Vaccine Refusal Violates Core Beliefs and Endangers Everyone
Prevention of childhood illness is the heart of a pediatrician’s mission. Immunization refusal violates that mission, putting everyone at risk: child, pediatrician, other children, and society as a whole. If we allow families to remain in our practices unvaccinated, we are giving tacit approval to parents that refusing vaccines is just fine. It is anything but fine.
Dr. Herschel Lessin
irst, the child is at risk to acquire deadly diseases with which few pediatricians have any familiarity.
Second, others in your office are at risk. If an unvaccinated child contracts vaccine-preventable disease and comes to your office for care, every patient you see that day is potentially exposed. This is not a hypothetical situation for my practice and many others around the country.
Third, pediatricians are put at risk. In the above situation, I must call every patient exposed, upset them, and provide services to their kids that would never have been needed had the parents of the index case been responsible. Furthermore, if I allow unvaccinated patients in my practice, I must remember to ask every ill child whose parents call me whether they have been vaccinated. I must consider invasive septic work-ups that I have not done in decades for simple febrile illness.
Refusal to vaccinate is a marker for noncompliance with medical advice. If the parents don’t believe me when I tell them vaccinations are safe and important, are they any more likely to accept my advice about diet, illness, or medications? What if the unvaccinated child contracts a preventable disease? The parents might file suit, claiming that they were inadequately informed about the benefits of the vaccine or the risks of refusing it.
Last, vaccine refusal is a danger to society and a public health hazard. When a large enough population is unvaccinated, herd immunity is lost. One only has to witness the many infants who died in the recent pertussis outbreak in California – a hotbed of anti-immunization fervor – to realize the impact.
The American Academy of Pediatrics has a somewhat different outlook on this issue. They discourage discharging patients solely because of vaccine refusal. However, they do acknowledge that the relationship might not be able to continue if there is a high level of distrust or major differences in the philosophy of care. For me, it comes down to whether you can have a relationship with a family when their choice not to vaccinate goes against pediatric core values and puts so many innocents at risk. I don’t believe that I can have a functioning doctor-patient relationship with parents who aren’t willing to accept my advice about such a core issue as keeping their children safe from potentially deadly diseases. I have practiced in an era when these diseases were common. I do not wish to return. Being codependent with the baseless and disproven anti-vaccine movement is not a choice we should be willing to make.
Dr. Lessin is a pediatrician in Poughkeepsie, N.Y., and is a member of the AAP Committee on Practice and Ambulatory Medicine. Dr. Lessin serves on the advisory boards of several vaccine manufacturers including Merck & Co. Novartis, Pfizer, and MedImmune. He is also a member of the speakers bureau for GlaxoSmithKline.
Staying With Patients Builds Trust
Pediatricians rightly feel proud of progress made in primary prevention of infectious disease through immunization. Vaccines make up a huge portion of the backbone of primary care pediatric practice. Thus, families who refuse to have their children immunized challenge a basic tenet of modern practice. We can understand a pediatrician’s frustration and even anger when parents invoke nonrational or irrational reasons to decline recommended vaccination. Does the refusal justify asking the family to seek pediatric care elsewhere? No, it does not.
Dr. Joel Frader
While most support universal immunization, we must admit that vaccines are neither 100% effective nor 100% safe. We cannot guarantee each child will benefit, and some children will have adverse reactions. As long as enough children are fully vaccinated for a given threat, typically around 85%-90% of the target population, the community will maintain herd immunity, limiting disease spread. While the 10%-15% not vaccinated have a "free ride," that is, they get the public health benefit but do not incur the risks of immunization, the still-high vaccination rates permit some latitude in personal, if idiosyncratic, parental choice.
Keeping families that refuse vaccinations in one’s practice permits the pediatrician to continue to develop a professional relationship and build trust with the family. Our experience suggests that many parents modify their anti-vaccine stance with continued discussion and education. Some families appreciate the pediatrician’s acceptance of their beliefs which, in turn, leads to greater openness to changing their views. More important, the children of anti-vaccine parents deserve expert pediatric care. Their pediatricians need to be especially mindful of and vigilant about an increased risk of serious infection when these children have febrile illnesses. Physicians who fully embrace or even encourage anti-vaccine attitudes and "collect" families of unimmunized children might harbor other less-than-fully scientific views, compromising the vigilance and care that ill, nonvaccinated children deserve. Pediatricians who turn away at risk children and families may unwittingly deprive especially vulnerable patients of the best available care.