What actually happens when a pediatrician has a vaccine policy that requires parents to vaccinate their kids or face dismissal from the practice?
Not surprisingly, there are a lot of myths about the controversial issue of pediatricians dismissing families who don’t vaccinate their kids.
1 ) It is a myth that the American Academy of Pediatrics has a policy encouraging pediatricians to dismiss families who don’t vaccinate their kids.
There is no such policy.
Instead, in 2016, about 400 leaders from AAP chapters, committees, councils, and sections voted on a resolution at the 2016 AAP Annual Leadership Forum (ALF) to support pediatricians who dismissed families who didn’t vaccinate their kids.
RESOLVED, that the Academy support, in their policy statements and clinical guidelines about immunizations, pediatricians who decide to discharge patients after a reasonable, finite amount of time working with parents who refuse to immunize their children according to the recommended schedule or who fail to abide by an agreed-upon, recommended catch-up schedule, and be it further RESOLVED, that the Academy continue to support pediatricians who continue to provide health care to children of parents who refuse to immunize their children.
Resolution #80.81SB Supporting Pediatricians Who Discharge Families Who Refuse to Immunize
The resolution also voiced support for pediatricians who didn’t dismiss these patients.
2) It is a myth that pediatricians dismissing families who don’t vaccinate their kids is a new thing.
Although it is getting a lot more attention now, since that 2016 resolution and a report on Countering Vaccine Hesitancy that soon followed, dismissing or firing families who don’t vaccinate their kids is not new.
A 2005 AAP report, Responding to Parental Refusals of Immunization of Children, discusses the issue.
“In general, pediatricians should avoid discharging patients from their practices solely because a parent refuses to immunize his or her child. However, when a substantial level of distrust develops, significant differences in the philosophy of care emerge, or poor quality of communication persists, the pediatrician may encourage the family to find another physician or practice.”
Responding to Parental Refusals of Immunization of Children
And a study, Dismissing the Family Who Refuses Vaccines, also published in 2005, made it clear that many pediatricians “would discontinue care for families refusing some or all vaccines.”
3) It is a myth that dismissing families who don’t vaccinate their kids is an evidence based policy.
There is nothing beyond anecdotal evidence that families, when faced with the decision of getting vaccinated or getting dismissed from an office, will choose to get vaccinated.
Again, the latest resolution supporting the idea of dismissing families came because it was voted on and became an official Annual Leadership Forum resolution. In general, only the top 10 ALF resolutions are acted upon urgently by the AAP.
At the time, many pediatricians felt constrained by the previous statements from the AAP that discouraged dismissing these families.
4) It is a myth that pediatricians dismiss families who don’t vaccinate their kids because they don’t want to be bothered talking about vaccine safety.
Although few pediatricians would want to talk to a parent who is arguing that vaccines are poison, aren’t necessary, and never work, fortunately, most vaccine-hesitant parents don’t actually talk like that. They are usually on the fence or simply scared because of all of the anti-vaccine propaganda they are exposed to and need a little extra time to understand that vaccines are safe and necessary.
And most pediatricians give them that extra time and do talk to them about their concerns. Despite the perception from some of the headlines you might see, families typically don’t get fired after one visit because they refused one or more vaccines.
5) Pediatricians who don’t dismiss unvaccinated families are supporting the use of alternative vaccine schedules.
While this is certainly true for some providers who actually advertise that they are “vaccine-friendly” and encourage parents to follow a non-standard, parent-selected, delayed protection vaccine schedule, most others understand that there is no evidence to support these alternative schedules and they are simply tolerated until the child can get caught-up with all of his vaccines.
6) It is illegal to dismiss a family who doesn’t want to vaccinate their kids.
While some pediatricians think that it is a bit of an ethical dilemma, the legal issues are very clear.
Physicians can’t simply abandon a patient so that they go without care, but they are typically free to end the physician-patient relationship after giving them formal, written notification, and continuing to provide care (at least in emergency situations) for a reasonable amount of time, giving the family time to find a new physician.
Of course, state and federal civil rights laws protect families from being terminated because of sex, color, creed, race, religion, disability, ethnic origin, national origin, or sexual orientation.
7) It is a myth that dismissing families who don’t vaccinate their kids will protect those families who do vaccinate and protect their kids.
This is often the main reason that pediatricians use to justify dismissing families who don’t vaccinate their kids. After all, it isn’t fair to the families who come to your office, those who do get vaccinated and protected, if someone who is intentionally not vaccinated gets measles and exposes them all, right?
There seem to be several problems with this idea though:
- relatively few exposures during outbreaks actually occur in a pediatrician’s office. Looking at most recent measles outbreaks, for example, exposures were more likely to occur while traveling out of the country, in an urgent care center, emergency room, somewhere in the community, or in their own home.
- infants who get pertussis are usually exposed by a family member
- while measles is very contagious and the virus can linger in an exam room for hours, other vaccine-preventable diseases are far less contagious. Mumps, for example, typically requires prolonged, close contact, which is why you are unlikely to get mumps at your pediatrician’s office.
- when dismissed by their pediatrician, there is a concern that families might cluster together in the offices of a vaccine-friendly doctor or holistic pediatrician, making it more likely for outbreaks to erupt in their community if any of them get sick
And that’s the key point. Just because families get dismissed from a pediatrician’s office, it doesn’t mean that they leave the community. Your patients might still see them at daycare, school, at the grocery store, or walking down their street.
Pediatricians who don’t dismiss families who don’t vaccinate their kids often feel that it is better to keep working to help them understand that vaccines are safe and necessary, so that they eventually do get vaccinated and protected.
What about the extra risk in their own offices?
With RSV, strep, cold viruses, and everything else that kids have in the average pediatrician’s office, it is best to take steps to reduce the chances that kids are exposed to all of them. How do you do that? Don’t have a waiting room full of kids that are exposing each other to germs!
8) Most families don’t vaccinate their kids because they don’t trust their pediatrician.
While this is likely true for some, those families who want to see a pediatrician and don’t refuse any other treatments, like their newborn’s vitamin K shot and eye ointment, likely do trust their pediatrician.
Then why don’t they vaccinate and protect their kids?
“In today’s world, smallpox has been eradicated due to a successful vaccination program and vaccines have effectively controlled many other significant causes of morbidity and mortality. Consequently, fear has shifted from many vaccine-preventable diseases to fear of the vaccines.”
Marian Siddiqui et al on the Epidemiology of vaccine hesitancy in the United States
They are likely afraid.
What are they afraid of?
More and more these day, if you ask them, they will likely tell you that they don’t know. It would be much easier if they were afraid of something specific, like the myth that a baby’s immune system is too immature to handle any vaccines, that there are hidden ingredients in vaccines, or that vaccines are somehow associated with autism.
You can answer specific questions about vaccines, but it is harder when they are afraid because they see anecdotal vaccine scare videos or because friends and family members are feeding them misinformation.
“With all the challenges acknowledged, the single most important factor in getting parents to accept vaccines remains the one-on-one contact with an informed, caring, and concerned pediatrician.”
“…nearly half of parents who were initially vaccine hesitant ultimately accepted vaccines after practitioners provided a rationale for vaccine administration.”
“Developing a trusting relationship with parents is key to influencing parental decision-making around vaccines.”
“Pediatricians should keep in mind that many, if not most, vaccine-hesitant parents are not opposed to vaccinating their children; rather, they are seeking guidance about the issues involved, beginning with the complexity of the schedule and the number of vaccines proposed.”
“Because most parents agree to vaccinate their children, this dialogue, which can be started as early as the prenatal interview visit if possible, should be an ongoing process.”
AAP on Countering Vaccine Hesitancy
It is also clear that we need new ways to talk about vaccines.
And we definitely new more ways to help everyone learn to think critically, be more skeptical about the things they see and read, and overcome their biases.
What to Know About Pediatricians Who Discharge Families Who Refuse to Immunize Their Kids
Whether they have a vaccine policy that dismisses families who don’t vaccinate their kids or they continue seeing them, pediatricians want to do what is best for their kids.
More on Pediatricians Who Discharge Families Who Refuse to Immunize Their Kids
- Is Firing Vaccine-Hesitant Families Unfair? Definitely…I think.
- The Prism Podcast
- AAP – Responding to Parental Refusals of Immunization of Children
- AAP – Countering Vaccine Hesitancy
- AAP – Should Pediatric Practices Have Policies to Not Care for Children With Vaccine-Hesitant Parents?
- AAP – Letter from the President: Vaccines on minds of Annual Leadership Forum attendees
- Study – Vaccine Delays, Refusals, and Patient Dismissals: A Survey of Pediatricians
- Should Doctors “Fire” Vaccine Refusers? A Physician’s Point of View
- A letter to physicians refusing to see vaccine-hesitant families
- Dismissal of Child-Patients for Nonvaccination Should Not Be Policy
- AAP Policy on Vaccine Hesitancy Glosses Over Real World Solutions
- Considering Whether the Dismissal of Vaccine-Refusing Families Is Fair to Other Clinicians
- Should Pediatricians Refuse to Treat Patients Who Don’t Vaccinate?
- Should doctors fire families who refuse to vaccinate?
- Child vaccines: When parents refuse them and are dismissed by pediatricians
- Study – Dismissing the Family Who Refuses Vaccines
- Does immunization refusal warrant discontinuing a physician-patient relationship?
- Working with vaccine-hesitant parents
- Provider dismissal policies and clustering of vaccine-hesitant families
- When is it permissible to dismiss a family who refuses vaccines? Legal, ethical and public health perspectives
- Sample Vaccine Policy Statement
- AAP – Reducing Vaccine Liability: Strategies for Pediatricians
- AAP – Documenting Parental Refusal to Have Their Children Vaccinated
- Dr. Paul Offit: “A Choice Not To Get a Vaccine Is Not a Risk-Free Choice”
- I used to be a vaccine skeptic. Now I’m a believer.
- Why I wish my daughter had been vaccinated
- ‘Manipulation’ of vaccination fears
- The end of vaccine anxiety
- Study – Epidemiology of vaccine hesitancy in the United
- I Used To Be Anti-Vaccine
- I was Duped by the Anti-Vaccine Movement
- Learning the Hard Way: My Journey from #AntiVaxx to Science
- I Didn’t Vaccinate My Child—And I Regret It
- Termination of the Patient-Physician Relationship