Commentary: What can you do if your parents or siblings refuse COVID-19 vaccination?

SINGAPORE: My colleagues and I are seeing an increase in cases of intractable family conflicts over vaccines. While many of these clients also report frequent and intense conflicts compared to other families, COVID-19 has opened up some of these fissures even more.

Take Sarah* for instance. She is the main caregiver of her elderly mother. Besides the mental strain of caregiving, Sarah experiences anxieties over her unvaccinated siblings visiting their mother.

She tried explaining to her siblings that they might endanger the health of their elderly mother who has pre-existing allergies, but they are adamant the vaccines are unsafe.

Pleas for them to get vaccinated often turned into arguments, causing a rift in their relationship.

Then there’s Mike* who has been talking to his parents for months trying to persuade them to get their jabs. But these conversations often become heated, creating tension.

His parents are religious and believe that vaccines are harmful. As a result of their arguments, Mike’s relationship with his parents has become very strained.

Tension and conflict are unavoidable realities in every family setting. Family members can hold strong but opposing views on many issues: Money, politics, chores, romantic partners, tastes and preferences.

But few issues come with a similar measure of gravity and consequence as the decision to take or decline COVID-19 vaccinations, both within the family and externally.

WHY FAMILY CONFLICTS ARE DIFFERENT

As fissures form between family members with strong and polarising views, it can end up in deeply upsetting consequences – active conflict, avoidance, a “cold war” stand-off or even estrangement are all situations we see in our practice.

During a pandemic however, the ultimate consequence of choosing or declining vaccination is serious illness or death.

Even if unvaccinated family members are spared these dire outcomes, vaccination-differentiated rules disrupt family life and relations among members with different vaccination statuses.

Unlike conflicts with friends, conflicts in a family are thorny because they involve people with whom you have deep relations, shared connections and common experiences. And sometimes, these relationships spiral and become irreversibly damaged – like family members who sue one another or cut off ties completely.

While we cannot wish away differences in attitudes, beliefs (some of them deeply held) or behaviours, it helps if we know how to navigate some of the trickier conflicts, without having to sacrifice the relationship altogether.

DON’T SHAME OR LECTURE

Many conflicts become intractable because family members do not possess all the information available to the other members. For example, some older persons have suspicions over the effectiveness and risks of taking a COVID-19 vaccine.

Quite often, they get this information from their group of friends or community.

It is important not to dismiss or ridicule these as “conspiracy theories” or “rubbish”. Hear them out and then show them information from official sources, using graphs, tables or other visuals if necessary. Show them why their information might not be accurate – point out the source or the lack of details.

There’s a caveat though: We find that overloading a person with information that conflicts with personal views can be futile. It can end up in an information tit-for-tat that goes nowhere.

Quite often, individuals can make opposing conclusions even with the same set of facts.

An MIT study in March found that COVID-19 sceptics had marshalled and presented sophisticated data visualisations using datasets from official government sources to argue against wearing masks as a precautionary measure.

This study illustrates that facts alone do not lead to one conclusion – as individuals we can interpret information in vastly different ways.

FOCUS ON THE PROCESS

Generally, what helps is being honest and respectful in your dialogues. It involves listening with empathy (“I hear your concern that COVID-19 vaccines have not been around as long as vaccines”), establishing common ground (“We all want what is best for our family”), and sharing information only with permission (“Can I share more information about the vaccines with you?”).

Ask them to share their reasons for their beliefs. Try to actively listen to what their needs and concerns are and acknowledge their viewpoint makes sense to them.

For instance, it is reasonable to be hesitant to inject unknown chemicals into their bodies or to be worried about the side effects after hearing troubling stories. All fears are relative but real.

Next, it is helpful to explore common concerns and priorities. Find points of agreement – because that helps reduce the idea that they are adversaries.

For example, family members can usually agree they want the best for the family but disagree on what that involves or looks like. When the discussion takes a turn for the worse, you can always take a step back to re-establish the common ground of making decisions in the whole family’s interest.

Lastly, always politely ask for permission before sharing unsolicited information. If they express an unwillingness to have a conversation, respect their wishes.

Even if we are declined an opportunity to do so, we can still politely state the reasons or motivations behind our desire to share, for instance: “I am concerned that you might fall seriously ill if you do not vaccinate.”

But shaming, pressuring or lecturing them for having an opinion different to yours is the surest way to shut down all conversation.

AGREEING TO DISAGREE

Still, we may have to accept our loved ones have the right to disagree with us even if their disagreement appears irrational. This is no different from a child becoming an adult and deciding on a path parents disagree with – whether it’s pursuing an unconventional career or marrying someone from a different background.

But if your family member is still not persuaded despite your best efforts, a lack of compromise does not mean that there cannot be family harmony or that you are not free to set limits.

In fact, allowing each member to voice their thoughts and agree on certain limits helps families reduce conflict and maintain good relations.

Communicate your concerns and set limits of engagement.

In the context of the pandemic, engagement boundaries might involve no home gatherings to prevent transmission among the unvaccinated, no family meals outside or no travelling together until every member is vaccinated.

Ensure everyone is aware of the limits and agrees to abide by them.

From my family sessions, I observed a common method of conflict resolution is the “midway” compromise: Attempting to meet each other some but not all the way.

For example, if a family member wants to go for a nature walk while the other member does not, the family might decide to take a shorter walk at the air-conditioned domes at Gardens by the Bay instead.

But conflicts about medical conditions and procedures are more difficult to navigate and reach realistic compromises on compared to other types of conflict.

When presented with polar opposite views between full or no vaccination, and the smorgasbord of other non-approved therapeutic and home remedies in between, many might explore middle ground options for the sake of family harmony.

As we have seen across the world, many even contemplate or administer dangerous options without medical advice such as chloroquine, an antimalarial medicine, or ivermectin, which has been approved by the US Food and Drug Administration to treat some diseases caused by parasites, but not COVID-19.

It must be categorically stated that strongly held lay opinions are not a replacement for validated research. Real and grave consequences can arise from misinformation.

For instance, a Singaporean senior who doubted the efficacy of the vaccines was hospitalised after taking ivermectin, and many Americans attempted to self-medicate by drinking disinfectants, which is potentially fatal.

This means there are clear red lines – no one should look to compromise or find a middle ground by doing something evidently harmful.

These are certainly not easy times for families but with some effort, sympathy and a common goal of caring and loving each other, conflicts can be resolved.

*Pseudonyms have been used in this commentary.

Dr Annabelle Chow is Principal Clinical Psychologist at Annabelle Psychology.