Refuse to vaccinate? You may be told to seek care elsewhere

Say a family comes into your pediatrician’s office for a regular checkup. And say this is also a family that refuses to vaccinate their children. Your doctor can tell them to take their business elsewhere. And in fact, the American Academy of Pediatrics today recommends that action.

“Parents, pediatricians and policymakers all have a role in protecting children from diseases like measles and whooping cough,” said Benard Dreyer, president of the AAP, which is taking a stronger position on this issue than ever before. “No child should have to suffer through a disease that could have been prevented by a vaccine.”

In an effort to address the anti-vaccine trend, the AAP issued a new policy statement today opposing all nonmedical exemptions for vaccines. If, after counseling, skeptical parents still choose to opt out, doctors may request “that they seek care elsewhere.”

Bayla Sandman, a mother of two sets of twins, ages 5 and 2, applauds the new recommendations. “I think it’s great,” said the paralegal, who lives in New Haven, Conn. “People read all this stuff on the Internet and it’s not based on any science. It’s based on nothing.”

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Anxiety about immunizations has increased in recent years, according to survey findings, also included in the latest report. Of about 630 pediatricians polled in a 2013 survey, 87 percent had encountered vaccine refusal, up from 75 percent in 2006. Top concerns include: the child’s pain, too many injections at a single visit – causing some parents to delay rather than refuse vaccines – and a fear of autism. Many have a mistrust of health-care professionals.

Likewise, the number of providers who dismiss families for noncompliance nearly doubled between the two time periods, reported the AAP.

Despite the new position, Todd Ochs won’t change the way he has interacted with skeptics for the past 30 years. “Why should I punish a child for a parent’s bad decision?” the Chicago pediatrician said. “If I kick out these families, there will always be some homeopath or alternative medicine practitioner who will give parents exactly what they want. I’d much rather have an ongoing conversation with them than isolate them.”

To counter vaccine-hesitant parents, more providers are implementing an office policy requiring that all patients comply with the AAP vaccine schedule, which recommends two MMR vaccines at 12 to 15 months and a second dose at 4 to 6 years. This way, pediatricians are not really severing ties with families, but declining to treat them at all.

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After a national measles outbreak last year, Anita Chandra-Puri, a pediatrician who also practices in Chicago, has tried to walk a more nuanced path. If after six months of counseling a family is still undecided on whether to immunize, she will recommend they seek care elsewhere.

“You just can’t take part of my advice. If you trust me when your child has a fever or a rash, you should trust me on this, too,” she said. “If after six months, you still aren’t convinced, then we don’t really have a working relationship.”

As for delaying vaccines, “There is no alternative schedule,” said Chandra-Puri. “There is only one schedule. . . . The rest is parental choice.”

High community immunization rates protect vulnerable individuals – those who are too young to get vaccinated or can’t be vaccinated because of medical problems, such as undergoing chemotherapy. Those people are protected by the majority who are inoculated, called herd immunity.

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For example, when the vaccination rate for measles drops below 95 percent, a community loses its herd immunity to highly infectious diseases, explained Kathryn Edwards, one of the co-authors of the report and a professor of pediatrics at Vanderbilt University.

Measles was all but eradicated in 2000, but last year, the disease came roaring back, with many cases linked to the Disneyland outbreak in California, where an estimated 3 percent of kindergartners had a nonmedical or philosophical exemption from the MMR.

Later, California responded by passing legislation that ended exemptions for nonmedical reasons. West Virginia and Mississippi are the only other states that have similar requirements, according to the Centers for Disease Control and Prevention.

The AAP has called for all nonmedical exemptions to be eliminated and recommends that public health officials release immunization rate data for individual schools and communities, so parents can make informed decisions about their children’s safety in those settings.

Sandman, the New Haven mother, said that the vaccine debate is most heated among those who spend a lot of time on social media, debating the merits of everything from sleep training to home schooling.

“There’s so much pressure to be perfect. I was nervous because there was so much from the anti-vaccine people on the internet, like doctors were being paid by the pharmaceutical companies,” she said. “I eventually stopped reading and searching . . . because what you really need to find is a doctor you can trust.”

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Bonnie Miller Rubin is a former reporter at the Chicago Tribune.