Archive for May 9th, 2009

The role of doctors in vaccine acceptance

May 9, 2009

From an enlightening New England Journal of Medicine article:

Between 1991 and 2004, the mean state-level rate of nonmedical exemptions [for childhood vaccinations] increased from 0.98 to 1.48%. The increase in exemption rates was not uniform. Exemption rates for states that allowed only religious exemptions remained at approximately 1% between 1991 and 2004; however, in states that allowed exemptions for philosophical or personal beliefs, the mean exemption rate increased from 0.99 to 2.54%.

Why? From separate data:

As compared with parents of vaccinated children, significantly more parents of exempt children thought their children had a low susceptibility to the diseases (58% vs. 15%…), that the severity of the diseases was low (51% vs. 18%…), and that the efficacy and safety of the vaccines was low (54% vs. 17% for efficacy and 60% vs. 15% for safety…). … The most frequent reason for nonvaccination, stated by 69% of the parents, was concern that the vaccine might cause harm.

Parents want to trust their doctors:

In a study by Smith et al., parents who reported that their immunization decisions were influenced by their child’s health care provider were almost twice as likely to consider vaccines safe as parents who said their decisions were not influenced by the provider.

In focus-group discussions, several parents who were not certain about vaccinating their child were willing to discuss their immunization concerns with a health care provider and wanted the provider to offer information relevant to their specific concerns. 

Some doctors take a hard stand: 

In a national survey of members of the American Academy of Pediatrics, almost 40% of respondents said they would not provide care to a family that refused all vaccines, and 28% said they would not provide care to a family that refused some vaccines.

They shouldn’t:

The academy’s Committee on Bioethics advises against discontinuing care for families that decline vaccines and has recommended that pediatricians “share honestly what is and is not known about the risks and benefits of the vaccine in question.” The committee also recommends that clinicians address vaccine refusal by respectfully listening to parental concerns, explaining the risk of nonimmunization, and discussing the specific vaccines that are of most concern to parents. 

One policy tool:

[A] model law proposed for Arkansas suggested that parents seeking nonmedical exemptions be provided with counseling on the hazards of refusing vaccination.