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.