Pediatricians push back on parents resisting vaccinating their children

U.S. pediatricians are pushing back against parents who resist having their children vaccinated against a broad range of dangerous diseases by calling on states to stop offering waivers to those with nonmedical objections to the practice.

In a policy statement issued Monday, the American Academy of Pediatrics also said that if parents continue to refuse vaccinations despite exhaustive efforts to change their minds, it would be acceptable for doctors to exclude these families from their practices.

The pronouncements are intended to guide U.S. pediatricians as they grapple with a rising tide of vaccine "hesitancy" on the part of parents. Among doctors who are members of the nation's largest organization of pediatricians, 87 percent have been challenged in the last year by parents who refused to have their children immunized, up from 75 percent in 2006.

Many pediatricians have reached the end of their patience with parents who are unconvinced of vaccines' lifesaving benefits. In 2013, 12 percent of pediatricians routinely asked parents to find another physician if they weren't willing to vaccinate their children. In 2006, only 6 percent routinely showed such parents the door, according to surveys by the academy.

That step should be a last resort, the group said.

In a lengthy report also released Monday by the academy, 23 specialists in pediatrics and infectious diseases said doctors should begin discussing the benefits of vaccines as early as the first prenatal visit. In doing so, they should be prepared to explain the scientific evidence supporting vaccines' use.

The panel also urged pediatricians to "personalize" the message that vaccines are safe, effective, and powerful by sharing their own decisions to vaccinate their children or grandchildren. This particular advice was prompted by studies showing that skeptical parents tend to value the safety and comfort of their own children over arguments emphasizing the role of vaccines in benefiting the public at large.

Even as it gave physicians its blessing to dismiss vaccine refusers from their practices, the pediatricians' group acknowledged a widely held view among rank-and-file members: that for a profession dedicated to the well-being of children and their families, the decision to show patients the door is often difficult.

"It was gut-wrenching," said Alison Ziari, chief of pediatrics at the Austin Regional Clinic, a multi-specialty practice with 70 pediatricians in Texas that adopted a vaccinate-or-leave policy in July 2015. "These are our families. We love them, and we want to care for them."

The survey results released Monday show that parents' concerns about vaccines have shifted. In 2006, pediatricians reckoned that nearly three-fourths of parents reluctant to vaccinate their children were motivated by fear that some vaccines could cause autism or have other adverse effects on a child's safety.

By 2013, safety concerns and the discredited link between vaccines and autism appeared to be less prominent causes of parental resistance. Instead, physicians attributed a growing number of parental objections to the view that vaccines are an unnecessary discomfort for their young children.

Pediatrician Paul Offit, who directs the vaccine education center at the Children's Hospital of Philadelphia, called the academy's new position an "about-face." The driving force behind it, he believes, was last year's large, multistate measles outbreak that started with a single unvaccinated child with measles at Disneyland in California.

"The AAP has historically advised doctors to continue to treat patients who decline vaccination. The AAP has historically supported these nonmedical exemptions," Offit said. "I'm pleasantly surprised. Basically, what they're saying is they support physicians who tell parents, 'I can't see you because you've made a decision that I think hurts your child.' "

Pennsylvania allows parents to let their children skip vaccination for medical, religious or philosophical reasons. New Jersey allows only medical and religious exemptions, but school officials cannot investigate the exact nature of the religious exemption, which critics consider a loophole.

Still, both New Jersey and Pennsylvania generally rank above the national average in school vaccination rates.

Staff writer Marie McCullough contributed to this article.