Internists play an important role in encouraging vaccination not only in their adult patients but also the entire family unit. Although pediatricians counsel parents on childhood vaccination as part of routine care, the biggest driver of whether children are vaccinated is whether their parents are vaccinated.1 Perceived risk of vaccines, social norms, and mistrust about vaccination, especially among racial minorities and under-resourced communities, are some of the barriers to vaccination in adults and children.2
The Advisory Committee on Immunization Practices (ACIP) defines vaccine hesitancy as the intention to delay or avoid vaccines that are recommended for a particular individual. Primary care providers can employ strategies to encourage vaccination, dispel myths about vaccines, and communicate the rationale for this important public health measure.
Achieving high levels of childhood vaccination requires partnership between internists and pediatricians. Frank, open, honest conversation and using motivational interviewing techniques are crucial to addressing concerns that parents might have about vaccines. Techniques including the presumptive delivery strategy (“We will be doing some shots today”) and cohorting vaccines together (for example, HPV, Tdap, and Meningococcal at 11 years old) have been shown to increase vaccine uptake.3 Similarly, influenza and COVID-19 vaccination can also be given together and no longer requires a waiting period of 14 days. As parents often have long lasting relationships and trust in their providers, internists are a crucial first line for combatting hesitancy and misinformation among patients and their families.
The role of general internists in promoting vaccination in adult patients and their children is particularly important as COVID-19 vaccination is at the forefront of combatting the pandemic. Like other vaccines, a significant predictor of a parent’s willingness to vaccinate his/her child against COVID-19 is whether the parent is already vaccinated. Young mothers (18 to 35 years old) are most likely to be hesitant.1 As of September 2021, the Pfizer Bio-N-Tech COVID vaccine has been authorized for use in 12-18 year olds. The emergency use authorization (EUA) of the Pfizer vaccine for children 5 to 11 years is expected soon. Furthermore, data about the use of the Moderna vaccine in children and the Pfizer vaccine in those less than 5 years old is also anticipated.
General internists can help increase pediatric COVID vaccination by the following:
- Encouraging parents to get vaccinated: As mentioned previously, whether parents vaccinate their children is directly related to their own vaccination status. Therefore, counseling adult patients to get the COVID-19 vaccine can inherently impact their likelihood to vaccinate their children.
- Discussing household risk: It is critical to counsel patients regarding the importance of vaccinating all eligible household members against COVID-19 to prevent spread. Though children are not typically the index case in households, once infected, young children are the most likely to transmit COVID to household members; secondary transmission can occur in up to 27% of households after a pediatric index case.4
- Promoting the safe return of children to school and routine pediatric care: Although children generally have milder symptoms if infected with COVID-19 than adults, there remains a risk of severe complications from COVID-19, MIS-C, and long COVID-19 in children. School closures during the COVID-19 pandemic have already affected children’s learning outcomes and mental health. Vaccinating children will enable their safe return to school and the resumption of routine pediatric care, both of which were disrupted by the pandemic.
As general internists, the long-term relationships we have built with our patients offer the unique opportunity to counsel patients not only about the importance of COVID-19 vaccination to their own health but also the critical importance of vaccinating young family members.
- Simonson M, Baum M, Lazer D, et al. The COVID states project: Covid vaccine hesitancy and resistance among parents. OSF Preprints. https://osf.io/e95bc/. Published March 18, 2021. Accessed November 15, 2021.
- McGregor S, Goldman R. Determinants of parental vaccine hesitancy. Can Fam Physician. 2021 May; 67(5): 339–341. doi: 10.46747/cfp.6705339.
- Domachowske J, Suryadevara M. Practical approaches to vaccine hesitancy issues in the United States: 2013. Hum Vaccin Immunother. 2013 Dec 1; 9(12): 2654–2657. doi: 10.4161/hv.26783.
- Paul L, Daneman N, Schwartz K, et al. Association of age and pediatric household transmission of SARS-CoV-2 infection. JAMA Pediatr. 2021 Aug 16;e212770. doi: 10.1001/jamapediatrics.2021.2770. Online ahead of print.
ACLGIM, Clinical Practice, COVID-19, Health Policy & Advocacy, Medical Education, Research
Dr. Pilapil (firstname.lastname@example.org) is associate professor of medicine and associate professor of pediatrics at Northwell Health. Ms. Subramanian (email@example.com) is a medical student at Zucker School of Medicine at Hofstra/Northwell. Dr. Jan (firstname.lastname@example.org) is chief of general pediatrics at Cohen Children’s Center at Northwell Health.
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