Pediatricians feel the pressure from parents to delay vaccines

An increasing amount of parents are choosing to delay or spread out vaccines for their infants and toddlers. Dr. Allison Kempe and her colleagues at the University of Colorado School of Medicine found that in a typical month, 93 percent of pediatricians and family physicians reported that some parents of children less than 2 years of age requested to spread out their vaccines. The findings, published in the April 2015 edition of Pediatrics, revealed that almost a quarter of pediatricians surveyed said that one out of 10 parents make this request. Unfortunately, this news rides on the heels of a large, multi-state outbreak of measles linked to a California amusement park.

Pediatricians are walking a thin line when it comes to making sure their patients are vaccinated. More are beginning to turn away families who do not vaccinate (or delay or spread out vaccines), even though the American Academy of Pediatrics (AAP) suggests that pediatricians should not do so. In 2012, the AAP reaffirmed its Clinical Report, saying, “In general, pediatricians should endeavor not to discharge patients from their practices solely because a parent refuses to immunize a child.” However, it goes on to say that “…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.”

So what’s the real problem here? Many perceive that alternative schedules, where vaccines are often spread out over a longer period of time and are given in fewer simultaneous (not combination) injections, are safer than the routine schedule recommended by the Centers for Disease Control and Prevention (CDC) and the AAP.

So why should parents vaccinate their children according to the routine schedule?

  • A report from the Institute of Medicine (IOM) concluded vaccines are safe. Multiple studies have proven vaccines have no link to autism.
  • Vaccines are scheduled early in life to protect infants when they are most vulnerable. They are given when the body’s immune system will respond best. Using a series of doses (booster) improves the percentage of patients who develop immunity and the duration of such immunity.
  • There is no scientific evidence to show that a person can have an overload to the immune system from vaccines. The amount of antigen in the recommended vaccine schedule is far less than that seen by the body’s immune system in just a day of playing, eating, and breathing.
  • Alternative vaccine schedules have never been tested and their effectiveness and safety are unknown. The only known in delaying vaccines is that protection is also delayed. The recommended schedule has been studied and examined repeatedly by experts.

Although almost all of the pediatricians and family doctors surveyed by Kempe believed it was important to give all recommended vaccines in the primary series at the recommended times and supposed there was harm in spreading out vaccines, the majority still usually agreed to do so. Why? Eighty-two percent said they were trying to build greater parental trust. Could it be most pediatricians are also subscribing to the “for my patients, some vaccines are better than no vaccines” dogma? Perhaps. Eighty percent of respondents also believed if they didn’t agree to spread out the vaccinations, families might leave their practice.

A 2011 internet survey of parents of young children revealed that more than 1 in 10 currently use an alternative vaccine schedule. Yet, in the same survey, among those parents who did choose to follow the recommended vaccine schedule, 28 percent thought that delaying vaccine doses was actually safer than the schedule they used, and 22 percent disagreed that the best vaccination schedule to follow was the one recommended by vaccination experts. So, statistically for pediatricians, a large portion of their patient panels presumably either disagree with the notion of a routine vaccine schedule or are inclined to be skeptical of it. It’s no wonder pediatricians are having a rough time keeping their practices on board with their vaccine message!

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About Dr. Justin Morgan, Bundoo Pediatrician

Justin Morgan, MD, FAAP, is a board-certified pediatrician who practices general pediatrics in Louisville, Kentucky. He cares for children of all ages.

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