Why we vaccinate
Some of you may have read Russell Saunders’s blog entitled “Vaccinate the kids—or get out of my office” in which he discusses why he chooses not to treat vaccine-refusing families. For Saunders, a pediatrician who is clearly frustrated and upset, it comes down to a matter of trust. He feels like if families distrust his belief in and use of vaccines, then how will they ever trust his opinion on anything else? He writes, “Any potential partnership we might create in caring for them together would rely on their belief that I have something other than a signature on an order form or prescription pad to offer…After all, for immunizations to be as malign as their detractors claim, my colleagues and I would have to be staggeringly incompetent, negligent or malicious to keep administering them.”
Dr. Saunders has a point. Vaccinations are one of the cornerstones of pediatric care. In fact, they are a standard of care by which we could be deemed negligent if we were not to offer them. The standard childhood immunization schedule is a big part of my daily life as a doctor. Vaccines and the diseases they prevent were an important part of my training in pediatrics. The science behind vaccinations is valid, and their data about disease prevention is clear. And yet I spend an increasingly large amount of time discussing them and debunking myths surrounding vaccines.
I’d be lying if I didn’t admit that discussing vaccine myths is tiresome. I’d much rather discuss child safety concerns, breastfeeding, nutrition, child development and a whole host of other much more interesting topics. But the reality of where I live and practice medicine requires me to make time for parents who are nervous about or refusing to vaccinate their children. Our office allows non-vaccinators and partial vaccinators but requires a vaccine discussion at each well visit as well as a vaccine refusal form for any vaccine recommended but not given. It’s time consuming for both families and the healthcare providers. We often discuss this policy of accepting non-vaccinating families and the discussions are passionate.
When I chatted with Dr. Paul Offit, Chief of Infectious Disease at the Children’s Hospital of Philadelphia and an outspoken advocate of vaccination according to the CDC schedule, I asked him about what pediatricians are doing wrong that their patients won’t trust their advice on vaccination. His answer was interesting. He feels like we lack the passion of our convictions. That we are so concerned about making sure our families feel they have our respect and attention that our message is lost. We have become so wary of being the paternalistic doctor of yesterday that we give the impression that vaccines are not as important as they once were.
If that is true, maybe we should have a firm policy regarding accepting patients who are not vaccinated. I’m not certain. One thing for sure, is that pediatricians spend more and more time considering the vaccines than ever before in the history of pediatric medicine. I’d love to hear what Bundoo families think of vaccination policies.