Parental noncompliance with the American Academy of Pediatrics and Centers for Disease Control and Prevention immunization schedule is an increasing public health concern. We examined the frequency of requests for vaccine delays and refusals and the impact on US pediatricians’ behavior.
Using national American Academy of Pediatrics Periodic Surveys from 2006 and 2013, we describe pediatrician perceptions of prevalence of (1) vaccine refusals and delays, (2) parental reasons for refusals and/or delays, and (3) physician dismissals. Questions about vaccine delays were asked only in 2013. We examined the frequency, reasons for, and management of both vaccine refusals and delays by using bivariate and multivariable analyses, which were controlled for practice characteristics, demographics, and survey year.
The proportion of pediatricians reporting parental vaccine refusals increased from 74.5% in 2006 to 87.0% in 2013 (P < .001). Pediatricians perceive that parents are increasingly refusing vaccinations because parents believe they are unnecessary (63.4% in 2006 vs 73.1% in 2013; P = .002). A total of 75.0% of pediatricians reported that parents delay vaccines because of concern about discomfort, and 72.5% indicated that they delay because of concern for immune system burden. In 2006, 6.1% of pediatricians reported “always” dismissing patients for continued vaccine refusal, and by 2013 that percentage increased to 11.7% (P = .004).
Pediatricians reported increased vaccine refusal between 2006 and 2013. They perceive that vaccine-refusing parents increasingly believe that immunizations are unnecessary. Pediatricians continue to provide vaccine education but are also dismissing patients at higher rates.
Arumugham V. Evidence that Food Proteins in Vaccines Cause the Development of Food Allergies and Its Implications for Vaccine Policy. J Dev Drugs. 2015;4(137):2.
It was certainly disheartening to see the increase of dismissal from practice rising from 6% to 11% over the course of this study. Most concerning is the justification of this action from some of my colleagues that "parents aren't listening to me". I find this to me a most paternalistic and selfish stance on the part of community pediatric providers. Are we dismissing patients who fall off their bikes and weren't wearing the helmets we recommend, or the children who were in motor-vehicles accidents and not properly restrained?
I have always advocated in my practice, and now teaching, that I am an adviser for my patients and their families. I am not the only source of "how-to-raise-your-children". Unfortunately in today's media aggressive society, there are sometimes far too many others who proclaim their expertise in just that arena.
The ultimate responsibility for raising children is with parents/caregivers. My job is to give them educated, evidenced-based (when available) advice, which they will then add to advice from grandparents, teachers, and other members of their child's community, and formulate decisions which they feel are in the best interest of their child. I don't mind telling them when I disagree with their decision, and will always try to understand their point of view in a respectful and supportive fashion. Kind of like raising your own children, don't you think?
So my question for those who would simply "dismiss" patients and their families because they are not following your rules is this: are you kicking your own kids out of the house when they do the same? Or do we have double standards on respect and compassion which we are too angry, impatient, or perhaps too stressed, to apply outside of our personal lives?
Just a thought...
Paul J. Sagerman, MD, MD, FAAP
Associate Professor of Pediatrics
Wake Forest University School of Medicine
Winston-Salem, North Carolina
disclaimer: the above comments are strictly those of the author and are not meant to reflect the philosophy of the author's employer
Australia had 347 cases of whooping cough and a 53% vaccination rate in 1991. No baby deaths for years. Since DTap introduced in 1997, by 2011, we had 40,000 or 180 out of every 20,000 vaccinated dTap kids with whooping cough. This wasn't the problem, the problem is all the DTap kids, without symptoms, spread whooping cough, over and over for 6-12 years, all thanks to that DTAP is crap vaccine. If USA doesn't ban that vaccine, in four years, you will follow the exact same thing, Uk is following, that is Australias timeline,,,,,,,,,,,,,,,,, we got to be lab rats for Dtap, aint we lucky, now we have 1 in 16 DTap kids (or more) spreading whooping cough, every year, to their little sibling babies............ And yes, the babies get real sick.. When are you people, who are paid to write this rubbish, actually going to admit, you are paid, and immoral