The number of American parents who delay or refuse routine vaccinations for their children is becoming a growing concern to public health officials who say about 85,000 cases of vaccine‐preventable diseases occur each year.
According to researcher Thomas Tryon, MD, associate professor of pediatrics at the University of Missouri-Kansas City School of Medicine, pediatricians are responding quite differently to the trend. Tryon and colleagues surveyed 700 American Academy of Pediatrics (AAP) members that practice in nine Midwestern states including, Iowa, Minnesota, Wisconsin, North Dakota, South Dakota, Illinois, Kansas and Missouri.
The survey revealed that the three most commonly delayed or refused vaccines are measles, mumps, and rubella (MMR), human papillomavirus (HPV) and influenza. Physicians shared that parents cited fear of autism, too many shots given at one time, and serious side effects as the most common reasons for delaying or refusing a vaccine.
Chris Harrison, MD, director of the Infectious Disease Research Laboratory at Children’s Mercy Hospitals and Clinics in Kansas City, said some parents carry “misconceptions” about vaccine safety. He said many of today’s parents have not lived through a serious outbreak of a preventable disease. When one does, he says, “it affects your outlook.”
“Vaccine avoidance is a problem in all states that were surveyed,” Tryon said. Depending on their location, pediatricians reported that anywhere from 1 percent to greater than 50 percent of parents were delaying or denying the recommended vaccine schedule. From 0 percent to 40 percent of parents refused at least some vaccines. Overall, 21 percent of practitioners reported discharging families from their practice for continued refusal of all vaccines. In Minnesota, less than 1 percent of pediatricians dismissed their non-complaint patients, while Iowa reported the highest discharge rate of 38 percent.
Responding to Vaccine Skepticism
About 95 percent of pediatricians surveyed said they engaged reluctant parents in discussion; 66 percent referred families to health information websites; and 63 percent shared evidence‐based literature with the parents. Just 1 percent of those surveyed said they didn’t offer some intervention with hesitant or refusing families.
Among states overall, less than 5 percent of pediatricians encountered vaccine refusal and less than 20 percent encountered parents who wanted to delay vaccinations. However, some physicians encountered much higher rates of vaccine delay or denial.
Follow-up discussions with those who have or would consider dismissing families from their care suggest that pediatricians are reluctant to expose other compliant patients to non-vaccinated individuals and an unwillingness to care for patients that don’t follow professional advice.
The researchers said the pilot survey will be used in the design of a more comprehensive and definitive survey and could aid in the design of educational or intervention strategies for practitioners.
Bruce Gellin, MD, MPH, director of the National Vaccine Program Office in Washington, DC, said the nation’s latest vaccine plan places a greater emphasis on aiding both patients and physicians with informed decision-making regarding vaccines.
One area that the vaccine policy group will need to address is the diminishing trust in vaccine manufacturers and government public health organizations. Failure to address the concerns with more transparent monitoring and reporting of adverse events, and failure to engage with anti-vaccine groups in two-way communication as opposed to public bashing which some parents see as a dismissal of their concerns, could lead to a steady lowering of vaccination rates and a continued increase in preventable diseases that had once been under control.
Tryon presented the research, “Parental Vaccine Hesitancy and Refusal: Perceptions of Midwestern Members of the American Academy of Pediatric” at the Infectious Disease Society of America’s (IDSA) 2011 annual meeting.
