COMMENTARY

Don't Dismiss Patients Who Won't Vaccinate!

Arthur L. Caplan, PhD

Disclosures

March 12, 2012

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I am Art Caplan from the Department of Medical Ethics and Health Policy at the University of Pennsylvania Perelman School of Medicine. I want to talk to you today about a problem that is small but growing.

Some of you may know that there was a Wall Street Journal[1] article recently that said that a lot of doctors are starting to turn away parents who won't vaccinate their children. One study showed that about 40% of pediatricians said they had at least 1 family that wouldn't vaccinate or hesitated to vaccinate, and they didn't want to keep them on as patients. Happily, this is a small problem, but it is growing. There has probably been an increase over the past 3 years, and 3%-5% of parents are not vaccinating their children. It can be higher in some communities.

Ethically, I think I understand why doctors may say, "Look, I don't want to deal with nonvaccinators. It's poor practice, it puts people at risk in my waiting room, and I'm not going to do it." But that gets these parents into the office, and you may have a chance at persuading them to vaccinate their children. I am going to argue that it is important to try hard, to not dismiss these people but stick with them to see if you can persuade them.

If that is the moral position that I want to defend, then what can be done? What can you do as an individual doctor to try and change their minds? The 2 reasons that parents hesitate about vaccination are safety concerns, and that their child is receiving too many vaccines at once. It just seems like the vaccine schedule is constantly resulting in their child receiving inoculations.

What can we do about that? How can those concerns be answered? With respect to the safety issue, it isn't a bad thing for a parent to worry about safety. It's that they are listening to inappropriate sources. They hear it from celebrities, they get information about vaccine risk on the Internet, or they may hear from a neighbor or a friend that there are still worries about autism.

To get at that particular worry about safety and the worry about too many shots at once, first of all, we have to have good knowledge of the facts. Know where the resources are; know the good Websites to send people to where they can get valid information. Know about places like the Vaccine Education Center at the Children's Hospital of Philadelphia. They keep tabs on the latest rumors and wild ideas that might be promulgated and can help counteract them with good, hard evidence. Knowing the facts is probably the most important thing that you can do to try and overcome vaccine hesitancy.

It's important that you receive your vaccines. If you have children, you can say to parents, "I have had my kids vaccinated." If you could say, "I got my flu shot. I think it's important, I do it every year," that can really make a difference in convincing people. If their doctor thinks it is important, and if their doctor makes sure that his or her own children are vaccinated, that's a very good role model.

Finally, you can try and get over vaccine hesitancy by pointing out that you are not just having your child vaccinated because you want to protect them, but you want to protect others who can't receive vaccines, such as babies, people with immune diseases, people who have had transplants, and the elderly. You want to have your child vaccinated to protect grandmothers, grandfathers, or a new baby in the family. That moral reason may swing some parents over, too.

At the end of the day, doctors who stick with it do have a chance, and studies show that when parents change their minds, it's because they talk with doctors whom they trust and are persuaded to start vaccinating. I hope these tips prove useful as a way to make that happen.

Thanks for watching. This is Art Caplan at the Department of Medical Ethics and Health Policy at the University of Pennsylvania.

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