccinate their kids discussed it regularly with their friends and family by posting about it on social media or sharing their experiences during playdates.
Alyssa McCann, another “heart mom” in Harker Heights, Texas, says she’s upfront with loved ones about what her family must do to protect her two young children with heart issues.
“We know that some don’t agree with our decision to keep our kids away from people who haven’t been vaccinated, but we won’t apologize for taking every precaution necessary to keep them as healthy as possible while they’re fighting other battles,” McCann wrote in a Facebook post to friends and family. “It’s our job to do everything we can to keep our children protected from vaccine-preventable diseases. We can’t control much when it comes to their health, but we can control this.”
