There is a lot of debate in the pediatric community whether it is appropriate for pediatricians to stop treating children if their parents refuse vaccinations. I caught up with Dr. Herschel Lessin, founding partner at the Children’s Medical Group to ask him what he thought of this debate.
Dr. Lessin, do you think pediatricians should stop treating parents that refuse to give their children immunizations?
Prevention of childhood illness is the heart of a pediatrician’s mission. Immunization refusal violates that mission, putting everyone at risk. 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.
You said it puts everyone… how so?
First and foremost, the unvaccinated child is at risk to acquire deadly diseases with which few pediatricians have any familiarity (due to the success of our immunization programs). Second, other infants, children and parents present at pediatricians’ offices are at risk. If an unvaccinated child contracts vaccine-preventable disease and comes to one’s office for care, every patient one sees that day is potentially exposed. Sadly, this is not a hypothetical situation for my practice and for many others around the country.
Pediatricians are put at risk as well. 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 for infections (including spinal taps) that I have not done in decades for simple febrile illness, and would have no need to do, had this child been effectively immunized.
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 current measles outbreak in the Somali community in Minnesota is another most unfortunate reminded when enough members of a community refuse to allow their kids to be immunized by fear conjured up by a single fraudulent and now repudiated study.
In addition to putting everyone at risk, it seems there is a non-compliance issue as well.
Yes, 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 risk of refusing it.
What is the American Academy of Pediatrics take on this issue?
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.
As a pediatrician, what does it come down to then?
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 critical 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.
Survivor: Pediatrics 
While my partners and I will normally dismiss parents from our practice if we cannot convince them to begin vaccinating after several months, I’ve begun using a new angle when speaking with these parents. I ask them the following, “where will you run when your child breaks out in a strange rash and a high fever?” Of course they respond that they will come right to my office. I tell them that I cannot needlessly endanger the rest of my patients with a possible case of measles in my waiting room amongst children who may either be too young or chronically ill to have received the MMR vaccine. Every now and then, a light bulb goes off.
n the annals of fraudulent science, said Michael Fumento, no study did more damage than the one that linked autism to childhood vaccines. That 1998 study has since been disproved by more than 100 subsequent studies, and last week, the British Medical Journal reported that physician Andrew Wakefield doctored evidence and committed “deliberate fraud.”
MYTH 1: Vaccines cause autism.
FACT: Until 2001, some childhood vaccines included thimerosal, a preservative containing ethylmercury. (Thimerosal isn’t gone from all vaccines — it’s still present in some influenza formulations. But none of the vaccines routinely required for school admission contains thimerosal as a preservative.)1 Mercury, of course, can cause neurological damage. But there’s scientific consensus that the amount once used in vaccines — around 50 micrograms per 0.5-ml dose — was far short of toxic. And autism rates have continued to climb, suggesting that there’s either a different cause or, more likely, that a better understanding of the condition has increased diagnoses. A comprehensive review of the research, conducted in 2004 by the prestigious Institute of Medicine, found no evidence of a connection between vaccines and autism. None.
MYTH 2: Giving too many vaccines overwhelms a child’s immune system.
FACT: This argument echoes the “too much of a good thing” chestnut, but there’s no science behind it. With millions of vaccines administered every year, a handful of allergic reactions do happen. But severe cases are so rare that the CDC cannot calculate a statistical risk for the population — the numbers are just too small.
MYTH 3: Vaccines cause diabetes.
FACT: This idea relies on the flawed work of one doctor, who gathered data on a slew of vaccines and failed to follow standard study protocols. No other study — including those using the same data — could reproduce the results. The CDC and the Institute of Medicine have both dismissed any possible link. This argument also ignores the obvious and well-established fact that diabetes rates in children are climbing because obesity rates are climbing.
MYTH 4: Vaccines are no longer necessary, because the diseases are no longer a threat.
FACT: The opposite is true. Because of vaccines, diseases that once killed millions are now invisible. But if only a few families stop vaccinating, the illnesses could reemerge in a community. And the diseases are horrible — mumps and Haemophilus influenzae type b cause meningitis, which can lead to deafness, epilepsy, and cognitive impairment. Measles can lead to encephalitis, blindness, and death.
MYTH 5: Scientists are divided about the safety of vaccines.
FACT: By any measure of scientific consensus, there is total agreement: Vaccines are safe, effective, and necessary. Twelve studies have shown that the measles/mumps/rubella vaccine is safe. Many other studies have disproved the theory that the Hib shot is toxic. The few dissenters get lots of attention, but it’s always the same old names.
MYTH 6: Aluminum in vaccines is just as toxic as mercury.
FACT: Aluminum, the most common metal in nature, is perfectly safe in small amounts. (A dose of antacid has about 1,000 times as much as a vaccine does.) Aluminum salts are used in vaccines to increase antibody response. They make it possible to use less vaccine less often
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I think parents who refuse vaccines should be asked to leave the country. They are deliberately endangering society and spreading infectious disease around. When I have children one day, I would be really upset if my child was infected with one of these diseases because an ignorant parent decided to listen to Jenny McCarthy and all the myths about these amazing vaccines.