Our practice has experienced a marked increase in parents requesting to delay or decline vaccinations. This may be a result of recent appearances by celebrities claiming that vaccines harmed their children in some way as a result of the tremendous increase in the numbers of vaccines and injections in recent years.
My colleagues and I find ourselves spending an inordinate amount of time defending our use of vaccines in each well-child check, as well as during increasing numbers of telephone inquiries. Furthermore, we found ourselves on the defensive side more often than not.
In response to this heightened demand on our time and energy, PRIMA Pediatrics has carefully reviewed our approach to vaccinations in our practice. There are several factors that we feel have a bearing on a new office policy and include the following:
We want the greatest health and safety for the children we care for in our practice
- In the past year, there has been a steady increase in the number of parents choosing to not vaccinate, to follow their own schedule and or delay vaccination
- There have been pockets of increased vaccine preventable diseases in the United States. Many of these pockets have involved un-vaccinated children as a strong component of these surges in disease.
- Well funded, well polished Anti-Vaccine Groups have continued to re-cycle non evidence based hype regarding vaccines lending confusion to this issue. This emotional appeal to parents leads to confusion and is a disservice to well intentioned parents who want to do what is best for their children. It needs a strong un-equivocal statement from doctors to show confidence in vaccination.
- School policy has traditionally been consistent with the principle that the needs of the many outweigh the needs of the few. Therefore schools have required children to be vaccinated to attend with few exceptions. We believe this approach to be appropriate. We believe it is also medically appropriate to exclude un-vaccinated children from a pediatric practice to protect the vaccinated children from communicable infectious diseases.
- The California Legislature just passed a law allowing only medical exemptions from vaccines.
With these issues in mind, the following reflects our vaccine policy
PRIMA Pediatrics Vaccine Policy Statement
- We firmly believe in the effectiveness of vaccines to prevent serious illness and to save lives.
- We firmly believe that parents want their children safely protected from infectious diseases.
- We firmly believe in the safety of our vaccines, though we understand that they are a drug.
- We firmly believe that all children and young adults should receive all of the recommended vaccines according to the schedule published by the Centers for Disease Control and Prevention and the American Academy of Pediatrics.
- We firmly believe, based on all available literature, evidence, and current studies, that vaccines do not cause autism or other developmental disabilities. We firmly believe that thimerosal, a preservative that has been in vaccines for decades and remains in some vaccines, does not cause Autism or other developmental disabilities, although none of the vaccines we use contain thimerosal.
- We firmly believe that vaccinating children and young adults may be the single most important health-promoting intervention we perform as health care providers, and that you can perform as parents/caregivers. The recommended vaccines and their schedule given are the results of years and years of scientific study and data gathering on millions of children by thousands of our brightest scientists and physicians.
- We firmly believe that public health policy excluding un-vaccinated children from school is appropriate for a school setting, and is also appropriate at this time in our office setting. The sickest children are seen in a doctors office and can be a source of spread of infectious disease to patients.
- We firmly believe that much of the protection of vaccines comes from herd immunity. Most vaccines produce immunity in 90-95% of children. The remaining 5-10% who do not produce immunity are protected from herd immunity, meaning that a highly vaccinated population limits the spread of most infections. As more people choose not to vaccinate, herd immunity is eroded. Now more than ever, it is important to protect parents who choose to vaccinate their children from those who do not vaccinate.
- We firmly believe that we have spent hundreds of hours educating parents individually, in the community and through a series of articles on our website. Our education has been solidly founded on evidence.
These things being said, we recognize that there has always been and will likely always be controversy surrounding vaccination.
The vaccine campaign is truly a victim of its own success. It is precisely because vaccines are so effective at preventing illness that we are even discussing whether or not they should be given. Because of vaccines, many have never seen a child with Hemophilus influenza, tetanus, whooping cough, bacterial meningitis, or even chickenpox, or known a friend or family member whose child died of one of these diseases. Such success can make us complacent or even lazy about vaccinating. But such an attitude, if it becomes widespread, can only lead to tragic results.
Over the past several years, many people in Europe have chosen not to vaccinate their children with the MMR vaccine after publication of an unfounded suspicion (later retracted) that the vaccine caused autism. As a result of under-immunization, there have been outbreaks of measles and several deaths from complications of measles in Europe over the past several years. These outbreaks are now becoming more common here in the United States with more frequency and involving more diseases. In a study based on nationwide surveillance data from 1985 through 1992, children with non religious exemptions were 35 times as likely to contract measles as nonexempt children.1 In another study in Colorado based on data for the years 1987 through 1998, children with exemptions, as compared with unvaccinated children, were 22 times as likely to have had measles and almost six times as likely to have had pertussis.2 This past spring, there was an outbreak of measles in Disneyland that sickened 154 people, mostly children.
Our policy is written to emphasize the importance of vaccinating children. We recognize that the choice may be a very emotional one for some parents. We will do everything we can to convince you that vaccinating according to the schedule is the right thing to do. Please be advised, however, that delaying or “breaking up the vaccines” to give one or two at a time over two or more visits goes against expert recommendations, and can put your child at risk for serious illness (or even death) and goes against our medical advice as providers at PRIMA Pediatrics. We follow the recommendations of the American Academy of Pediatrics and its schedule, and as such do not recommend that parents pick their own schedule or follow schedules like the “Dr. Bob” schedule.
For our new patients if despite our recommendations after 60 days, you feel you cannot follow the CDC and AAP recommendations for these vaccines, we will ask you to find another health care provider who shares your views. For our established, un-immunized patients we will revisit the topic of vaccines at your next office visit and if within 60 days you choose not to follow the CDC and AAP recommendations for these vaccines, we will ask you to find another health care provider who shares your views. We do not keep a list of such providers, nor would we recommend any such physician, any more than we would recommend a doctor who prescribes antibiotics by request. This approach does not include parents who choose to not vaccinate for certain vaccines based on firmly held religious beliefs.
As medical professionals, we feel very strongly that vaccinating children on schedule with currently available vaccines is absolutely the right thing to do for all children and young adults. We want your trust and will work to earn it. Thank you for your time in reading this policy, and please feel free to discuss any questions or concerns you may have about vaccines with any one of us.
- Salmon DA, Haber M, Gangarosa EJ, Phillips L, Smith NJ, Chen RT. Health consequences of religious and philosophical exemptions from immunization laws: individual and societal risk of measles. JAMA 1999;282:47-53. [Erratum, JAMA 2000;283:2241.]
- Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE. Individual and community risks of measles and pertussis associated with personal exemptions to immunization. JAMA 2000;284:3145-3150.