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Pediatricians struggle over patients who won’t vaccinate

Associated Press
Sitting in her home in Ashland, Ore., earlier this month Jennifer Margulis shows off empty vials of vaccine that she saves in case one of her children has a bad reaction. Like many parents, she is concerned about the right schedule for vaccinations.

Doctors across the country are saying they might fire you as a patient if you refuse to let your child be immunized, according to a few stories that have ignited all kinds of discussions about vaccines and the role of pediatricians.

But a new survey confirms that’s a minority viewpoint, particularly among pediatricians in Washington. 

The survey started  with Dr. Doug Opel and some of his colleagues at Seattle Children’s and the University of Washington. They noticed they were seeing a lot of parents with questions about immunizations – often based on "The Vaccine Book" by Dr. Robert Sears.

"Our collective clinical experience was that we were seeing more parents coming in with that book under their arms to the office, saying, 'I want this.' "

Sears has an alternative schedule of vaccines, which delays many of them by several years. 

Washington has possibly the highest rate in the country of children who are only partially-immunized. (You may read elsewhere that Washington has the highest rate based on a 2009 survey, but that survey was less than scientific, and Opel says there is no definitive ranking.)

Child's health at risk

Opel sent an online survey to pediatricians statewide, and most (77 percent) of those who responded said that they are getting requests from parents about delaying vaccines.

The problem, he says, is many of the diseases prevented by immunization are dangerous – even deadly – to infants and toddlers.

"I see it as a difficult spot. They have to balance two competing interests. One is the need to respect a parent's decision making authority, to make these decisions on behalf of their child. That's on one hand. But on the other, a pediatrician's obligation to protect a child's health."

Three critical vaccines to get on time?

There are three vaccines most pediatricians said they are uncomfortable delaying:

  • DTaP (Diptheria, Tetanus and Pertussis aka Whooping Cough)
  • Hib (Haemophilus influenzae type b, a major cause of meningitis for infants)
  • PCV (prevents pneumococcal infections, including forms of pneumonia and meningitis)

Nearly two-thirds of pediatricians do try to accommodate parents who want an alternative, according Opel’s survey, published in the journal Pediatrics. That leaves a third who won't agree to delays, but the survey didn't ask if they send patient's elsewhere.
Tools of persuasion

The goal of most pediatricians is to persuade parents to immunize, but they’re not sure what’s the best way to have that conversation. Should they be insistent? Or sympathetic?

Opel's research team is now videotaping some patient visits to see what seems to work. Another research team based at Group Health Research Institute is devising a set of communication "tools" for health providers to use when discussing vaccines.

On the Web:

Debate over the MMR vaccine

Dr. Paul Offit on the dangers of the anti-vaccine movement

Keith Seinfeld has been KPLU’s Health & Science Reporter since 2001, and prior to that covered the Environment beat. He’s been a staff reporter at The Seattle Times and The News Tribune in Tacoma and a freelance writer-producer. His work has been honored by the American Association for the Advancement of Science (AAAS) and the Knight Science Journalism Fellowships at Massachusetts Institute of Technology.
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