Should Doctors Fire Parents Who Refuse Vaccines For Their Children?

Vaccine RatesLast 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 reporteda 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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7 thoughts on “Should Doctors Fire Parents Who Refuse Vaccines For Their Children?”

  1. Good morning,

    I always read your posts with interest. Of course, vaccination is very emotional… But after reading the tragic story of Callie Grace, here is what appeals to me, if you do not mind me giving my appreciation of the facts stated.

    Appearently the Doctors this poor baby met with while having whooping cough could not give a proper diagnosis. They had probably read the baby’s file -if they did not, they should have asked about vaccination (that’s usually what the Doctors I meet with for my children ask first) and not assume that she had received all her shots -specially knowing your figures : “13% of Americans are spacing out vaccines”. They shoud have known she had not received DTaP shots. Examined her. Ruled out -or not- whooping cough. After all, they are professionals, and their high fees enforces their specificity. Dont’ you think, as a Doctor yourself ? Still, they never thought before a few days after she was dead that maybe she had caught whooping cough, thus, they never treated her for the disease she had -maybe, relaying so much on vaccination prevented them from learning how to give adequate treatment ?- thus, whatever the decision of the parents, I feel thatin the end, the Doctors were responsible for not being able to give Callie Grace adequate treatment. In my opinion, they are the ones who failed eventhough parents, in this specific story, had made a mistake in trusting the ability of Doctors to treat deseases.
    Learning is an obligation. Parents still have the choice not to send their children to school as long as their kids learn the basics. Parents also have the choice not to vaccinate, appearently only as long as their kids do not catch these diseases. If they end up ill, families are punished, the hard way : Doctors will not treat them properly as they should not have caught the disease. As Callie Grace’s story enlightens, it is death sentence in some cases. Do you think it is right ? Is this why Doctors became Doctors ? so as to have the right of life and death on their patients and their families and punish them for not having followed sacro-saint advices of scientists ? These people even end up becoming example among the community. Somethings make me shiver in this world of ours… But maybe, my interpretation of Callie Grace’s story as stated at the bottom of your e-mail is wrong… And I still want to thank you for all the advice you provide us with on weekly basis. They are indeed very usefull.

    1. Thanks for the thoughtful comment! Regarding your opinion of the doctor, “hindsight is always 20/20” so it’s always a bit unfair to judge when we weren’t there: but I personally think their steps seemed appropriate. Firstly, the baby in the first doctor visit sounded like she had what 99% of babies have on these common visits: a very slight cold, almost always caused by a virus. The issue is later when the baby was admitted — but there still isn’t an automatic need to give a child antibiotics on admission, because many times it’s a viral infection and the child simply needs supportive care as an inpatient. I assume (but don’t know) that the doctors did a CBC on admit which didn’t show any raging bacterial infection (no high neutrophils), so antibiotics would not be indicated.

      But let’s try to get back to the main issue, that this child got pertussis from someone else: it didn’t have to be from an unvaccinated person, by the way. The pertussis vaccine fades away after a few years which is why a Tdap booster is now recommended for adults (please, everyone, get a Tdap if you haven’t gotten one and you have infants at home!)

      And I disagree a bit with your conclusion that “Parents also have the choice not to vaccinate, appearently only as long as their kids do not catch these diseases. If they end up ill, families are punished, the hard way”, because you leave out a crucial component: it’s not so much their own kids that are punished, it’s the tiny infants that we worry about — because they get sick from unvaccinated others! This is the major issue: there many documented cases of infants, too young to be vaccinated, who got sick from hanging out in a doctor’s office and catching an infection from a sick unvaccinated kid next to them. THIS is why some peds doctors are really scared and now firing patients, because they worry about these nightmare stories happening in their own waiting room.

      If you look at this issue from a community-level “it takes a village” approach, I’m sorry if this sounds harsh but it is selfish for parents not to fully vaccinate their children — because they are relying on the other 90% of the population to be vaccinated; in other words, they are assuming their own kids are protected because “everyone else” has the vaccine so the chance of getting infection is rare. For any vaccine to really work, “herd immunity” is needed where >90% of the population is vaccinated. 

      I seriously doubt we’d be having these debates if something like polio made a raging comeback. Only a few decades ago Drs Salk and Sabin were international heroes because they developed vaccines against this devastating disease. Now we have some parents thinking a new doctor hero is Dr Andrew Wakefield, who for years was the #1 quoted doctor for anti-vaccine groups and yet whose research not only has been completely discredited and recused from the journal, but who lost his license to practice medicine last year in the UK — and yet now runs around America preaching the same message. Very sad. What happened to the American love of science and progress?

  2. sorry, a concerned mom, the facts about Pertussis are these:

    For babies under two months of age Pertussis is really quite deadly.  Many babies of this age, whether or not they receive proper diagnosis and antibiotic treatmant, will die if they get Pertussis.

    A NZ Medical writer and friend writes it this way:
    Bordetella pertussis has some special properties that not all bacteria have, and that is what makes it terribly difficult to deal with: It secretes several toxins, and has adapted to stick to the cells of the airway.

    There are two first-line bacterial toxins(reference); Pertussis toxin (PTx) which stops the body from sending neutrophils(immune cells) to kill the bacteria, and Adenylate Cyclase Toxin (ACT). ACT inhibits the immune cell function and poisons the immune response(ref), acting as a “force-field” to shield the bacteria from the immune system while the bacteria start stripping the bronchiolar cilia off of the epithelial cells.

    Vaccinated children cannot mount antibody to ACT (reference  Cherry JD et. al., 2004. “Determination of Serum Antibody to Bordetella
    pertussis Adenylate Cyclase Toxin in Vaccinated and Unvaccinated
    Children and in Children

    and Adults with Pertussis.” Clin Infect Dis. Feb 15;38(4):502-7 PMID 14765342)

    Vitamin C will neutralize these toxins while the body is mounting a proper immune response, which takes weeks.

    And it seems you have misunderstood something.  This baby was too young to get DTaP at all.  The doctors in the case description did not assume anything incorrect in this regard.  If you read it all again, you’ll see that Dr. Richard makes that clear in the writeup.  

  3. If a mom is not breastfeeding, or wants to be sure to protect her new infant from Pertussis, Adults should make sure they are immune to Pertussis. 

    Don’t run out and get the vaccine, though.  GET YOUR TITERS CHECKED to see if you have “enough” circulating antibody to be considered protected.  You may not be able to tell easily if this is natural immunity or vaccine induced immunity.  But having a high enough Titer will give you peace of mind without taking unnecessary shots. 

  4. What about the family with a child who already got the recommended vaccines, yet had an adverse event from those vaccines?

    Parents whose child has been harmed by a vaccine (like my oldest child, at age 2 months, with years of hell I dare not go into here, a slow recovery, and residual learning and speech problems at age 8) – I personally will never, ever, accept the FDA’s legal status of vaccines as “unavoidably unsafe” (look it up, this is the class they are called)

    I do not accept that it is morally correct to accept some “collateral damage” for “the greater good”.  The toll is too high.  Seizures, brain damage, lymph system disorders, systemic disorders, neurological disorders are listed on just about every package insert as known (rare, but acknowledged) unintended effects. 

    Parents must investigate the risks of the vaccine, against the risk of the disease (actual incidence rate in China and in our home countries, risk factors, transmission patterns, allopathic and alternative home treatments, nutritional status bearing on disease resolution, for instance Vitamin A has been known since 1938 to prevent complications from Measles, etc)

    Some families (with atopy, allergy, autoimmune disorders, cancer) are at higher risk of vaccine reactions- at least this is the model they are working under- the people who deal with large volumes of parents reporting negative vaccine reactions have seen patterns.

    My daughter had a medical condition which would have exempted her from getting a live virus vaccine.  I have seen figures from 1 in 300 to 1 in 600 persons having this condition, the most common immune system problem by far.  Yet, doctors do not bother to look for this relatively common condition, or any others that would be contraindications to vaccination- just jab all babies indiscriminately.

    Our children are not to be fit into some public health policy one size fits all calendar. 

    Parents have a moral responsibility to look into the issues, and decide for themselves which shots they want or do not want.  They should remember they have a right to refuse any of them:  Chickenpox, Rotavirus, whatever. 

    There are three recent orthodox studies—all raising serious question about vaccine adverse events:

    From the professional journal, Archives of Disease in Childhood:

    Early diphtheria-tetanus-pertussis vaccination associated with higher female mortality. 
    http://adc.bmj.com/content/early/2012/02/13/archdischild-2011-300646.full

    Infant mortality rates regressed against number of vaccine doses routinely given: Is there a biochemical or synergistic toxicity?
     http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170075/

    Do aluminum vaccine adjuvants contribute to the rising prevalence of autism?
    http://omsj.org/reports/tomljenovic%202011.pdf

     

  5. http://www.chestjournal.org/cgi/content/full/115/5/1254

    “Investigations of outbreaks have documented that adults develop
    infection with B pertussis and transmit the organism to susceptible
    children or other adults. Thus, previously immunized adults and adolescents are the main sources of transmission of B pertussis…

    “The
    period of immunity induced by the pertussis vaccine tends to wane
    within 5 to 10 years and is shorter than that induced by the disease
    itself.. Furthermore, in vaccinated populations, adults maintain the
    ability to transmit B pertussis and are now the primary source of
    infection to susceptible children who may develop severe disease..”

    Babies who are ages with the highest at risk of death from Pertussis are far too young to have received all three rounds of Pertussis vaccine.

    And, mothers should breastfeed. So often, we just stick the sleeping baby in a stroller and go on with
    our busy lives as if nothing has happened.  This would be good, if they
    at least got some Vitamin D from the sunshine.  But that isn’t even
    happening the vast majority of the time.

    Therefore, to protect infants like Callie from Pertussis, the Adult Vaccine Schedule from the CDC is here for those who want to put their money where their mouth is

    http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm

    Roll up your sleeves, folks, there are 190 new vaccines in development as of 2010, in Phase I, II or III clinical trials.  Everything from  to Aeruginosa bacteria to Chikungunya virus to Yersinia (sorry, no Z’s on the list)

    http://www.phrma.org/sites/default/files/354/infectious_diseases_2010.pdf

    What? Never heard of them?  Well, you will.  Why bother scaring people about some rare disease, until there’s a vaccine to sell them?

  6. Is it proved this baby had a strain of B. Pertussis contained in the vaccine?  If not, vaccination would have no bearing at all on this child getting the disease.

    “Despite wide-scale vaccination in many countries, [Pertussis] is reemerging throughout the world in both adults and children.

    Emergence has been explained by many factors: wane of vaccine and natural immunity, increase of asymptomatic carriers, and/or ****natural selection of non-vaccine strains.”**** even back as far as 2001

    http://www.ncbi.nlm.nih.gov/pubmed/11395787?dopt=Abstract

    meaning that we are pushing mutation of the Pertussis bacteria, to non vaccine types.  This is credited as a big reason for the California Pertussis outbreaks the last couple of years. 

    in addition, vaccinated people can be and are carriers

    http://www.cdc.gov/ncidod/eid/vol6no5/srugo.htm

    “We demonstrated B. pertussis infection in fully vaccinated children
    ages 2-3 years and 5-6 years who had contact with an infected child. We
    investigated whether younger or recently vaccinated children may be
    protected from classical clinical illness but remain susceptible to
    infection and become asymptomatic carriers. ..Conclusions;  The effects
    of whole-cell pertussis vaccine wane after 5 to 10 years, and infection
    in a vaccinated person causes nonspecific symptoms (3-7).   Vaccinated
    adolescents and adults may serve as reservoirs for silent infection and
    become potential transmitters to unprotected infants (3-11). The
    whole-cell vaccine for pertussis is protective only against clinical
    disease, not against infection (15-17). Therefore, even young, recently
    vaccinated children may serve as reservoirs and potential transmitters
    of infection…. Our results indicate that children ages 5-6 years and
    possibly younger, ages 2-3 years, play a role as silent reservoirs in
    the transmission of pertussis in the community”
     

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