Published onChildren's Doctor
Barbara Rolnick, MD, is a primary care pediatrician in the CHOP Care Network Roxborough practice.
It was my first time meeting this family with a 2-week-old baby girl whose parents had refused the hepatitis B vaccine in the hospital. After answering questions about newborn feeding, behavior, hiccups, burping, sneezing, and breathing, I recommended the hepatitis B vaccine. The father crossed his arms and announced, “If you go anywhere near my baby with an immunization, I will sue you!”
I was stunned, verbally tasered. I took a deep breath and tried to do as the American Academy of Pediatrics suggests: “First and most important, the pediatrician should listen carefully and respectfully to the parent’s concerns, recognizing that some parents may not use the same decision criteria as the physician and may weigh evidence very differently than the physician does.”
Earlier that morning, I had a completely different conversation. A mother asked if our practice accepted patients that refuse immunizations. She wanted to know: How do we safeguard her children from those patients who could be harboring infectious diseases like the measles? I reluctantly admitted that we did have patients who were unimmunized or under-immunized despite our best efforts. Up front, we tell vaccine-refusing patients, “Our practice is not a good fit. We are strongly pro-immunization.” But still they come and we are expected to change their hearts and minds.
I also explained to this concerned parent that our state has one of the weakest immunization laws and that she frequently unwittingly encounters unimmunized children at the playground and in the supermarket. But I share this mother’s discomfort. The unimmunized children in our waiting room could be vectors of disease to other patients who are unable to receive vaccines due to immune compromise. Yet the AAP instructs us to continue to care for these vaccine-refusing patients despite these risks.
Some of our parents understand immunizations are required and protective, but they object to so many, so soon. While agreeing to vaccinate, these parents want to take control of the timing and schedule.
Other parents have a deep fear and distrust of immunizations. This is a belief system. Like religion or politics, this is nearly impossible to change, especially in a 15-minute visit. These parents strongly believe they are protecting their children from danger—and possibly autism—by refusing immunizations.
When I explain that the risk of the immunization is far less than the risk and danger of the disease itself, these parents are not convinced. Most families have never seen polio, tetanus, or diphtheria, but everyone knows the epidemic of autism. Our patients know friends, family, and neighbors who are struggling to parent children with autism, and they want an explanation. The reality—a complex mix of genetic, epigenetic, and environmental influences—is not as easy to swallow as suspecting the immunizations.
Despite scores of studies and Dr. Paul Offit’s eloquent books, this belief system is not based on logic and facts, but on fear. Unfortunately, logic is not the cure for fear. Fear needs to be brought to light, addressed, and understood if it is to be overcome.
Before speaking to the father of the newborn, I collected my thoughts. The vaccine refusal decision is based on love and fear. Both of these powerful emotions must be addressed.
I said to the father, “I know you love your baby and are trying to protect her. I understand that you are afraid of the immunizations. But I am afraid of diseases that are here in community, and I do not want your little girl to get these diseases and suffer.”
Does this work? Sometimes. Other times, I take a deep breath and remember the words of Gandhi: “Glory lies in the attempt to reach one’s goal and not in reaching it.”
Visit CHOP's Vaccine Education Center for vaccine information and resources.