Pediatricians report upswing in vaccine refusal, dismissing patients

A survey of pediatricians from Connecticut reveals that more parents are refusing vaccines for their children, and pediatricians are increasingly dismissing families from their practices for vaccine refusal.

The survey was sent in November and December 2007 to be returned by February 2008; 133 of 600 randomly selected pediatricians in Connecticut responded. More than 60% had at least 1 family refuse all vaccines for safety concerns during the previous year; 62% indicated an increase in parental concerns and refusals over the previous 5 years. More physicians practicing in suburban or rural areas reported an increase in parental vaccine concerns and refusals than those practicing in urban areas.

More than 30% of the respondents indicated that they had asked families to leave their practices because of their refusal to immunize.

The researchers note that the American Academy of Pediatrics, the American Medical Association, and the Centers for Disease Control and Prevention (CDC) advise against discharging families from practices for the sole reason of refusal to vaccinate. Tools are available for download from the CDC Web site to support communication with parents on topics such as vaccine safety.

Writing in the journal Primary Care, Jason L. Schwartz, MBE, and Arthur L. Caplan, PhD, both from the University of Pennsylvania in Philadelphia, indicate that outright refusal of vaccines is still rare. They discuss the larger group of vaccine-hesitant people who may have questions about certain vaccines or the theories they hear from friends and family and read in the media.

To overcome potential hesitancy, Schwartz and Caplan suggest that providers strive to be familiar with the best available information regarding vaccine safety, as well as those theories and allegations receiving significant attention among the public. “Familiarity with this information will best equip the physician to answer questions, clarify concerns, and allay uncertainty regarding the risks and benefits of vaccines,” they write.

They also note that in 1 survey, information obtained from health care providers was the most common reason that parents who initially refused or delayed vaccines changed their minds and eventually accepted vaccination.

Finally, they question the wisdom of terminating families from their practice for vaccine refusal. “Excluding patients who question or oppose vaccines may appear to be an attractive method to demonstrate the importance of vaccination, but it leaves vulnerable infants and children without advocacy, and only adds to the climate of antagonism that often poisons contemporary discussions of vaccination in the United States,” they conclude.

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