Another perspective on childhood vaccines

I’m writing to follow-up on a recent blog post on the subject of childhood vaccines (http://phcprimarycare.org/?p=978). Perhaps I have a different perspective as a practicing pediatrician who works on the front lines of this immunization “controversy.” I recently instituted a policy, with a note to our families, that I will not see patients for Well Child visits unless they fully follow the immunization schedule. Over my 16 years in practice I have grown increasingly frustrated with families claiming to know more than infectious disease specialists after consulting Dr. Google. Recently I had a 20-something-year-old mom who, when I tried to explain how the immune system works, stated that all my professors in medical school lied to me. (I’m thinking about asking my med school for a refund.) It’s akin to playing a flight simulator game, getting on a plane, and then going to the cockpit to tell the pilot how he or she should fly the plane.

Dr. Catherine Hough-Telford from the Univ. of Alabama-Birmingham recently compared data from the AAP periodic surveys of 2006 and 2013. She found the number of pediatricians encountering non-vaccinators increased from 75% to 87% and the proportion of pediatricians who discharged families for vaccine refusal increased from 6% to 12%. While this may reflect a national average it appears some regions may be higher (30% in Connecticut, 21% in the Midwest). The reasons given for vaccine refusal by families included risks of autism or thimerosal (the proportion of parents voicing this concern actually decreased from 74% to 65% – still way too high in my opinion) and the belief that the vaccine was unnecessary (increased from 63% to 73%!!)

I highlighted the word belief because that’s what these decisions are being made on. Not science nor facts. There are so many issues to discuss about raising kids and so many decisions to be made… but this isn’t one of them. The evidence is overwhelming in favor of the safety and efficacy of vaccines.

The official policy of the AAP is to continue to work with families and try to educate. But many non-vaxxers, especially those who refuse all vaccinations, are not open to education. Or as many call it, “propaganda.”  Many pediatricians, myself included, would argue that if a parent does not trust our knowledge and judgment on this issue, what else will they not believe? A quote from Dr. Russell Saunders (who wrote the article in the last link) sums it up well:

The physician-patient relationship, like so many other human relationships, requires an element of trust. I certainly neither want nor expect a return to the paternalistic “doctor knows best” mindset of bygone years, but I do need to know that patient’s parents respect my training and expertise. Refusing an intervention I desperately want all children to receive makes that respect untenably dubious.

I often wonder why a parent who believes vaccines are harmful would want to bring their children to a medical doctor at all. After all, for immunizations to be as malign as their detractors claim, my colleagues and I would have to be staggeringly incompetent, negligent or malicious to keep administering them.

Jeff Ribordy, MD

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