WASHINGTON — Refuting inaccurate information about vaccines and providing additional education are key to addressing parental concerns about childhood immunizations, according to Dr. Gary S. Marshall.
Many parents have concerns about the safety and necessity of childhood immunizations or simply refuse to vaccinate their child. It comes down to what the parents believe. “We have to fight the belief with the science,” he said at the annual meeting of the American Academy of Pediatrics.
Dr. Marshall recommended beginning the discussion before the baby is born, if possible. He also recommended having materials and resources that parents can take home. Be persistent and keep repeating your message. “Ultimately, though, you will have to make the decision about how long you're going to fight the fight.”
“It is legal and ethical to discontinue with that family. Whether it does any good is the question,” he pointed out. The American Medical Association Code of Ethics (E-8.115 and E-10.05) notes that while physicians are obligated to support continuity of care, it is ethically permissible for physicians to decline a potential patient when “the treatment request is known to be scientifically invalid.” Likewise, the AAP's All Star Pediatrics' Vaccine Policy Statement provides language for asking parents who refuse to vaccinate their children to find another physician for their child (www.aap.org/securemoc/immunizations/allstarpediatrics.doc
During his talk, Dr. Marshall offered several vaccine truths to keep in mind when dealing with concerned parents.
Vaccines Save Lives
“We've made tremendous progress in controlling disease,” said Dr. Marshall, who is chief of the pediatric infectious diseases division at the University of Louisville (Ky.). For example, the childhood immunization schedule saves more quality-adjusted life years than any other public health intervention. In addition, for every dollar spent, vaccine programs saved $5 in direct medical costs and an additional $11 in societal costs, based on estimates for the 2001 birth cohort (Arch. Pediatr. Adolesc. Med. 2005;159:1136-44).
Vaccine Refusal Can Cause Harm
“Being afraid of vaccines is not a benign thing. It does result directly in public harm,” warned Dr. Marshall. For example, a 1974 case series of children allegedly injured by the pertussis vaccine resulted in a precipitous drop in vaccinations in the United Kingdom. “What do you think happened after that? There were outbreaks of pertussis and about 600 infants who coughed themselves to death unnecessarily.”
Many states allow personal belief exemptions from vaccines. “If you live in a state that allows for personal belief exemptions, then you are at higher risk to get pertussis—even if you're immunized,” said Dr. Marshall. Interestingly, it's possible to correlate the risk with how easy it is to get the exemption (JAMA 2006;296:1757-63).
In recent years, parents have been concerned about purported links between the measles-mumps-rubella (MMR) vaccine and autism, but the evidence is overwhelmingly against such a link. Although autism rates have been steadily rising in the United States, the United Kingdom, and Canada, MMR vaccination rates have held steady over the same period, findings that call into question an autism-vaccine link. In addition, retrospective epidemiologic studies, such as the Danish Cohort study (N. Engl. J. Med. 2002;347;1477-82), have found no increased risk of autism with vaccine exposure. The rise in autism cases may be explained in part by both better detection and a broadened definition of autism spectrum disorders.
Back in 1994, measles had been eliminated in the United Kingdom. However, because of concerns about a possible autism link to the MMR vaccine, some parents chose not to have their children vaccinated. The result is that measles are now endemic again in the United Kingdom. “We now have had a resurgence of measles in the United States. This is directly related to people who have intentionally not been vaccinated,” said Dr. Marshall.
Fear of Adverse Events Is Pervasive
Dangerous infectious diseases have been effectively controlled through vaccination programs, and as a result, these diseases are no longer in the public mind. There has been a shift from fear of diseases to fear of adverse events from vaccines, said Dr. Marshall.
“Fear of vaccines is not new … but what people didn't have back then, that we have now, is the Internet.” A Google search using the word “vaccine” turns up hundreds of hits, many of which are for organizations dedicated to convincing parents that vaccines are dangerous.
Celebrities like actress Jenny McCarthy—herself the mother of an autistic son, though she claims to have cured him—and actor/comedian Jim Carrey keep fears of vaccine safety in parents' minds. They also promote misinformation about vaccines, claiming for instance that mercury (thimerosal) is still a vaccine component and that antifungal medicines can cure autism.