COMMENTARY

Fire Patients Who Won't Vaccinate?

Paul A. Offit, MD

Disclosures

March 16, 2012

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Hi. My name is Paul Offit and I am speaking to you today from the Vaccine Education Center at the Children's Hospital of Philadelphia. Today I want to talk about an article that was recently published in the Wall Street Journal,. "More Doctors 'Fire' Vaccine Refusers: Families Who Reject Inoculations Told to Find a New Physician."[1]

This is a growing trend in pediatrics, in part because of what is happening among parents. From 1% to 2% of parents now refuse to get all vaccines [for their children] and between 10% and 20% of parents are choosing to delay, withhold, separate, or space out vaccines.

What is a doctor to do? I think there are 2 possible choices, neither of which is completely satisfactory. The first is that doctors could do basically what they have been doing, which is to do the best they can to try and convince parents to allow children to get the vaccines they need, and if parents want to delay or separate or space out vaccines, to educate them about the importance of getting vaccinated.

The advantage of that approach is that it keeps the dialogue open and allows the pediatrician to continue to be the children's advocate, to get them the vaccines that they need. The downside of that approach is that it means there will be children in the practice who will be susceptible for a longer period of time to diseases that are prevented by vaccines. Furthermore, it means that more children in the waiting room may potentially be infectious or contagious because they have acquired a vaccine-preventable disease. What responsibility do you have to those patients in your waiting room? Certainly, physicians take care of patients who are receiving immunosuppressive therapy for rheumatologic diseases or asthma, as well as patients who are on cancer chemotherapy who cannot be vaccinated or, at least, cannot be adequately vaccinated. What is the responsibility to them?

The second possibility is to do what this article suggests and simply decide not to see those patients. When you choose to see patients who are delaying, separating, or withholding vaccines, you are making a tacit agreement that this is acceptable practice. Whereas when you decide not to see such patients, you are saying, "I can't do this; I can't be asked to practice substandard care; let me love your child; I do not want to send your child out into a world where I know there are increasing numbers of patients in the United States who have measles or mumps or whooping cough or chicken pox, so do not put me in that position; do not ask me to practice substandard care for your child."

The downside of that approach is that if you choose not to see that family you have lost any chance to convince them about the importance of vaccines. I do not know the right answer to this dilemma. I would like to think that there could be studies in the future that look at different populations of people, children whose parents are of different socioeconomic backgrounds or different educational backgrounds to see [which tactic] works best, because I think doctors are, in many ways, put in an impossible position here.

Thank you for your attention.

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