The XX Factor

Pediatricians Are Increasingly Dismissing Anti-Vaxxer Patients

A doctor delivers a flu vaccination to an infant’s leg at the Miami Children’s Hospital in January.

Joe Raedle/Getty Images

More pediatricians are dismissing patients from their practices when parents refuse to vaccinate children, according to a study published in the journal Pediatrics in August.

The researchers compared national surveys conducted by the American Academy of Pediatrics in 2006 and 2013 to measure how doctors’ experiences dealing with the issue of childhood vaccination have changed. They found that 6.1 percent of pediatricians in 2006 reported that they “always” asked intransigently anti-vaccine families to take their kids elsewhere; that number had nearly doubled, to 11.7 percent, by the time the 2013 survey was taken. This could have something to do with the fact that more doctors are coming into contact with vaccine refusers. In the more recent survey, 87 percent of pediatricians said they’d has to deal with vaccine refusals; in 2006, only 75 percent said they’d encountered the problem.

The American Academy of Pediatrics doesn’t support the practice of “firing” patients, as the Wall Street Journal termed it in a 2012 trend piece. “The AAP recommends that pediatricians continue to engage with vaccine-hesitant parents, provide other health care services to their children, and attempt to modify their opposition to vaccines,” advices a new round of recommendations released alongside the study, titled “Countering Vaccine Hesitancy.” “Fortunately, most vaccine-hesitant parents are responsive to vaccine information, consider vaccinating their children, and are not opposed to all vaccines.” The Pediatrics study found that doctors are following this advice: About 94 percent of 2013 respondents said they had tried to educate parents who refused vaccines, and about a third reported having success.

But when families won’t budge, doctors have to weigh the unvaccinated child’s need for care against the risk he or she may pose to other patients—particularly vulnerable children too young, or perhaps too ill, to have received certain shots. In the WSJ story, for example, Dr. Allan LaReau described barring anti-vaxxers from his Michigan practice after an unvaccinated child came in with what he feared might be meningitis—a contagious, potentially deadly infection, for which inoculation usually begins at age 11 or 12. “I lost a lot more sleep than I usually do,” LaReau said at the time—but he ultimately told the vaccine-resistant parents, “This is going to be a difficult relationship without this core part of pediatrics.” “Some families chose to go elsewhere while others agreed to have their kids inoculated,” the WSJ reported.

Some doctors are also justifiably frustrated with anti-vaxxer parents, whose behavior is eroding modern medicine’s greatest gains. While fewer and fewer people seem to be refusing vaccines due to baseless concerns that they cause autism—74 percent of doctors had encountered that reasoning n 2006, versus 64 percent in 2013—more and more parents believe that vaccines simply aren’t necessary. Seventy-three percent of doctors surveyed in 2013 had heard that line, versus 63 percent seven years earlier.

Dr. Kathryn Edwards, a pediatrician and director of the Vanderbilt Vaccine Research Program who was not involved in the study, bemoaned the irony of that reasoning in an interview with STAT News. “Vaccines have been so good at taking diseases away that when we don’t see diseases, we don’t think they’re important,” she said. Vaccine-refusers risk compromising the herd immunity that keeps us all safe; since no vaccine is 100 percent effective, even those who’ve had one are at risk once a virus starts to spread. In the past year, the U.S. has started experiencing outbreaks of infectious diseases that regular inoculation had rendered anachronisms—from measles at Disneyland to mumps on the Harvard Quad.

“Firing” recalcitrant parents may be justified to protect a doctor’s other patients, but it won’t save our herd immunity. The only way to do that, as the AAP’s new recommendations point out, is to convince as many families as possible that vaccination is the safe and rational choice—and that forgoing it is anything but.