Rachael Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and Medical Economics.
There are dangers in straying from vaccine recommendations, so physicians play a critical part in educating patients.
For several years now, alternative vaccine schedules have been touted as an option for parents who worry about the impacts and side effects of the immunization schedule currently recommended for infants and children.
Numerous organizations have spoken out against such schedules, and the American Academy of Pediatrics (AAP) recently released a series of statements on vaccine hesitancy that specifically address the dangers of alternative schedules.
Amanda Cohn, MD, a pediatrician and senior advisor for vaccines at the Center for Disease Control and Prevention (CDC) National Center for Immunization and Respiratory Diseases, said alternative vaccine schedules can be particularly harmful to vulnerable populations.
“Infants and young children who follow immunization schedules that spread out shots-or leave out shots-are at risk of getting sick,” Cohn, who is also executive secretary of the Advisory Committee on Immunization Practices (ACIP), told Medical Economics. “Several vaccine-preventable diseases remain common in the United States, and children may be exposed to these diseases during the time they are not protected by vaccines. This places them at risk for serious illness that might cause hospitalization or death.”
While practitioners may be tempted to follow an alternative vaccination schedule for parents who are hesitant to have their child vaccinated, they need to stress to parents the importance of adhering to the guidelines.
“Following the recommended immunization schedule is the best way to protect babies against 14 serious diseases before they turn two. It’s important to stress to parents that the vaccination schedule is designed to protect infants and children by providing immunity early in life, before they are exposed to life-threatening diseases,” Cohn said.
Provider recommendations are one of the top motivators for vaccine compliance, as evidenced in several studies, and Cohn said physicians can help clear up all the conflicting information circulating about immunization.
“As a mother and pediatrician, I understand that there is lots of information that can be confusing to parents about immunizations, so it is important that parents have access to clear and accurate information about the safety and effectiveness of vaccines,” Cohn said.
Alternative vaccination schedules emerged in the last decade over fears that childhood vaccination contributes to autism or poses a number of other risks. In 2007, Robert Sears, MD, published a book recommending two alternative immunization schedules for vaccine-hesitant parents and he maintains a website promoting these schedules even today. His argument, according to these guides, is that spacing out vaccines lowers the potential for negative side effects. Sears’ theories, however, have been widely denounced by leading public health and vaccine experts.
According to a 2016 AAP report, the number of pediatricians who encountered a parent who refuses vaccines for their child increased from 75% in 2006 to 87% by 2013. The number of parents refusing one or more vaccines for their child increased from 9% to 17%, according to AAP.
The report, and other resources from AAP, recommend that pediatricians may even-as a last resort-dismiss families who refuse vaccination from their practice, effectively “firing” them as patients. Almost 12% of pediatricians reported dismissing families who refused vaccines from their practice by 2013, up from 6% in 2006.
Kathryn M. Edwards, MD, a pediatrics professor at Vanderbilt University in Nashville, Tennessee, and an expert in pediatric vaccinology, helped author the AAP report and said there is no data to support the use of alternative schedules for vaccination, and that the efficacy of the vaccines administered over an alternative course is uncertain.
“For vaccines to be licensed, they have to be administered and studied in a very specific way. The reason vaccine schedules are designed as they are is to provide the best benefit at the earliest possible time,” Edwards said. “The use of alternative schedules has not really been evaluated.”
AAP has also made statements addressing vaccine hesitancy as a result of medical or non-medical exemptions. Edwards said vaccine hesitancy for non-medical reasons in particular can put children who are unable to receive vaccines at increased risk. It’s up to clinicians to educate vaccine-hesitant parents about the risks to both their children and other children.
“It involves talking about the diseases, which ones are the most severe and greatest risk for the child, and going over what their priorities should be, then working with families and providing information that might help them reach some goal. But it has to be done in a way that’s respectful for the doctor and the patient,” Edwards said.
It is one thing for parents to refuse vaccines for themselves, but to refuse vaccines that could put their child at risk becomes a larger concern, and physicians have a duty to speak up-even if it’s uncomfortable and time-consuming, Edwards said.
“There are more questions about vaccines, and doctors are spending more time answering these questions,” Edwards said. “It’s taking an increasing amount of time and might detract from some of the other message they are trying to get across.”
Regardless of anti-vaccination movements, the U.S. still has very high immunization rates, which is a testament to the good job physicians are doing, Edwards said.
Successful immunization programs in the U.S. have led to an eradication or nearly elimination of many of the diseases that were fatal to previous generations.
“Most of the diseases our grandparents feared no longer exist,” Edwards said, explaining that parents often need to be reminded that these diseases are just an airplane ride away and can easily be reintroduced in today’s globalized culture.
Finding ways to educate parents in a respectful and effective way can be a challenge, Edwards said, but clinicians should emphasize the extent to which vaccines are studied and evaluated for safety before and after licensing. Parents also need to be reminded of the public health implications of their decisions and their role as a member of society in terms of disease prevention.
Researchers are finding that how clinicians approach vaccine discussions have a huge impact, and practitioners should stick to simple cause-and-effect messages for the greatest impact. Don’t start with the controversy surrounding Human papillomavirus vaccination, for example. Instead, emphasize its ability to prevent cancer, she said.
“If you present it that way, it’s hard to argue against it,” Edwards said. “Presenting vaccines in a knowledgeable approach and emphasizing that the standard of care is the administration of vaccine is helpful.”
Physicians should be respectful of the questions parents have and why they have them, and do their best to answer them fully and without judgment, she added. Clinicians can also personalize their own vaccine experiences and share those with their patients. “Doctors must also show patients that they adhere to their own guidelines. Often I will say, ‘my grandchildren are all immunized and that’s the most important thing I can do for them,’” Edwards said.