An increasing number of families in North America are concerned about vaccine safety and this controversial issue occasionally may lead to some families refusing vaccines altogether.
This trend has led the State of California to mandate vaccinations this past year. Pediatric organizations considered this a major step in the right direction, arguing that no child should suffer from vaccine-preventable infections. Some families who support vaccination also applauded this development, because they are upset that unvaccinated children put society at risk.
However, there are now families in California who are so convinced of the dangers of vaccines that they elected to leave the state and move to another state which allows for exemptions on philosophical or religious grounds.
Some doctors harbor strong convictions too– so strong that they show the door to parents who refuse to get children vaccinated.
What are the characteristics of these physicians when they are researched in terms of where they work, who they care for and does it matter if they are pediatricians in private practice, family doctors or academic pediatricians?
The first national study which researched these doctors was published in the recent edition of Pediatrics. A national survey launched from Colorado found that one in five pediatricians dismiss families who refuse vaccines. These pediatricians are mostly in private practice. Pediatricians affiliated with hospitals or large HMOs in the US are less likely to dismiss families who refuse vaccines. Few family doctors dismissed families, but there were some.
The American Academy of Pediatrics discourages its members from dismissing families who refuse vaccines. The Academy published its first position paper on this issue in 2005 and then revised it three times since, softening the language somewhat (The original paper states that “Pediatricians should avoid discharging patients” but the most recent position paper states “Pediatricians should endeavor not to discharge patients.”) The Canadian Pediatric Society strongly supports vaccines but their website has no forms for doctors dismissing vaccine refusers.
Pediatricians who work in jurisdictions where there are no philosophical or religious exemptions tend to dismiss families more often. In jurisdictions where vaccine refusal has almost become the social norm, dismissing families is less acceptable.
The Sears method of spreading out vaccines has grown in popularity, much to the dismay of academic pediatricians. In the Pediatrics study it appears that families who request to have vaccines spread out are less likely to be dismissed by physicians.
Physicians who dismiss families from their clinics often ask parents to sign forms stating that they are aware of risks and benefits of vaccines; that they comprehend there may be potential consequences of refusal. The form also acknowledges that refusal to vaccinate may endanger the health or life of the child.
There is currently no definitive research to show that the use of these forms increases the uptake of vaccines although the Pediatrics paper published by the Colorado group suggests that having a policy for dismissing families may potentially increase vaccine uptake as it provides a strong message to families on the importance of vaccination.
The intended and unintended consequences of dismissing families for vaccine refusal remain murky. There is data to support the concerns that the harder some families are pushed to vaccinate their children, the more likely it is that these families will increase their opposition and activism even more.
Some hypothesized that dismissing families could lead to increased clustering of vaccine-refusing families within certain regions, leading to outbreaks of vaccine-preventable diseases. This has not yet been the case.
Dale Carnegie, author of How to Win Friends and Influence People stated that “A man convinced against his will is of the same opinion still.” This may be the case when we research vaccine refusals.
There essentially are three groups of parents: the group who do their online research from reputable sites such as the Bloomberg School for Public Health (See www.vaccinesafety.edu/) and elect to have their children vaccinated; a second group who are aware of the risks of having a child vulnerable to getting permanent neurological damage from meningitis, but who are leery of other vaccines or who may opt for the non-academic choice of spreading out vaccines; and finally a third group who will never ever get vaccines done and who will remain relentlessly defiant and convinced that absolutely all vaccines are evil.
In a provocative piece of journalism Jef Rouner writing for the Houston Press on Tuesday March 17, 2015 made it very clear that an increasing number of parents are getting exasperated that unvaccinated children are putting vulnerable children at risk. In a litigious society one can anticipate future litigation if it can be shown that a child suffered due to being exposed to an unvaccinated child who spread an illness to an immune-compromised cancer survivor for example.
DR. NIEMAN IS A COMMUNITY PEDIATRICAN AND A CLINICAL ASSISTANT PROFFESOR AT THE UNIVERSITY OF CALGARY MEDICAL SCHOOL. HE IS THE AUTHOR OF “MOVING FORWARD”. DR. NIEMAN IS A BI-WEEKLY CONTRIBUTOR ON CTV CALGARY AND HOSTS A WEBSITE WWW.HEALTHYKIDS.CA