Vaccination Refusal and Parental Education: Lessons Learnt and Future Challenges

Robert M Jacobson


Pediatr Health. 2010;4(3):239-242. 

In This Article

What we Should Not Do

Several approaches fail to recognize that the parent is after all seeking to make a decision. These include:

  • Absolute mandates that those parents refusing vaccines accept the vaccines

  • Requirements for making parents sign an 'against medical advice' form

  • Bans of those families refusing vaccine from one's practice

  • Alternative vaccine schedules that accommodate parents' concerns

Absolute mandates are rare and for good reason. While data clearly support the success of school and daycare requirements in bringing children behind in vaccines up-to-date, 48 states offer some sort of exemption.[4] While few parents claim such exemptions, their existence is a political expediency. Without the opt-out options, legislators would meet more resistance from the antivaccine movements. Again, these mandates actually work as reminders. Clinicians should seek not to vaccinate against parents' will, but instead persuade parents to choose vaccination.[14] Clinicians depend upon parents to provide for their children and primarily serve parents in their work through persuasion. Resorting to force of law to engage parental behaviors should be a last resort.

The American Academy of Pediatrics (AAP) has devised a template for clinicians to use to record parental refusal,[15] and experts recommend such official documentation to minimize legal risk or at least to minimize a clinician's concern for legal risk.[14,16] But documenting a parental refusal in some sort of legal instrument might, as a result, bring any ongoing efforts to advance past the parental hesitancy to a halt. It implies that the parent's decision to refuse stands for all time; it permits the clinician to rest if not retreat from efforts to persuade.

A survey of members of the AAP in 2005 found that 39% of the respondents claimed that they would refuse to provide care to families who refused all vaccines and 28% claimed that they would refuse to provide care to families who refused certain vaccines.[17] The AAP, ethicists and others recommend that clinicians avoid such an approach.[1,12,16,17] Firing the patient, however, fails to respect the decision-making efforts of the parents. It ends the efforts the clinician should pursue through continued discussions to inform and persuade.[14]

The schedule offered by Robert Sears is attractive to some hesitating parents, particularly those who fear the number of vaccines given at once.[18] He has published Dr Bob's Alternative Vaccine Schedule for parents to use to eliminate, delay, separate and spread out vaccine doses. Some clinicians admit to acquiescing to this popular physician and his best-selling publication as some form of compromise, but the compromise may very well convey to the parent the clinician's implicit acceptance of the arguments behind the schedule: arguments that lack a basis in logic and evidence.[19] Furthermore, the delays leave the child and others at risk for vaccine-preventable diseases.


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