Grandparents have an important role in improving the public health of America. They cannot sit idly by, biting their tongues and not saying a word. They must talk with their children who have refused to vaccinate their grandchildren. Their children tend to converse with like-minded anti-vaccination parents and must be exposed to another perspective. Grandparents don't want to be overbearing; on the other hand, they want to protect their grandchildren. It's a difficult path -- one that many pediatricians grapple with. How does one retain the trust and ability to help parents when parents may not want advice, especially when it conflicts with their firmly-held beliefs? According to the World Health Organization, during 2000-2013, measles vaccination prevented an estimated 15.6 million deaths. Yet many parents have trepidations about vaccinating their own children and are influenced by myths about potential harm circulating among their peers, often based on discredited claims.
Just because parents do not want advice is not a reason for grandparents to remain silent. The older generation is responsible not only for their own grandchildren's welfare, but for the welfare of the nation's children. The herd immunity, the percentage of children who are vaccinated in each community and overall, requiring between 92 and 96 percent to protect those ineligible for vaccination coverage, influences some parents to vaccinate their children and other parents to rely on the immunization of others. It doesn't work in communities where personal beliefs are so strong that parents ignore reason, scientific knowledge, and the debunking of claims about a disproved link between vaccinations and autism. Some children cannot be vaccinated due to a compromised immune system; those that can be vaccinated have a moral obligation to contribute to the protection of these vulnerable peers. In addition, newborns cannot be vaccinated until they reach their first birthday; the rest of society has a moral obligation to protect these infants by being vaccinated themselves. It falls on the rest of us to protect our children through vaccination. Speeches and other forms of education are unlikely to work. Perhaps words from a trusted family member might.
Grandparents can explain their concerns for their grandchildren. If they -- like me -- are old enough to have had measles or remember past epidemics, they can recall a person in their community who died or was impaired by this seemingly-innocuous disease. They can share their own memories of their discomforts. Grandparents may want to ask how parents would feel if their child is the one not only to get measles but also to suffer permanent loss or death from it, or how they would feel if an outbreak comes to their town and their child is the vector causing illness for others. This is an opportunity to talk about the uncertainties of life. Grandparents might share some of the difficult choices they have faced. Parents make many decisions for their children without being 100 percent certain of the outcomes. In this case, one is trading a real threat of infection with an imagined threat of putting poisons in the body.
The vaccines for measles have been thoroughly vetted. The one study that suggested that there was a connection between the measles, mumps, rubella (MMR) vaccine and autism has been thoroughly discredited. The prestigious Lancet medical journal that published that article has retracted it. According to the Mayo Clinic, measles can cause ear infections, pneumonia, and encephalitis, which can lead to death. A grandparent might ask whether parents have read the opinions of experts in infectious diseases. Grandparents might also ask what the child's doctor recommends. These might plant a seed of doubt in the parents' minds. They should also explore their children's deepest fears about adverse impacts on their grandchildren from immunization and try to address these concerns with scientific evidence and understanding.
Americans believe that parents have the ultimate authority to bring up their own children, but parents do not have the right to endanger their own children. Just as freedom of speech has its limits (one is not allowed to falsely yell "fire" in a crowded theater), so the right of parents to put their child at risk has limits. When abuse and cruelty is a factor, both the state and other individuals are mandated to intervene. When public health is concerned, all of us already have given up many "freedoms." For example, we are required by zoning laws to have sewage control in rural areas by septic systems and in cities and towns by connection to the waste management system.
It is difficult to communicate complex scientific ideas to the public. Scientists are aware of the limits of human knowledge and use phrases like "to best of our knowledge," "the weight of evidence," and "as far as we know." When giving their conclusions, the public reads these comments as hedges. The paradox here is evident: Those with the most knowledge are aware of the limits of human knowledge and those with the least knowledge are certain of their views. Parents want absolute certainty when this is only very good information based on good data. One of the most daunting tasks of parenting is facing our inability to protect our children from pain. Sometimes we need to allow them to experience pain to learn and grow. Parents may fear causing their children pain, but the momentary discomfort from an injection hurts far less than the pain and risk of harm of measles, mumps, or rubella.
We are all in this together. Public health compliance is a necessity to protect us all. It is important to do your part as a member of society, and also as a grandparent.
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