Medical Professional Publications

To Accept or Not Accept the Children of Vaccine Refusing Parents

(From the August 2017 Issue of MedStat)

Ben Almasanu, DO By Ben Almasanu, DO

Dr. Almasanu is a graduate of Ohio University College of Osteopathic Medicine, and completed his Pediatric Residency at Maimonides Medical Center in Brooklyn, NY.  He is in private practice with COPC/Pediatric and Adolescent Practitioner, and has been on the medical staff of Nationwide Children’s Hospital since 2004.

To accept or not to accept the children of vaccine refusing parents? That was the question my five partners and I asked ourselves in 2015 amidst the aftermath of the mumps and measles epidemics of the previous year.

Historically, our office had maintained a somewhat liberal approach; we welcomed families whether they strictly adhered to the Advisory Committee on Immunization Practices (ACIP) vaccination schedule, elected to modify this timetable, or decided to refuse immunizations for their children altogether. Grounded in the belief that it was our responsibility not just to administer potentially life-saving immunizations but also to provide education on their benefits, we felt uncomfortable turning away families who didn’t see eye to eye with us when it came to shots for their kids.

Optimistically (and perhaps somewhat naively) we believed that by fostering long-term relationships with families, we could build trust and gradually enlighten vaccine-averse parents. Certainly, given time and adequate evidenced-based information, we posited, families would come to share our belief in the importance, safety, and efficacy of childhood immunizations which represent the core of our preventative medicine practices.

Although taking this somewhat permissive stance naturally appealed to our inclinations as nurturing, non-confrontational pediatricians, in retrospect, it did have negative consequences. We often found ourselves spending inordinate time and emotional energy in combating the potent messaging of the anti vaxxer movement. Discussing the inaccuracies of countless websites and popular media reports became exhausting.  After all, we queried parents, who knows more about immunizations — your child’s pediatrician or Oprah Winfrey and Jenny McCarthy? Though we were successful in changing the hearts and minds of some, the majority of strongly vaccine-averse parents seemed largely unmoved by our educational efforts to debunk myths such as the linkage of vaccines with autism.

The acceptance of vaccinating families who chose to modify or delay the evidence based vaccine schedule also presented some unique challenges. There was often confusion when parents deviated from their already altered schedules (“We’re not going to stick with Dr. Bob’s’ schedule anymore”) or when they failed to return in the expected time frame for catch-up vaccines. Our nurses and medical assistants were often left in the lurch.  Vaccine schedule modification also placed us as physicians in the awkward position of having to arbitrarily advise parents on which vaccines were most important at a given visit. How ought a self-respecting pediatrician respond to parental insistence that their child only get one shot at a well check when several are due?  “Doctor, should we go with the DtaP or Pneumococcal for Johnny today?”

When my partners and I discussed revising our vaccine policy, we framed our deliberations in terms of our practice’s broader responsibilities. The still fresh memory of vaccine preventable disease outbreaks in Ohio served as an impetus for us to embrace change. These epidemics reminded us of our duty to protect patients and families in our waiting room. On even larger scale, we recognized that our policy decisions could significantly influence the health of the broader community.

 Unanimously, the six of us concluded that the status quo of tacitly condoning refusal or alteration of the accepted vaccine schedule was no longer tenable. The time had come for us to send a strong and clear message that in our practice, vaccination is non-negotiable. In order to implement this change in policy, we have been very forthright in communicating with patients. Our reception staff has been instructed to inform the parents of all new patients that our office does not allow for declining or delaying vaccines. We have also made this a standard talking point in presentations delivered to prospective families at our monthly prenatal meetings. Additionally, we provide copies of our practice specific and corporate vaccine policy statements.

We made exceptions for existing patient families who had elected to modify the vaccine schedule prior to the implementation of this new policy. ‘Grandfathered’ in, these parents are asked to sign a waiver form declaring that they have chosen to go against the recommendations of their health care provider and that they understand and assume responsibility for the potential harm that might result from their decision.  

The response to our policy has been overwhelmingly positive based on the feedback we have received from parents — many of whom have stated they respect our stance and appreciate knowing their children’s exposure to vaccine preventable diseases has been limited. We did not experience a mass exodus of existing patients from our practice, and we do not feel that our policy shift hindered our ability to attract new patients. In fact, there has been no discernible down-side to our decision. We have not abrogated our ongoing responsibility to provide education about vaccines, but find that our experience in sharing information about immunizations is much more pleasurable than it was previously. We and our patients’ families now share common ground when it comes to immunizations; they are safe and effective tools to keep kids healthy — the goal of every parent and pediatrician.

The articles in this ongoing series will feature news and items of interest to pediatric primary care providers. If you would like to contribute, email William.Long@NationwideChildrens.org.

The opinions and policies expressed in MedStat are those of its contributors, and are not necessarily the opinions or policies of Nationwide Children’s Hospital. Nationwide Children's Hospital does not endorse or recommend any specific opinions, policies, tests, physicians, products, procedures, or other information that may be mentioned in MedStat. The content made available on MedStat, such as text, graphics, images, and other material contained on the website are for general educational and informational purposes only and do not constitute medical advice; the content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Reliance on any content provided by MedStat is solely at your own risk. 

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