Family Matters

Should Pediatricians ‘Fire’ Patients Whose Parents Don’t Vaccinate?

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Recently, my 4-year-old got poked five times, and vaccines for measles, mumps and rubella, diptheria, tetanus and pertussis — among other nasties — coursed into her loudly protesting body. Within hours, she’d spiked a fever, one of the potential side effects of some immunizations, and complained about sore thighs where the injections were delivered. Once she calmed down, she was curious about the source of her misery: “Why I got to get shots to make me healthy?”

Figuring that explanations about herd immunity were above her level of understanding, I stammered something about special magic in the injections helping her fight off disease.

I assume her friends are similarly immunized, yet that’s likely not the case for all of them. We live in Washington State, which has the highest vaccine-exemption rate in the country. More than 6% of incoming kindergarteners are not vaccinated here, compared with the less than 1% of U.S. children between the ages of 19 to 35 months who are unvaccinated, according to recent statistics from the Centers for Disease Control and Prevention (CDC).

Now, pediatricians across the country — and particularly in vaccine-averse pockets such as northern Idaho, Boulder, Colo., Washington State and Marin County, Calif. — are stuck figuring out how to respond to patients whose parents obtain immunization exemptions on medical, philosophical or religious grounds. Although the American Academy of Pediatrics (AAP) recommends doctors continue to treat — and educate — anti-vaccine families, some pediatricians are electing to “fire” patients who swear off vaccines.

“In my personal experience (and I have only fired a couple of patients in my entire career), the decision not to vaccinate is one of several differences in opinion, and I am not able to adequately provide care for a patient when their parent clearly does not respect my medical advice,” says Dr. Ari Brown, a pediatrician in Austin, Texas, and an AAP speaker who lectures regularly to other physicians about vaccination, in an email.

MORE: Chicken Pox Death Rate Drops Dramatically, Thanks to Vaccine

In July, the Chicago Tribune chronicled the phenomenon of doctors severing ties with unvaccinated children, describing a letter that one eight-physician practice sent to its more than 5,000 patients, announcing they would no longer see children whose parents didn’t follow the CDC-advised childhood immunization schedule. Fewer than a dozen families elected to leave the practice.

The Tribune reported:

“All of the available research shows that the safest and most effective way to vaccinate children is on the schedule set by the CDC and AAP,” said Dr. Scott Goldstein, one of the pediatricians. “To go against that schedule goes against proven scientific research and puts patients who do follow the schedule at risk.”

Health officials aim for an immunization rate of no lower than 90 percent in order to prevent epidemics, and say clusters of unvaccinated people weaken the “herd immunity” made possible through vaccines. That raises the risk of disease outbreaks.

Those who cannot be vaccinated, such as infants too young to get all their shots and children with underlying medical problems, rely on herd immunity, as do children who have gotten their shots but don’t develop immunity.

Brown says there are “hot pockets” in certain communities where parents choose not to immunize. “Birds of a feather flock together — and those kids attend the same preschool or charter schools — which leaves them at very high risk for vaccine preventable disease epidemics,” says Brown.

Experts maintain that it’s far riskier to forgo vaccination than to chance a rare reaction. “Parents overestimate the risk to their child and underestimate the benefit,” says Dr. Kate O’Brien, a pediatric vaccinologist at Johns Hopkins University’s Bloomberg School of Public Health and deputy director of the International Vaccine Access Center, which works to provide evidence of the benefit of vaccines. “The really important thing for parents to understand is that the illnesses for which we vaccinate are still present.”

Take measles, for example. Recent outbreaks have resulted from lapses in vaccination; in order to confer protection to the general population, an exceptionally high proportion of the population must be immunized against measles, mumps and rubella (MMR). Yet some parents have been leery of the vaccine, particularly because of widespread suspicions that it causes autism. But there has been no scientific evidence to substantiate that claim; earlier this year, a controversial 1998 paper that was largely responsible for perpetuating the link between the MMR vaccine and autism was declared to be “an elaborate fraud.” Months earlier, the paper’s author, Andrew Wakefield, lost his medical license.

MORE: U.S. Measles Caseload Hits a 15-Year High

Brown has a name for those who question pediatricians about the safety of immunizations: she calls them “vaccine-concerned” or “vaccine-cautious” parents. They ask lots of questions before deciding to vaccinate their kids, and Brown advises pediatricians to take the time to answer thoughtfully. “For vaccine-cautious parents (and that is the bulk of parents who don’t readily accept vaccines right off the bat), the level of empathy and reassurance is what tips the balance for a parent to choose to vaccinate,” says Brown. “If a pediatric practice closes the door on these families, it’s possible that their anger or frustration will lead them to not vaccinate at all.”

But unlike media reports of rising sentiment against vaccination, Brown believes that the tide is actually turning. Ultimately, she says, she and her colleagues are witnessing more and more parents decide to immunize their kids.

For your kids — and mine — that’s a good thing.

Bonnie Rochman is a reporter at TIME. Find her on Twitter at @brochman. You can also continue the discussion on TIME‘s Facebook page and on Twitter at @TIME.

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