How Doctors Could Improve Childhood Vaccination Rates


vaccineBy KJ Dell’Antonia

How should pediatricians handle a parent who wants to refuse or delay a child’s vaccinations?

In November, the question of whether that pediatrician could ethically refuse to treat the child was debated on the Armchair Ethicist, and here as well. Putting the ethical question aside, Dr. Douglas Diekema has a simple answer for pediatricians who might want to turn away those patients (and in his experience, many routinely do so, some by screening them before an appointment is even made): Don’t.

Dr. Diekema, a pediatrician and professor at the Seattle Children’s hospital, wants his fellow physicians to reconsider their approach to parents who delay or refuse vaccinations for their children. “They’re not,” he told me firmly, “all Jenny McCarthy.”

Dr. Diekema doesn’t necessarily think his fellow physicians should invest a lot of time in trying to change the minds of Ms. McCarthy’s acolytes (many of whom persist in believing in an autism/vaccination link). But many parents who’ve delayed or refused vaccinations on behalf of their children without a medical reason to do so might be open to influence. Vaccine resistance occurs in clusters, so the influence of their friends and communities is probably what prompted their decision in the first place. Physicians who turn these parents away may be protecting the patients in their waiting rooms, but they’re missing an opportunity to protect public health.

In “Improving Childhood Vaccination Rates” in the New England Journal of Medicine, Dr. Diekema invites doctors to consider the reluctant or recalcitrant parent as a diagnostic problem. A parent who’s read that multiple vaccines might weaken a child’s immune system requires one tactic; one who’s concerned with the number of shots in a single visit another. What’s most important is keeping the conversation alive, and a doctor who won’t provide routine care to a family that won’t adhere to the vaccine schedule is one who won’t have the chance to revisit the question.

With vaccination rates in some pockets of the country shrinking (in one Washington State county, Dr. Diekema says, 72 percent of kindergartners and 89 percent of sixth graders are either noncompliant with or exempt from vaccination requirements for school entry, and at a Bay Area Waldorf school I wrote about last year, only 23 percent of the incoming kindergarten class had been fully vaccinated), doctors who support vaccination (as the vast majority do) need strategies to work with parents. A physician who’s willing to talk parents through doubts and fears may be a physician who can persuade a family determined to wait for all vaccines to accept, for example, the DTaP (or Tdap) shots, which vaccinate infants against pertussis – a disease that’s still common, and is most deadly for infants under six months.

Have you had a conversation with your pediatrician about vaccinations that involved more than the pro forma handing over of the sheet of possible side effects? Have you changed your mind about vaccination with the help of a physician, or learned something new from a doctor who was willing to talk? If you know families who haven’t vaccinated their children on schedule (or at all), what approach would you like to see your pediatrician take?

{NY Times Motherlode/ Newscenter}



  2. Very important discussion. Parents need to become well informed before making a decision that could affect not only their own children, but all those around as well. Too much hype, not enough education.

  3. Crazies and conspiriciests are impossible to change, I doubt any birther changed their mind when Obama birth certificate was released. Similarly, all loons who are anti-vaccine won’t change their minds regardless of the facts they are presented with.

  4. I think a doctor is a doctor and should not refuse patients, including those suffering from contagious diseases and including those suffering from issues that border on mental health. Of course a doctor should take precautions to protect his health and safety, his other patients’, and public health and safety.

    I am not a medical doctor but as a general rule, when I meet someone whose beliefs I strongly disagree with, I ask them what it would take for them to change their mind or at least to consider the opposite positions. Those who would never change, those who demand impossible burden of proof but accept naively all sorts of garbage which fits their agenda, and those who keep pushing for more and more “evidence”, I cut them off. There are plenty of reasonable people out there. No need for me to interact with the conspiracists and other crazies.

  5. Right now there are pockets of whooping cough in Israel. These are only occuring ammongst children who have been vaccinated for , du du du du – whooping cough!
    My friends wife was given a miesels vaccine, and then introduced it to the rest of her class.
    My children are not vaccinated. I take offense at being called a “crazy” and what not. I consulted a Rav, and NOT your Rav! Have you consulted YOUR Rav??? Please, go ahead, and if he tells you to go on a screaming campaign calling other people crazy etc. I will know to stay clear of that “Rav”.
    When and where I grew up kids werent given needles to prevent silly things like flu and miesels and mumps.
    2 blocks away from me, is a man, a jewish man, who is paralyzed by a shot he was given. If you are preaching to us, you are not sharing the whole story. There are studies showing very problematic things resulting from innoculation of children.
    Some physicians suggest its better to wait for your children to be older before giving certain shots, and some physicians, who are just as physianal as any and every other physician are of the oppinion that immunization has side effects that do not warrant having them.
    There are many oppinions, and you are shouting out one very narrow oppinion.
    The frum doctors I have spoken to (you might try that yourself sometime too eh) are supportive of avoiding silly shots like for mumps and flu and other non life threatening things.
    And again, if you live in a place where a given life threatening disease is not a threat, my Rav says you dont need to vaccinate.
    There are studies linking autism to vaccination. Yes you can put together some long long list of doctors who will poo poo those studies. But I dont.
    Do you use a cell phone? There are also more than enough studies out, for Rabbanim to suggest limiting their use, and forbidding children from using them.
    Do you feed your kids lots of sugar? There are endless studies dirrectly linking over consumption to a plethora of health problems. But you sit their and preach about us!
    Do you let your children drink cola? Do you drink it yourself? Cola contains an agent that causes internal bleeding, never mind what is common knowledge about tooth damage and decay! your Rabbanim arent speaking out on these things. I dont hear Rabbanim actually at all, unless they are hounded by your types, the “concerned” types freaking out about vaccines and cigarette smoking.
    ABout your doctors, the kind that will force people into having shots, we dont need them, we have more than enough doctors, who openly and actively support not giving shots. Is Matsav on some sort of one sided agenda here? 2nd article ina week! Bring your sources, bring your Rabbanim! Lets hear from them, not some campaining crusader, who if they cant win here, will find something else to go on about!

  6. Pinchas are you aware that flu is deadly to elders, immunodepressed people, and people in bad general health? Are you able (and willing) to avoid e.g. busses, schools and other places where bacteria and virus exchange thrives? Can you stay away from people who must not catch the flu (transplant receivers, cancer patients, etc etc) during an outbreak? If you don’t feel well, do you stay home as long as needed? (As opposed to going to work, to the supermarket, to synagogue…) If so, no doctor will advise you to get the flu shot. If not, draw your conclusions.

    Can we know who is your Rav? I would like to tell him some stories.

    PS I don’t drink cola, but last time I checked, it is kosher. As for cellphones, looks like you are missing the reason some Rabbis speak against them.

  7. Um #9 you are very confused. I hope you dont ask basar vechalav shailas to your Doctor, Im not sure why you are asking medical advice from your Rav. and no their is no study linking vaccinations to autism, not even one. There was one, but the author turned out to be a fraudster

  8. When my pediatrician told me I would have to leave his practice if I refused to have my sons immunized, that’s exactly what I did, and I never looked back! I found a wonderful holistic MD who helped me heal my children without medication when they were sick. I will be forever grateful to him.

    Incidentally, I do not use cellphones, I do not own a microwave, I do not serve soda, when my son wanted to attend a yeshiva notorious for allowing smoking, I refused to allow him to go.

  9. People have been indoctrinated from day 1 about the benefits of vaccines. It is not a lack of understanding of the importance of vaccination that leads people not to vaccinate. It’s rather when they have decided to research the issue often after having seen a child having a serious reaction that they realize there’s a great discrepancy between what doctors and health officials tell us and what science really shows. They exaggerate the risk of the diseases, yet minimize the risk of the shots to make it look like the benefits outweigh the risks, when in reality research shows otherwise. This research is done by conventially trained doctors (such as Drs. Sherri Tenpenny and Russell Blaylock) who have spent thousands of hours poring over the original CDC’s studies before being manipulated to make them look safer and more effective than they really are.
    If doctors want to convince these parents to vaccinate, all they have to do is show them well documented studies clearly proving that injecting toxins like formaldehyde, aluminum, mercury, etc. into our children is perfectly safe and that giving multiple shots at one time will not harm them. The only way to prove this is to compare vaccinated and unvaccinated children over many years. Such studies have never been done and attempts to do so have been blocked by the CDC. If vaccines are so safe and effective why are they afraid to do such studies? Vaccines are typically studied on small numbers of healthy children for several days to several weeks. Kids who display reactions are conveniently eliminated from these studies. There is much more to say, do your own research.

  10. 1) All autism links with vaccines have been proven to be from a tampered study. No later studies have been found to show this link.
    2) The chemicals that had people concerned about in regards to the (non-existent) autism link have been taken out.
    3) Multiple shots at the same time have been decreased. Most common practices have them spaced out over a few months.
    4) Are you glad POLIO is not an issue anymore? Deadly and dangerous diseases have been eradicated ONLY due to vaccines. Smallpox is another one.
    5) People who have such large problems with vaccine studies (as #14 claims) and state that people “are conveniently eliminated from these studies” are like the birthers and truthers- blind, crazies and conspiracy nuts.
    6) If there was a vaccine out there that promised you immunity from all cancer would you take it? Would you give it to your kids so that they never have to experience the horrors of chemo, radiation, surgery, amputations, possibly never being able to have children… from cancer? (Meet anyone who has gone through it- they would have wished for anything else to avoid it) If so, I have to suspect your convictions… If you won’t give it to your kids, I would hate to be your child. You would allow them to die instead of giving them a vaccine since you hate all vaccines.
    Now think- polio was the cancer of their day. No way to stop it. No way to predict who will get it. Loss of limb function. stuck inside a wheelchair for life. The iron lung needed to help them breathe.

  11. daniela: Are you aware that after receiving a live virus vaccine such as chickenpox or MMR people are advised to stay away from immuno-supressed patients(as stated in the package inserts)? How ironic! And you thought the UNvaccinated were spreading disease!
    Science nerd: If there are no studies to prove the correlation between vaccines and autism, for what reason did they remove the ‘chemicals’?! You will probably be suprised to learn that they did NOT remove the mercury from all vaccines- multi dose flu vaccines have the full amount and other vaccines have trace amounts. Make up your mind- if its bad for you, remove it from all vaccines, if not, why go through the trouble of partially removing it and convincing people its not in vaccines anymore?
    You tout the polio vaccine for having eradicated polio- did know there is only one way to contract polio nowadays and that is from the vaccine itself? You also long for the day when an anti cancer vaccine will become available. Forget anti cancer: the polio vaccine was KNOWINGLY contaminated with the SV40 virus- a virus found nowadays in tumors. DO the research! Your kids deserve it!