Why would a parent refuse to provide his or her child with a time-tested, effective, safe, and simple medical treatment that prevents serious diseases and saves an estimated 3 million lives each year?
Pediatricians and other health care professionals are seeking answers to this question, as many parents and guardians continue to delay immunizations for their children or refuse the life-saving treatments altogether. The dangers of refusing to immunize children against diseases such as measles, mumps, diphtheria, tetanus, and pertussis (whooping cough) extend far beyond the unvaccinated children and their families. An unimmunized population poses grave dangers to public health by increasing the risk of disease for everyone — especially for people with compromised immune systems.
Some parents cite religious beliefs for their decision not to provide their children with immunizations. Others have concerns about the safety of the treatments or claim personal or philosophical reasons.
Health care professionals are responding to the growing dangers of immunization refusal by educating the public about the tremendous benefits of immunizations, as well as the scientifically documented risks associated with the treatments.
Why Vaccinations Are Important
The ultimate goal of health care is to prevent disease rather than treat it, and vaccinations have played a major role in advancing that goal. As recently as the mid-20th century, polio, smallpox, and other infectious diseases posed dire threats to public health. Today, smallpox has been vanquished around the world, and polio has been wiped out in North America — all thanks to comprehensive immunization programs. Germs that cause mumps, measles, whooping cough, and other dangerous maladies still exist, but widespread vaccination programs have made the diseases rare in the U.S.
The human immune system comprises organs, glands, and cells throughout the body that identify antigens (germs that invade the body and cause disease) and produce special proteins called antibodies to defend against them. A healthy immune system “remembers” antigens it has previously encountered and is prepared to fight them should they recur.
Newborns are protected against antigens in their first year of life via antibodies they receive from their mothers, but this immunity eventually dissipates. When unimmunized children encounter antigens, their immune systems begin to produce antibodies, but the production is usually too slow to prevent the disease from taking root in the body.
Even children who cannot be vaccinated because they are too young or have certain medical conditions are protected by the vaccinations other people receive. When disease-causing germs are less prevalent in the environment, fewer people get sick, and the chances that someone who hasn’t been vaccinated will encounter the disease-causing antigens are diminished greatly. Also, by reducing the number of infections, immunizations prevent expensive medical treatments and lost work time for parents.
Statistics on Parents Refusing Immunizations
To make knowledgeable decisions about their children’s care, parents need complete information on the medical treatments their children are scheduled to receive. The American Academy of Pediatrics (AAP) promotes the provision of Vaccine Information Statements (VIS) as part of the discussion doctors and other health care providers have with parents about vaccination effectiveness and potential vaccine-related adverse effects.
Despite this ongoing educational outreach, however, a growing percentage of physicians are reporting vaccination refusals and delays. More than 85 percent of pediatricians who participated in a 2013 AAP survey reported that they had treated children whose parents had refused to allow vaccinations within the last year, up from about 75 percent in 2006.
Another AAP study conducted in 2011 found that 13 percent of parents of children between the ages of 6 months and 6 years chose to adopt an “alternative vaccine schedule.” Of those parents who chose to diverge from their pediatricians’ recommendations, 53 percent refused specific vaccines, and 55 percent delayed their children’s immunizations, both of which increase a child’s risk of contracting a preventable disease. In addition, 17 percent of these parents refused all vaccines for their children. The immunization that parents decline most often, according to the AAP, is the measles, mumps, and rubella vaccine; other vaccines that parents frequently refuse are varicella; pneumococcal conjugate; hepatitis B; and diphtheria, tetanus, and pertussis.
Common Reasons for Parental Refusal of Vaccines
At one time, health agencies believed that measles and mumps had been eradicated in the U.S. Recent outbreaks of both diseases prove otherwise: in 2017, 118 people in the country contracted measles, and an outbreak of mumps in Hawaii affected more than 800 people. Likewise, cases of whooping cough have increased steadily since the 1980s, peaking at over 48,000 incidents of the disease in 2012.
While some of the resurgence can be attributed to the tendency of some vaccines to lose effectiveness over time, the principal reason for the return of these and other preventable diseases is the reluctance of many parents to allow their children to be immunized. A report published in 2016 in the Journal of Pediatric Pharmacology and Therapeutics (JPPT) identified the four reasons most often given by parents for their refusal to immunize their children: religious objections, personal or philosophical beliefs, concerns about safety, and the lack of information received from health care providers about the vaccinations.
Many parents who refuse immunizations mistakenly believe that vaccines cause autism in healthy children. Unfortunately, misleading and inaccurate claims related to this issue — all of which lack scientific basis — are widespread on the internet, requiring pediatricians to be more proactive in providing families with factual information about vaccine safety.
Tips for Talking with Parents Who Refuse Vaccinations
Parents who hesitate to allow their children to be vaccinated do so out of concern for their children’s well-being. Health care providers should avoid making these parents feel as if they are being attacked or judged harshly for their decision. The researchers behind the JPPT study recommend that health care professionals work to understand the reasons parents refuse to immunize their children. Discussing the dangers of immunization refusal with parents will likely help make health care providers’ mitigation efforts more effective.
Attempts to educate the public about the dangers of failing to immunize children have been only modestly successful to date. The AAP recommends that pediatricians and other family health care providers listen sincerely to parents’ concerns about vaccines. It is also important to acknowledge that vaccines are not 100 percent effective, and while immunizations are safe, they do carry some risks. Providers should discuss these risks in relation to the risks to children who are not immunized. For example, the odds of developing encephalopathy from the measles vaccine are about one in 1 million, yet the risk of developing encephalopathy because of a measles infection is 1,000 times greater. Pediatricians can direct parents to the many science-based websites that explain the benefits and risks of specific vaccines, as well as the dangers of the diseases that they prevent.
The AAP provides information for pediatric health care providers about the best ways to document and respond to parents’ refusal to allow their children to be vaccinated. The organization also outlines strategies for engaging with reluctant parents to determine whether their concerns relate to specific vaccines, immunization schedules, or the pain they believe a child experiences when vaccinated.
By building a relationship with parents over the course of several office visits, pediatric care providers can better understand a parent’s decision to disregard advice about his or her child’s immunizations. As providers establish more trust with parents, parents may become more amenable to reconsider their decision to refuse immunizations despite the dangers.
Learn More
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Recommended Readings:
Pediatric Nurse Practitioner: Exploring the Field of Pediatric Nursing
What Is the Difference Between a Nurse Practitioner and a Doctor?
Sources:
American Academy of Pediatrics: Documenting Parental Refusal to Have Their Children Vaccinated
American Academy of Pediatrics: Responding to Parental Refusals of Immunization of Children
Pediatrics: Vaccine Delays, Refusals, and Patient Dismissals: A Survey of Pediatricians
Scientific American: Straight Talk About Vaccination
U.S. Centers for Disease Control and Prevention: Why Are Childhood Vaccines So Important?
Women’s Health Magazine: Mumps, Measles, and Whooping Cough Are Making a Serious Comeback