Infant receiving vaccination (courtesy CDC)
By Michelle Andrews
KHN Staff Writer
Provided by Kaiser Health News
When Rep. Michele Bachmann (R-Minn.) recently suggested that the human papillomavirus vaccine — recommended for girls and young women to protect against cervical cancer — was dangerous and might cause mental retardation, the American Academy of Pediatrics pushed back hard. The AAP, which represents 60,000 pediatricians, issued a statement saying the claim had “absolutely no scientific validity.”
Bachmann’s is only the latest attack on vaccine safety, as anyone knows who has tracked the persistent and discredited claims that vaccines cause autism, among other problems. Public-health experts insist that childhood immunizations are safe, but widespread misinformation by self-described safety advocates and others is one reason pediatricians frequently find themselves fielding questions from anxious parents.
When repeated efforts to educate parents fail, some pediatricians are now taking action: They’re refusing to treat children unless their parents agree to have them vaccinated according to guidelines set by the Centers for Disease Control and Prevention.
Pediatricians who go this route say they’re concerned about more than the health of the children. They’re also worried about other patients in the waiting room, some of them too young to be immunized or with health problems that compromise their immune systems. Unvaccinated children put those kids at risk.
“It’s my job to do the very best we can with patients in this practice,” says Dr. Harry Miller, a pediatrician with Four Seasons Pediatrics in Clifton Park, N.Y., whose practice stopped treating unvaccinated children last year. “Exposing that small percent who don’t vaccinate to those who do is a disservice.”
Most parents have supported the decision, he says, which was spurred in part by a rise in the number of the practice’s parents who refused immunizations. That number was very small, and those who felt strongly about avoiding all vaccines — about 0.5 percent of the families — have left the practice.
The AAP doesn’t think doctors should take such a hard line. “Over time, parents may be willing to reconsider previous vaccine refusals,” says the group’s policy statement.
When vaccination rates fall below roughly 80 or 90 percent, a population loses the benefit of “herd immunity,” which protects even those who can’t be vaccinated or for whom the vaccine didn’t work, experts say. According to the CDC, vaccination rates for children ages 19 to 35 months were at or above 90 percent for many illnesses, including polio; measles, mumps and rubella (MMR); and hepatitis B. Fewer than 1 percent of children received no vaccines. Vaccination rates for teens are significantly lower but increasing, the CDC found.
Although overall refusal rates may be low, they vary widely by location. In Washington state, for example, the rate of nonmedical exemptions from school vaccination requirements was 6 percent in 2007, with one county recording a 27 percent refusal rate.
Under the Affordable Care Act, starting last fall vaccines that are recommended by the CDC’s Advisory Committee on Immunization Practices must be provided at no charge to people in new health plans.
Melissa Henriksen says she would be thrilled to encounter a doctor who took a proactive stance on vaccines, but the Charlottesville practice where she takes her 5-year-old daughter, Jaya, has no such requirement. Noting that there was a recent measles outbreak in the city, she says, “I feel like these parents don’t get it: It is your own decision [whether to vaccinate], but there is a consequence for your community.”
An assistant professor of biology at the University of Virginia, Henriksen conducts cancer research using human cells. She occasionally has encountered undergrads who wanted to work in her lab but hadn’t been immunized against hepatitis B, which they might contract working with the cells. When she suggests getting the shot, they decline, often citing their parents’ concern about vaccinations.
States require that children be vaccinated before attending school, but in 2008, 48 states allowed parents to sidestep the requirement for religious reasons, and 21 states permitted exemptions for philosophical or personal reasons, according to a study published in the New England Journal of Medicine. (All states permit exemptions for medical reasons.)
Parents may have concerns about vaccines, says Douglas Diekema, a professor of pediatrics at the University of Washington School of Medicine. But in general, “they don’t have a strong philosophical objection.”
And that’s where the AAP thinks pediatricians can make a difference: by addressing parents’ concerns and educating them about the importance of vaccines. Ideally, that will convince them to go forward. But even if it doesn’t, pediatricians shouldn’t turn them away, says the AAP. “If the goal is to get children vaccinated, you don’t accomplish that by asking them to leave the practice,” says Diekema, the lead author of the AAP policy statement.
Nor is Diekema persuaded by the waiting-room argument: “Presumably these kids will get treated somewhere,” he says. “Maybe you’re keeping your own waiting room clean, but you’re not preventing the spread of disease.”
This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.
No, vaccinations should not be forced on anyone. Regardless of what any scientific consensus may be, that does not detract from the intrinsic rights of human choice. Of course that being said, that certainly means that a doctor should have the right to choose what patients they treat.
Great policy. They are liable for infectious diseases transmitted in their waiting rooms. Ditto any school that doesn’t require vaccines.
This isn’t about “force” and “rights on human choice.” This is about safe and healthy kids within public health. You either care about healthy kids or you make words. Vaccinate.
It shouldn’t be forced. Anyone should have a right to refuse vaccines. Agreed with Abe, it doesn’t matter what the scientific consensus may be, it is human right to refuse if they wish. I understand some vaccines, but I believe we are starting to over vaccinate at this point. Flu shots for all and Gardasil for 9 year olds? That is going a little too far, IMO.
Well if people are allowed to refuse vaccination, why can’t a physician refuse to treat that patient? If a person wants to be just plain stupid, then they shouldn’t be surprised when no doctor wants to take care of them.
What about the hippocratic oath? That doctors have an obligation to treat the infirm?
The first part of the hippocratic oath is “first do no harm” so by allowing unvaccinated kids with illnesses sit in a waiting room next to newborns or pregnant mothers etc, you are potentially harming those patients very seriously. I believe we should have the right to accept or refuse as well, and that includes pediatricians refusing to treat patients whose parents have made these decisions.
That actually isn’t in the hippocratic oath at all. Also, pregnant mothers and newborns typically visit different doctors than sick children.
Intrinsic rights must sometimes be abridged in a communal setting if by exercising them, you harm the community as a whole.
You may have the right to yell “Fire” wherever and whenever you please, but if you do it in a crowded theater and a stampede breaks out, you are liable.
A better analogy would be automobile liability insurance. You have the right to not drive a car and not buy insurance, but if you do drive, you better damn well get that insurance or else you are not only violating the law, you are also putting other motorists at risk.
So while vaccination may be voluntary, if you choose not to do it, I believe that you should not be allowed in settings (such as schools, general public, places with vulnerable populations) where you pose a danger to others. If that means you are virtually on house arrest, then so be it. It was your choice.
Pauline, you will find pregnant women, newborns and sick children at almost any pediatrician office.
Just because they decline vaccines doesn’t mean they need to be held back from the public! But yes, the doctor would have the right to dismiss them if they are not vaccinated. Or be allowed to put them in a different part of the office. Everyone keeps saying “what if there are others around and they expose them to illness”….Those people are probably vaccinated. If they aren’t then they most likely chose not to and understand their risks. So be it.
Very good Article.thank you
I’m pretty sure that “Do no harm” is part of the Wiccan code of conduct, not the Hippocratic oath.
Kind of obvious that some commenters didn’t read the story… “When vaccination rates fall below roughly 80 or 90 percent, a population loses the benefit of “herd immunity,” which protects even those who can’t be vaccinated or for whom the vaccine didn’t work, experts say”
Sorry, if it were adults refusing for themselves it’d be one thing, kids don’t have the power to choose if they’re immunized or not against diseases they should never have to be infected with. Frankly I think parents that don’t vaccinate should be charged with neglect the same way as if the kid had a broken arm and they decided to just treat it at home by wrapping it in a towel.
Sorry slave, it’s not just about not vaccinating. No newborn is going to engage in the kinds of activities that get them infected with Hepatitis B. The CDC vaccination schedule is a joke. They know that this is immunologic overload, and that’s the point. It’s not a conspiracy that the current White House “Science Czar” wrote that the world needs to be “depopulated” – these people are sick cretins who view everyone else as scum, and think that the world’s population needs to be tightly controlled. If parents want their children to be vaccinated in a slower, more judicious, sensible fashion, then by all means they should do whatever they want. It’s their child. For you to act like anyone who questions the vaccine schedule is some kind of thought criminal is pretty outrageous. That being said, it’s a free country and if a doctor doesn’t want to treat a patient because they haven’t gotten vaccinations, that’s their right.
First off, Pauline the hippocratic oath is not a gun you can hold to physicians. It’s a common misunderstanding. In a non-emergency setting such as this one, physicians have no obligation to treat.
This is a proactive public health measure that may help people who choose not to vaccinate their children realize that there are consequences for their actions. Ultimately these people are relying on others vaccinating their children so that their own (unvaccinated) children won’t get sick.
I hold Jenny McCarthy personally responsible for the Measles deaths that ocurred in California last year, and so should you. We need to stop publishing articles on the links between vaccines and autism; it’s been studied, and we have an answer: no link exists. Parents who still believe there’s a link aren’t exercising their right or have different cultural values, they are just *wrong* (we don’t like this word in science or medicine, but it’s necessary to use it here).
If I were a pediatrician I’d refuse to treat kids who weren’t vaccinated. Not out of anger against their parents, but out of concern for the life and limb of a pregnant mom bringing in her 2 year old, or the immunocompromised or immunodeficient kiddo in my waiting room.
And before saying what is or isn’t in the Hippocratic oath, at least Wikipedia the GD thing before you open your mouth. “Do no harm” aka nonmalfeasance is both a tenet of bioethics, and is indeed in the Hippocratic oath (first verse of the “I wills”).
HumbleMD, MS4
There are actually many kinds of people who cannot be vaccinated and are at greater risk for infection who regularly visit pediatricians on a regular basis. These include but are not limited to kids who have not completed their vaccine series, kids <6 mos who can't be vaccinated against influenza, immigrants who didn't have access to vaccines, patients (or parents of patients) who are on immunosuppresion medications or with HIV, so on and so forth.
As the article says the link between the MMR vaccine and autism was a complete fabrication. Are there complications from vaccination, absolutely, some are devastating, like demyelinating diseases, some are transient like flu-like symptoms. However, this is the case for any medical treatment, even getting an IV placed.
There have been more recorded deaths and complications related to breast implants than vaccines, I don't see Jenny McCarthy railing against those.
It is every parents right to choose not to vaccinate their kid, it is every patients right to choose not to follow a doctors advice, and it is every doctors (legal) right to not treat patients who will not follow their advice, particularly if not following that advice puts other people at risk.
I agree with docTOR. I’ve had this discussion with fellow medical students and residents about adult patients – say you’re treating a patient with hypertension who continually fails to make lifestyle changes, doesn’t take his medication, misses appointments…if that patient does not at least make an effort to follow your advice, then you as the physician have a right to tell him he should seek care elsewhere. I think the same applies to parents who don’t at least make an effort to follow your advice by vaccinating their kids (when possible – obviously I understand the ones that can’t be vaccinated for medical reasons). You don’t have to continue to spend your time with a patient that won’t do as you advise, and you should ask them to either get vaccinated as recommended or seek care elsewhere.
I’ve been thinking about this lately, and I’m not disagreeing about whether you should turn away people who refuse vaccinations. I’m just wondering what it accomplishes. It seems like it’s more of a convenience to the physician than helpful to the patients. And in the field of pediatrics it seems like you’re punishing the child for the parents mistake. Somebody’s got to treat the kid, and it’s not their fault that their parents refuse to vaccinate them. I understand the argument that you want to protect other young children from being exposed to things that they have not yet been vaccinated against. But, how big of a risk is that really? Does refusing to treat a child who is unvaccinated really benefit other children who could potentially be exposed to something the unvaccinated child could potentially (but improbably) bring to the clinic? I’m still mulling it over, but I’m not convinced.
clsguy, I agree with your point, but I think there is more at work than the risk of exposure to the immunocompromised etc., although I think that makes a good reason to publicize, and a good excuse to send out a satisfying message to your clientele about why you’re making that practice change.
I think these pediatricians are angry with the parents. And I can understand where they’re coming from. I honestly find myself getting so angry when I’m working up an unvaccinated kid for possible pertussis or Hib or something that I almost feel like it compromises their care. I mean, you’re looking them in the eye and telling them their kid could have a life-threatening infection because of the lack of vaccination, and they just respond with something like “I don’t care what you say, I’ll never get little Jayden vaccinated! I know how dangerous it is!”
I think with an effort I can still provide them with the same high quality care as I do for other difficult patients including abusive alcoholics, patients who threaten to sue me, and patients who are known murderers or rapists. It’s what I’ve got to do. But I can certainly understand feeling the urge to just not want to deal with these people. I’m not saying it’s the best way to deal with them – I’m in agreement with the AAP stance. But it’s like coming up against a staunch creationist when you have seen avalanches of proof of evolution throughout the world of science – it’s mind boggling.
The science is not settled on vaccines. Choice is the cornerstone of liberty. Liberty is impeded upon when choice is removed and replaced with “scientific consensus”.
Clear answer is: Fuck yes, parents, and all people should have a choice.
Hey, guys, I got this stuff I want to inject in your arm with a needle. It has a slight chance of killing you, causing permanent neuromuscular damage, could cause narcolepsy, but I got this scientific consensus that it could also help you. Want to shoot up?
Furthermore, the CDC is in bed with big pharma, and their recommendations are about as worthwhile as the recommendations from an astrologist.
James, when was the last documented case of smallpox?
I pray you don’t work in healthcare. It is no place for vaccine-deniers. Have you read the studies? Everything has risks (even radiationless imaging studies), but we do trials do demonstrate that benefits outweigh the risks. The CDC nor physicians, are in bed with big pharma. The only bedfellows I see are vaccine-deniers, and idiocy.