Give Kids a Shot: Take a Stand for Vaccines

Children in the United States are fortunate to have access to disease-preventing, life-saving vaccines. Vaccines have long been shown to reduce deaths and illnesses among children, yet vaccine hesitancy and refusal remains present in a small but seemingly increasing number of families.

As pediatric health care providers, we seek to balance parental autonomy with our desire to provide optimal care for children. Even parents who refuse vaccines truly want to do what is best for their children, but either they have received the wrong information about vaccines, or they do not understand or trust the information they have received. Many parents get vaccine information from Web sites and Internet discussion forums, Hollywood celebrities, and the mass media rather than from their health care providers and reputable sources on the Web. For the health of children, we must change that.

Parents’ Concerns

Parents who choose to refuse or delay immunizations for their children commonly have one or more of the following concerns:

• They believe that the vaccines will “overwhelm” their child’s immune system. They feel that it is too early in the child’s life to vaccinate, or that their child is receiving too many vaccines at one time.

• They want their child to be “all natural.” They believe that vaccine ingredients such as preservatives might cause developmental problems in children.

• They believe that the benefits of vaccinations are not sufficient to justify the perceived safety risk associated with them.

• They do not think that vaccines are necessary for their child, because the diseases that the vaccines immunize against are rare. And, the fact that others have been vaccinated will protect their child through herd immunity.

Make a Strong Recommendation

Of course, to knowledgeable medical professionals, it is clear that the benefits of vaccinating children far outweigh the potential risks. But we health care providers must do a much better job in our discussions of this subject with parents. Even when we are busy and 45 minutes behind schedule, we must take the time needed to have the necessary discussions. We must better convey the benefits of vaccines and the risks associated with not vaccinating.

Vaccine-hesitant parents often are misinformed or uninformed about vaccines, but they often are well-read and open-minded. We need to be able to respond quickly, accurately, and convincingly to parental concerns about pediatric immunizations. Using the available resources and personal anecdotes, we must make a strong recommendation to vaccinate the children of these hesitant parents.

An Ethical Dilemma

Some parents are hesitant but will vaccinate, whereas others refuse altogether. If, after hearing all of the facts about immunization, the parents still refuse to vaccinate their child, we must take a stand. Many parents feel that by not taking action, they are taking a safer pathway. However, their decision not to vaccinate their child is an active decision to increase their child’s risk for contracting preventable communicable diseases. Their decision not to vaccinate is a decision to go against our professional medical advice, and that is a deal breaker for me. If parents don’t trust our advice about vaccines, will they trust us to care for their child with a fever or a chronic illness?

Whether or not to continue providing medical care for an unvaccinated child is a controversial issue, and one with good arguments on both sides. The American Academy of Pediatrics (AAP) recommends against dismissing unvaccinated children. However, accommodating parents of patients who are not vaccinated seems to imply that we accept their beliefs that vaccines are unnecessary, unimportant, or even dangerous. That’s a message that no health care provider wants to send. Dismissing patients whose parents refuse vaccinations goes against current AAP recommendations, but it often is a necessary step to take.

I encourage you and every health care provider who cares for and about children to speak with passion about the importance of vaccines, and to consider adopting policies mandating that children be vaccinated in your practice. If parents see how passionate we are about vaccinations, then perhaps, just perhaps, they will allow us to protect their child in the best way we know how.

Christopher M. Barry, PA-C, MMSc, is a pediatric physician assistant at Jeffers, Mann, and Artman Pediatric and Adolescent Medicine in Raleigh, North Carolina, and is the medical liaison from the American Academy of Physician Assistants (AAPA) to the AAP. The opinions expressed here are the private views of the author and are not to be construed as reflecting the views of his employer, the AAPA, or the AAP.