Aug. 30, 2016 -- Pediatricians can dismiss families for refusing to vaccinate their children, but only as a last resort, the American Academy of Pediatrics (AAP) says.
In a new report published online Monday in the journal Pediatrics, the doctors’ group offers multiple approaches for pediatricians dealing with vaccine-hesitant families and stresses that doctors can also be educators.
But if no approach works and pediatricians need to dismiss a family, they must do so thoughtfully and professionally, the report authors emphasize. And they must ensure that the family has other options for medical care.
"The decision to dismiss a family who continues to refuse immunization is not one that should be made lightly, nor should it be made without considering and respecting the reasons for the parents' point of view," write Kathryn M. Edwards, MD, and Jesse M. Hackell, MD, of the AAP.
"Nevertheless, the individual pediatrician may consider dismissal of families who refuse vaccination as an acceptable option.”
The report is a change of course for the organization, which represents 66,000 pediatricians. The previous AAP policy was against dismissing families, but the report authors say rising rates of vaccine refusal and doctors’ frustrations led to the change, according to a related AAP news story.
But Edwards and Hackell emphasize that pediatricians are often the only medically trained people to talk about vaccines with families, and they have a responsibility to provide doubting parents with scientifically based information.
Pediatricians should be prepared to discuss the science behind vaccines and the testing each vaccine undergoes, as well as the severity of the diseases they prevent. Doctors should address parents’ questions and concerns and “most importantly, emphasize that infants and children are the ones at greatest risk of disease," they write.
They should also point out that the current vaccine schedule is the only one recommended by the CDC and the AAP.
But pediatricians also need to treat parental concerns seriously, the report says. In the case of the human papillomavirus (HPV) vaccine, for example, parents are often concerned not only about side effects, but also that the vaccine might lead to sexual activity. "Reassuring parents that the vaccine is safe and that there is no evidence that HPV vaccine increases sexual activity may dispel their concerns," they write.
Parents are more often persuaded by anecdotes and personal stories about vaccines than they are by data, so personalizing the conversation is important, the authors write.
In a related policy statement, also published online Monday in the same journal, the AAP says non-medical exemptions for vaccines, which allow parents to opt out of school-required vaccinations for reasons other than medical ones, should end. The exemptions are “inappropriate for individual, public health, and ethical reasons,” the organization says.