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One conversation at a time, pediatricians hope to prevent the spread of infectious diseases
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GPB's Sofi Gratas reports from Dodge County, Ga., about the importance of communication between pediatricians and parents.
Starting at 2 months old, all over the country, babies go into clinics like Dr. Brittany Lord’s for an important visit — they get their first big round of vaccines.
On the day of 2-month-old Memphis Exum’s appointment at the Eastman Pediatric Clinic in Eastman, Ga., first, he gets a basic exam. Lord checks his weight, eyes and skin while asking questions about his development.
“He's great. He's above average on height,” she tells the baby’s mom, Mahogany Brown, as the family clusters around her laptop to look at his chart. “You might have a tall one.”
Then, Lord goes through each vaccine Memphis will receive. There's a liquid that will protect him from rotavirus, which can cause life-threatening diarrhea. Then there are three shots that protect against polio, hepatitis B, and a series of respiratory infections.
She does this “vaccine counseling” with every patient.
“I kind of go through the vaccines in like layman's terms,” Lord said. “That's where we have that conversation: 'Why are you afraid of vaccines? Why are you hesitant of it? What is it?' And then that's where we can engage in the conversation.”
Lord has been at the clinic in Middle Georgia’s Dodge County for four years. The clinic is located between the county hospital and Tractor Supply Company. In mid-March, providers here had just come off a busy flu season that made loads of kids sick.
Lord said she’s been having more of these conversations about the safety of vaccination, with parents coming in not outright against vaccines but hesitant to give so many at one time.
“Whether they're worried about the ingredients or they're worried about autism ... why they're afraid of vaccines, the different reasons, comes in waves,” Lord said — waves that, in her experience, have a lot to do with content on social media.
Several large studies have investigated whether there is a link between the development of autism, and vaccine ingredients or the frequency at which vaccines are given. All have disproven such a link.
And certain vaccine ingredients that have raised red flags for parents, such as aluminum or formaldehyde, don’t exist at levels that could be harmful to people or cause adverse outcomes, according to the Food and Drug Administration.
But fears around vaccines are very real, and Lord empathizes. During her residency in Middle Georgia, Lord said conversations around vaccines were often presented as very one-sided.
It took coming to Eastman for Lord to realize that approach wouldn’t work if she wanted to build strong relationships with her patients.
When parents want to space out the timing of vaccines, Lord will. And she always welcomes questions.
“I knew I would be here [in this community] for a long time, and I needed to develop a relationship with these families, so I can't just shut them down and say, ‘You're wrong,’” Lord said. “I want them to be able to, if the next time they come, maybe ask me some more questions about it.”
If she didn’t leave that door for questions open, she fears families could stop coming to the clinic altogether, a risk in a rural community with limited access to health care.
Growing doubts about vaccines
The majority kids in the U.S. are vaccinated against preventable diseases. Most of Lord’s patients are vaccinated.
But there is evidence that since 2020 and the coronavirus pandemic, thousands of families in the U.S. have opted not to get routine vaccines for their kids and that, nationwide, the number of kids with religious and medical exemptions for vaccines has gone up.
And now, an outbreak of measles is making mostly unvaccinated kids sick, and threatening communities with low rates of vaccine uptake. One child in Texas died early this year as a part of the state’s growing outbreak, as well as one adult in New Mexico.
There have been other measles outbreaks before, but the U.S. has managed to maintain its elimination status since 2000, meaning the number of measles cases has stayed below a level of concern. Have we crossed that line this year? What is the threshold?
Disease prevention scientists and epidemiologists are raising the alarm about how widespread this current outbreak could grow, in part because of the population in which it started. Already over 500 people have been affected.
“It could be as large as infecting most of those individuals, up to 95% possibly,” said Amy Winter, epidemiologist at the University of Georgia’s College of Public Health. “The hope is that it doesn't last longer than 12 months.”
If it does, the U.S. would lose its elimination status and be back at square one in terms of controlling transmission.
Because of a downward trend in vaccine uptake among kids nationally — the U.S. average of kids covered by routine vaccines dropped from 95% to 93% in the years after COVID — the risk also exists for possible spread of other diseases down the line, said Robert Bednarczyk of Emory University’s Rollins School of Public Health.
“When we start to see those cases ... that is an indication that vaccine rates are starting to drop lower than they need to be to,” Bednarcyzk said. “And then that makes us worried that not only are we going to see measles, but we may see other diseases like whooping cough and other things that that may come about from that lower vaccine coverage.”
Meanwhile, Health and Human Services Secretary Robert F. Kennedy Jr. has challenged the current childhood vaccine schedule of over a dozen shots before age 18 in the name of investigating chronic diseases. In response to the outbreak in Texas, he said the HHS is working closely to offer support, including by providing information on therapeutic medicines including Vitamin A, though federal health agencies still recommend vaccination as the best defense against infection.
“The decision to vaccinate is a personal one,” Kennedy said in a press release. “Vaccines not only protect individual children from measles, but also contribute to community immunity, protecting those who are unable to be vaccinated due to medical reasons.”
He also promised “radical transparency” to regain public trust.
Bednarczyk, an associate professor in global health, said it’s hard for scientists like him to address the full spectrum of parents’ concerns around vaccines all at once, because they can vary from worries about one shot to total refusal of any immunizations.
“A lot of the work that we do is trying to understand, ‘What are people thinking? What are people feeling about these vaccines?’” Bednarcyzk said.
What some researchers have found, Bednarczyk said, is that they are increasingly reliant on people like Dr. Lord to help answer those questions. He said the relationship providers develop with families can break through the bombardment of information on social media, especially what’s false, fear-based or misconstrued.
“It’s not that people don't have the information," he said. "It's how are they getting the right information to weigh against everything else that's out there. Being able to have that open conversation is one of the best steps that we can have towards coming to better decision making around vaccines.”
Decisions parents make about their children’s vaccines are key to everyone’s health, he said, because vaccine-preventable diseases can be super contagious.
One person with measles, for example, has the chance of infecting 12 to 18 susceptible people. On the other hand, one person with the flu generally could infect just one to two susceptible people.
So far, there have been three reported cases of measles in Georgia, stemming from one unvaccinated individual who was infected during travel out of state.
Local response to shifts in public trust amidst disease outbreaks
In South Georgia’s Worth County, Dr. Grace Davis said she’s concerned about the outbreak, and what it could mean for her patients if it leads to the spread of other infectious diseases.
“This is what I explain to parents,” Davis said. “I'm like, 'You're not going to stay home, you're not in a bubble. You go to Walmart.'”
Worth County is rural, and neighbors the city of Albany. There’s no data on vaccine rates by county in Georgia, but according to records from the public school district, the number of kids with religious exemptions for immunizations on file have gone up over the past five years, though they’re still a tiny fraction of the total population at kindergartens and day cares.
Davis, a solo practitioner, runs Sylvester Pediatrics. She’s been practicing in the small, South Georgia community for over three decades.
Concerns around vaccines aren’t a new phenomenon, Davis said, but she did notice a shift even further in that direction following the introduction of masking mandates, and the frenzy over the first COVID-19 vaccine.
“We're seeing the impact of the pandemic and where people felt that it was something that was forced upon them,” Davis said. “People felt like they had no choice. But of course, this was a pandemic.”
Davis said when parents ask for her opinion, she’ll ask back — do they want her medical advice, or that from her perspective as a grandmother, someone whose seen their own kid cry from a shot? One may be easier to swallow, but the message is the same: Vaccines are safe, and effective, and she recommends them.
But Davis will also offer a delayed schedule of routine childhood vaccines, if parents want. And she encourages all parents to inquire about their children’s care.
“Because it's a partnership,” Davis said.
For the few unvaccinated families she cares for, Davis listens, and stays persistent.
“I tell them upfront, you know, this is going to be an ongoing conversation because we're not going to stop talking. They say, 'Yeah, we know,'” Davis said. “And then I tell them true stories.”
True stories including those from the time before vaccines, of hospitals full of kids with meningitis, and of kids now, unprotected from the bacteria that come with the normal cuts and scrapes of childhood.
Back in Eastman, Brittany Lord has her own stories. She once saw vaccine-preventable pertussis, or whooping cough, leave a baby gasping for air.
“And I still kind of get upset about it,” Lord said.
The baby lived, but Lord said she will never forget the struggle the child went through.
“I try to stress to parents, you know, I can’t guarantee that everything's 100%,” Lord said. “But we can do all we can to help prevent as much as we can. That's what matters.”
During his appointment, Lord explains that 2-month-old Memphis might have a low fever later or get a little knot in his leg from his shot.
The people in the exam room agree those are small discomforts for a lifetime of protection.
Correction
An earlier version of this story erroneously read: Davis, a solo practitioner, runs Sylvester Pediatrics. She’s been practicing in the small, South Georgia community for over four decades.
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