The following is the runner-up submission from the third annual Section on Pediatric Trainees essay competition. This year’s competition was informed by the 2018–2019 Section on Pediatric Trainees Advocacy Campaign: Advocacy Adventure, which empowered trainees to find their areas of passion, acquire and polish new skills, and organize advocacy efforts collaboratively. We asked writers to share experiences as physician advocates and were impressed with the broad variety of important topics submitted by trainees from around the country. This essay by Dr Ju describes advocating at the California state level for childhood immunization protections, which transformed her perspective of those who hold a different view. Along with the winning submission by Drs Panda and Garg that also appears in this issue, this piece is a wonderfully inspiring reminder that we are all well positioned to advocate for children in our roles as trainees and pediatricians.
April 24, 2019, was an unseasonably hot day in Sacramento, yet there I stood, in a narrow hallway inside the California State Capitol building, surrounded on both sides by hundreds of antivaccine protestors shouting and waving signs. I had come to Sacramento with a small group of pediatric residents, fellows, and attending physicians as part of an American Academy of Pediatrics (AAP) Legislative Day of Advocacy to learn more about how pediatricians can impact policies on a state level by speaking out on issues that affect our patients. I had not anticipated standing for hours in a line of physicians and trainees sweating in our white coats, waiting to enter the hearing room to voice our support for a provaccine state Senate bill while insults and accusations rained down around us. The protestors accused of us violating our duty as pediatricians to protect children. They called us greedy, ignorant, and negligent. They waved signs that included slogans implying that vaccines kill children. Some invoked imagery linking doctors to Nazi Germany. I had not anticipated this level of vitriol in preparing for my first foray into legislative advocacy on the state level and I did not know how to react.
The goal of California’s Senate Bill 276 is to tighten the regulation of vaccine medical exemptions and reduce exemptions that are not truly medically indicated. The AAP endorsed Senate Bill 276 because it is clear that vaccines save lives and factors that contribute to low vaccination rates, such as illegitimate medical exemptions, place our communities at risk. My support of childhood immunization is founded on this shared understanding. I do not view this as a belief because it is not based on subjective opinion but rather on overwhelmingly compelling data. Polio, smallpox, and diphtheria caused illness, suffering, and death in countless children throughout human history until vaccines were developed that could protect against these diseases. The use of vaccines is 1 of the most important tools I have as a pediatrician.
Throughout my training, I have encountered many families who have been hesitant to vaccinate for a variety of reasons: some fear autism as a potential side effect, others are concerned by the number of vaccines in the standard schedule, and many have a mistrust of the medical system as a whole. I have tried to approach each encounter with an open mind and to build a rapport with these families, but many remain reluctant to vaccinate. These encounters have left me feeling frustrated, and I have found myself blaming the antivaccine movement for spreading misinformation and stoking fear in our communities. My perception of the antivaccine activists was that they were an ignorant and aggressive group who stood in direct opposition to our efforts to promote children’s health through immunization. As I waited in the state capitol flanked on both sides by angry people shouting and waving signs, I found myself actually face to face with a large number of “antivaxxers” for the first time.
Confronted directly by their slogans, I felt shocked and threatened by accusations that pediatricians would act against the interests of children. I was distressed that those who had showed up to oppose the bill dramatically outnumbered those in support and that they had brought hundreds of unvaccinated children into close proximity during the largest measles epidemic in the United States in decades. And I felt frustrated that we keep making the same case over and over, that vaccines are safe and effective, and still were not able to reach the families standing before me, and likely many others.
I tried to ignore the chanting. I hoped that the line to testify in support of the bill would move quickly. I needed to escape the suffocating, sweltering hallway and the stares from the opposing crowd and flee into the fresh air outside. Unfortunately, the line would not budge. As I continued to wait in line for several hours, I found my initial response to the protestors slowly and unexpectedly evolving.
Rather than doing my best to ignore them, I started really looking at the faces around me. There were people of all ages, from grandparents to infants, and they looked just as tired, hot, and frustrated as I felt. No one seemed to be standing in that hallway to intentionally spread misinformation or harm their community’s health. They, too, felt strongly about children’s health and truly believed that they needed to raise their voices against the same bill I had traveled to support. I also saw that many of the antivaccine parents who carried signs about immunization-related injury had come with medically complex children and reflected on how painful it could be to have a child affected by disability, especially when modern medicine cannot always provide a clear cause. I did not agree with their arguments, but it was impossible to ignore their genuine concern for their children.
Most importantly, I realized that focusing on perceived ignorance in antivaccine families is counterproductive. Conversations about vaccination are often extremely challenging under the best of circumstances, let alone when I enter the room with preconceived notions and judgment. It may take more time and present new challenges, but I think that approaching these encounters with humility is important. If we are able to take a step back and refocus on our shared values, which include wanting what is best for each child and working together to make decisions that will promote health and protect against illness, we will ultimately be more effective.
Soon after I finally had my chance to voice my support for the bill before the committee, I went outside to find some fresh air and found myself in the quiet gardens of the capitol. As uncomfortable as that experience was, I could not help but reflect on the 2 hours I had spent waiting in that narrow hallway. The discomfort I felt there had pushed me to grow and question my previous assumptions. I found a new sense of empathy toward the parents of my patients, who just want the best for their children even if they may not agree with my recommendations every time. Moving forward, I hope that by focusing on that shared goal, we can all be better advocates.
This experience would not have been possible without the teaching, guidance, and leadership of the advocacy team at Children’s Hospital Los Angeles, including Drs Mona Patel and Susan Wu, and support from Amanda Daigle and Truc T. Nguyen as well as Drs Kevin Fang, Grant Christman, Jennifer Min, and Veronica Renov. Thank you to AAP California for cosponsoring the 2019 Sacramento Legislative Day and Advocacy and Leadership Seminar and to state Senator Richard Pan, MD, for being a champion for children’s health in California and a source of inspiration to pediatric trainees across the country.
American Academy of Pediatrics
Dr Ju conceptualized the piece, drafted the manuscript, approved the final manuscript as submitted, and agrees to be accountable for all aspects of the work.
FUNDING: The trip to Sacramento was funded by the Children’s Hospital Los Angeles Office of Academic Affairs Advocacy Fund.
POTENTIAL CONFLICT OF INTEREST: The author has indicated she has no potential conflicts of interest to disclose.
FINANCIAL DISCLOSURE: The author has indicated she has no financial relationships relevant to this article to disclose.