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Dr. Paul Mitchell, a pediatrician and second-year resident at Oregon Health and Science University, is an Oregon Pediatric Society board member.

MITCHELL"That's just how our family handles health. We prefer the natural way without vaccines."

As an Oregon pediatrician, it's common for my conversations with families about childhood vaccines to end this way. In 2018, Oregon ranked 44th out of 50 states in children fully immunized by age 2, and led the country in kindergarteners claiming a non-medical vaccine exemption at 7.5%.

Low vaccination rates in Oregon has led to outbreaks of deadly but preventable diseases like measles and whooping cough. In response, pediatricians strive to find collaborative, effective ways to discuss immunization with parents and families.

As the COVID-19 pandemic continues to rage, the delta variant has caused more serious illness in children. Despite the FDA's authorization of the vaccine in 5- to 11-year-olds, only 34% of parents say they will get them vaccinated "right away."

As more children are hospitalized in Oregon, community members must join health care providers in addressing vaccine hesitancy and deliberation among parents. Some evidence suggests that personal conversations with loved ones can ease concerns about the COVID-19 vaccine. A Kaiser Family Foundation poll found many who were previously vaccine hesitant "noted the role of their friends and family … in persuading them to get a vaccine."

Although difficult, these conversations can be a powerful tool to ensure more Oregon children are protected from COVID. To start, we know that lecturing, shaming, and overwhelming people with data is ineffective. Open-ended questions allow room for conversations about their concerns: "Tell me what worries you have about the COVID-19 vaccine."

We must allow space for the listener to be heard. Be prepared to listen, and don't just wait for the next opportunity to speak. Once we have heard the concerns, it's important to empathize and orient the conversation toward the shared goal of the child's health: "I hear you, I know how significant your child's health care decisions are to you and I promise you, as your brother, my only goal is their health and safety."

Vaccine hesitancy is not rooted in a desire to be contrarian or difficult, but in belief about what is best for someone's own or their child's health. The goal in advocating for vaccination is that same pursuit. You are on the same side. Steer away from moralizing about one's "duty" to public health. It's unlikely to resonate and may trigger defensiveness that derails a conversation. Keep focusing on the shared goal of your loved one's health as it may be the only common ground.

Next, address the specific stated concerns in a non-confrontational way. It's important to introduce facts respectfully and not as a direct refutation of their voiced concerns. It may go like this:

"The COVID vaccine was produced too quickly. I don't think it's safe."

"It's true that the vaccine was developed quickly, but not because of skipped safety steps. All safety trials were done as with previous vaccines, but the timeline was accelerated due to a massive funding effort that removed cost-limiting steps."

Keep conversations from escalating into arguments. Skeptics may become further entrenched in their views when challenged with aggressive, belligerent rhetoric. It's not a matter of expertise, but one of patience and understanding. Taking time to calmly, thoughtfully engage as a concerned loved one can help incrementally shift someone's thinking. If detailed concerns come up, encourage them to discuss their questions further with a trusted health care provider.

It's also important to be frank about the risks of COVID-19 and the proven benefits of vaccines. They may not hear this information elsewhere. Present it in the simplest terms possible: "We're seeing more and more children hospitalized with COVID. While not completely eliminating the chances of contracting it, the vaccine does significantly decrease the risk of being hospitalized or dying from it."

Most importantly, remember that these conversations rarely yield quick results. Don't be discouraged; parents need time to digest information, and most discussions like this do not end with an admission that they've been immediately convinced. Continue discussions over time and let patience and persistence, but not frustration and anger, demonstrate how much you care about their and their child's health.

These conversations are intimidating. It's natural to want to avoid conflict with those closest to us. An unprecedented mistrust of science, institutions and government means the top-down approach isn't working.

Take the time to have a respectful and authentic conversation with loved ones about vaccinating themselves and their children. You may just save their lives.

Dr. Paul Mitchell, a pediatrician and second-year resident at Oregon Health and Science University, is an Oregon Pediatric Society board member.

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