Should Doctors Fire Parents Who Refuse Vaccines For Their Children?

Last October I had a fantastic week in Boston for the annual convention of the American Academy of Pediatrics, and I still vividly remember the excitement and energy of these thousands of doctors. One common theme from their many discussions was the serious problem of vaccine underuse in America; more specifically, the alarming increase of American parents who are refusing to get vaccinations for their children. As the Wall Street Journal reported, a report last year in the AAP’s Pediatrics journal stated that 13% of Americans are now either “spacing out” vaccines or refusing some or all vaccines for their children. This is alarming data for many pediatricians and family doctors such as myself, who deeply believe both from training and first-hand experience that vaccinations are the cornerstone of childhood health and are the backbone of prevention against previously deadly diseases worldwide. And no matter what we do with our evidence-based publications and earnest pleading to the public, we face an even larger foe from the media and “celebrity experts” who have now totally confused many well-meaning parents who really don’t know who to believe anymore.

It’s getting so bad in parts of America that many pediatricians are starting to fight back in the strongest way possible; a new survey shows that 21% of all US pediatricians have fired families and patients from their practice for refusing to take all vaccines for their children. This certainly may come as a harsh surprise for many readers, and it’s not endorsed by the CDC or the AAP, but I do understand my colleagues’ sentiments and frustrations. I personally have never fired any family for this, nor do I plan to do so, even though quite a few parents in the Beijing community are skeptical of vaccines. I think a better approach is to keep these concerned parents in your “medical home” and keep trying to allay fears, which includes giving them handouts from websites such as the CDC’s outstanding PDF handouts on “Diseases and the vaccines that prevent them”. But if the parents still refuse to give the standard set of vaccines, doctors could get the parents to read the CDC handout about Vaccine Refusals, and then sign the American Academy of Pediatrics “Refusal to Vaccinate” form (PDF here), which details the very real risks they are subjecting their child to, including the increasing risk of getting pertussis or measles from another child.

I understand this is a complicated issue for parents, but in most doctor’s eyes, it’s not complicated, and it’s not a two-sided debate. Most of us feel the evidence is overwhelming in favor of vaccine effectiveness in wiping out polio, smallpox and a handful of other still-deadly diseases, and there are few truly legitimate reasons not to vaccinate. Of course there are some side effects, which were exhaustively reported in the important recent review from the Institute of Medicine, which I discussed last year. Pediatricians and family doctors need to provide concerned parents with the evidence. I strongly feel that if parents still refuse to vaccinate their child despite all the overwhelming evidence, then those parents really need to understand that they are putting their child’s health at risk — and also threatening the health of vulnerable infants and others in their community. Many parents indeed have deeply regretted not vaccinating their child. Here are some sad stories from victims of vaccine-preventable diseases for you to read. You can also read a few sobering articles from the CDC’s “Unprotected Stories” series, including this true story of pertussis (AKA whooping cough, now making a comeback):

“A Preventable Tragedy”: A True Story

Preventing whooping cough—and saving lives in the process—must be a community-wide effort to vaccinate infants, children, adolescents, and adults. Pertussis vaccine has saved thousands upon thousands of lives, but we need to keep up the fight against whooping cough by using vaccines. Here is one family’s story.

On Christmas Eve 2009, Katie and Craig welcomed their daughter Callie Grace into the world. After trying for 5 years to have a child—and suffering several miscarriages—the couple considered Callie their miracle baby. Callie was born 6 weeks early, but she was healthy and strong and came home after only 2 weeks in the hospital.

In January, when she was a month old, Callie developed a soft, dry cough. “It sounded like when a child mimics their parent to get attention. I took her to the doctor,” Katie recalls. The doctor did not find any serious signs of illness, so he sent them home. However, over the next couple of days, Callie’s condition worsened. She continued to cough, and she also became pale, didn’t move around much, and suddenly lost her healthy appetite. Katie took Callie back to the doctor, and while they waited, Callie stopped breathing. A nurse was able to get Callie breathing again, and they were rushed to the hospital by ambulance.
“At the hospital, nurses and doctors flocked to our room,” Katie remembers. “It was truly overwhelming. I was scared and Callie was screaming.” Callie was admitted to the Pediatric Intensive Care Unit, where the staff ran tests to try to find out what was wrong. After a couple of days of monitoring, they started her on antibiotics, while still waiting on test results.

During Callie’s second day at the hospital, she seemed to be doing OK and her parents were hopeful that she’d recover. According to Katie, “Callie was alert and would smile. She kept sticking her feet in the air so we could rub them for her. We never really thought her life was in danger.” But the next night, Callie stopped breathing again. Family members watched helplessly from behind a glass wall as doctors tried for 45 minutes to revive her. Tragically, Callie could not be saved. She was only 5 weeks old. “We never dreamed we’d lose her,” Katie said. “Callie was a more loved, more wanted baby than you’d ever find.”
A few days later, the family found out that whooping cough was the cause of Callie’s death. “We could not believe it,” Katie says, “We were so careful to not expose her to a lot of people. She never left the house except to go to the pediatrician,” Katie says.

The first dose of DTaP vaccine is recommended at 2 months of age but babies are not fully protected until they get all the recommended doses. Callie was too young to even get her first dose of DTaP. Babies need whooping cough vaccination on time, but there’s another important way to protect them. Family members and others who are around babies should be vaccinated—children should be up to date with DTaP, and everyone 11 years of age and older should get Tdap, the booster shot that prevents pertussis.

“Callie could have caught whooping cough from any of the few people that she had contact with—even from someone in the hospital right after she was born. People with even a slight cough might have whooping cough but not know it. I urge everyone to make sure their children have all their DTaP shots on time. I also encourage people to be sure they get the Tdap booster shot,” Katie says. “Getting that shot could save a life.”

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