A Physician's Perspective: Parents Who Refuse to Vaccinate

January 19, 2015

We accept patients whose parents refuse to vaccinate them into our practice, but it's not an easy road, and it's not an easy decision.

Online and in several parents’ groups, our practice has been deemed a “vaccine friendly” practice. The “vaccine friendly” label has been used by the anti-vaccine movement to designate a physician who will not discharge a family for refusing to vaccinate their children.

We’re not sure how we feel about being designated as such a practice. One the one hand, we agree to follow the American Academy of Pediatrics (AAP) recommendation that pediatricians continue to treat patients who refuse vaccination. And yet, by complying with this request, are we not signaling to patients that we agree with their vaccine refusal? This is our struggle.

We have a thorough policy on vaccination that we utilize with parents at every opportunity. We know that vaccines are safe and effective, and a parent who refuses them not only puts his child at risk for illness but also constitutes a risk to the unimmunized patients in our community. So, we try to convince parents to accept immunization; and we educate them on the proven benefits, the effectiveness, the safety, and the true but tiny risks of the vaccines.

Through our experience we have found that most parents are easy to convince to vaccinate, albeit on an alternate schedule, but what do we do about the ones who are not convinced?

Just this month, the amazing team at Freakonomics took an in-depth look at why people don’t get flu vaccination. Their data led them to conclude that scientific evidence is not effective in persuading non-vaccinators, but scare tactics are.

Yikes! Even if we believe this (and we kinda do), who is responsible for scaring patients into submission? It is certainly not the primary-care provider who gives patients a safe space to talk about sensitive issues including sexual and mental health.

There are some pediatricians who dismiss families that will not vaccinate. They dismiss them with the reasoning that by refusing the advice to vaccinate, the family has damaged the doctor-patient relationship.

We have had patients who drive an hour or more in order to come to our practice because they do not want to vaccinate or want to use a delayed or slowed schedule, and once they have received the delayed vaccines and are up to date, they return to their original practice.

This is terrible continuity of care. These children are at higher risk for serious infectious disease due to their parent’s decision. They need more diligent follow up and not more difficult access to primary care. This disruption delays or prevents the establishment of good primary care, and may lead to delay in diagnosis of things such as developmental delays.

The most needlessly controversial thing which we do every day in practice is to provide vaccines. We are sure that most (if not all) of the readers of this blog strongly support vaccination and recognize that the risks are tiny compared to the benefits gained, but that message is very hard to deliver.

The reckless publication of David Wakefield on the supposed link between MMR and autism, the grandstanding by celebrities using their fame to advance unfounded claims, and the sincere desire of families dealing with a child with autism to find the one thing to blame for all of their struggles, have all combined to paint vaccines as a threat.

If it were up to us, we would prefer that the Department of Public Health mandate vaccination with stiff financial penalties for those who refuse. In real life, there isn’t enough political will to make that happen, and so we must rely on groups like the AAP to set best practices and then encourage our colleagues to follow suit.

Do you dismiss patients for refusing to follow the CDC vaccine schedule? Do you think we providers or the department of public health should scare patients into following medical recommendations? Share your thoughts.