Pediatricians increasingly seeing, dismissing parents who refuse vaccines

VANCOUVER, B.C. – Physician response to parents who refuse to allow their child to be vaccinated is changing, and vaccine refusal is a growing problem, according to an analysis of national survey data.

More often, pediatricians are responding by dismissing these parents and children from their practice.

Researchers led by Dr. Catherine Hough-Telford of the department of pediatrics at the University of Alabama at Birmingham analyzed data from the 2006 and 2013 American Academy of Pediatrics periodic surveys. Analyses were based on 629 and 627 respondents, respectively.

The proportion of pediatricians encountering parents who refused vaccines for their children in the past year rose significantly, from 75% in 2006 to 87% in 2013, a 16% increase she reported at the annual meeting of the Pediatric Academic Societies.

There were decreases in the proportion of refusals in which the stated reason was the child being too small (from 23% to 15%), discomfort (from 42% to 17%), and autism or thimerosal (from 74% to 65%). Meanwhile, there was an increase in the proportion of parents who believed the vaccine was unnecessary (from 63% to 73%).

Nationally, in 2013, the leading reasons parents refused vaccines were believing they were unnecessary and safety concerns, whereas the leading reasons they requested a delay in vaccines were discomfort and concern that a child was getting too many vaccines at one time.

When faced with parental refusal, pediatricians increasingly reported dismissing the parent and patient from their practice: 6% did so in 2006, while 12% did so in 2013 – a 100% increase. In 2013, they had dismissed an average of about three patients for this reason in the past year, at a mean age of about 11 months.

"Vaccine hesitancy is increasing over time. The perception that immunizations are unnecessary has also increased, and the concern for autism or thimerosal has actually declined," commented Dr. Hough-Telford. "Pediatrician response to vaccine hesitancy has also been changing over time, and the rate of dismissal has doubled in the last 7 years."

Educational efforts have had a limited impact in this setting, she noted. "In fact, there was a study that came out this past March showing that provaccine messages may not or do not increase the intent to immunize, and providing correct educational vaccine information actually decreases both vaccine misperceptions but, counterintuitively, also decreases intent to immunize," she noted (Pediatrics 2014;133:e835-e42).

Session attendee Dr. Kelly Ochoa of Children’s Hospital Los Angeles asked, "Given the evidence from several recent studies showing that educating families about vaccine-preventable illnesses isn’t improving their willingness to get them, what do we do now?"

In the study on provaccine messages, the messages were ineffective mainly among parents whose beliefs were already fixed, Dr. Hough-Telford noted. "We still should do it, but perhaps find out what the parents’ beliefs are before [getting started]."

Session comoderator Dr. Heather Brumberg, a neonatologist in the department of pediatrics at New York Medical College, commented, "Do you think that some education is working, because there is less concern about autism?"

"I do," Dr. Hough-Telford replied. "Between 2006 and 2013, there has been a lot of effort on behalf of pediatricians, the CDC [Centers for Disease Control and Prevention], and the AAP to minimize the concerns about autism ... and to really debunk those myths. So I think that’s why we are seeing this downtick in autism and thimerosal concerns, but it’s very interesting that parents are thinking that immunizations are actually unnecessary. So it’s like they swapped [myths]."

"Have you changed your practice because of the results of the study?" Dr. Brumberg asked.

"Yes, I have, in how I approach parents who are refusing vaccines," said Dr. Hough-Telford, adding that she tries to find out parents’ beliefs before she starts her education efforts, explains to parents why vaccines really are necessary, and alerts them to vaccine-preventable diseases that are occurring in the country.

Dr. Hough-Telford disclosed no relevant conflicts of interest.

VANCOUVER, B.C. – Physician response to parents who refuse to allow their child to be vaccinated is changing, and vaccine refusal is a growing problem, according to an analysis of national survey data.

More often, pediatricians are responding by dismissing these parents and children from their practice.

Researchers led by Dr. Catherine Hough-Telford of the department of pediatrics at the University of Alabama at Birmingham analyzed data from the 2006 and 2013 American Academy of Pediatrics periodic surveys. Analyses were based on 629 and 627 respondents, respectively.

The proportion of pediatricians encountering parents who refused vaccines for their children in the past year rose significantly, from 75% in 2006 to 87% in 2013, a 16% increase she reported at the annual meeting of the Pediatric Academic Societies.

There were decreases in the proportion of refusals in which the stated reason was the child being too small (from 23% to 15%), discomfort (from 42% to 17%), and autism or thimerosal (from 74% to 65%). Meanwhile, there was an increase in the proportion of parents who believed the vaccine was unnecessary (from 63% to 73%).

Nationally, in 2013, the leading reasons parents refused vaccines were believing they were unnecessary and safety concerns, whereas the leading reasons they requested a delay in vaccines were discomfort and concern that a child was getting too many vaccines at one time.

When faced with parental refusal, pediatricians increasingly reported dismissing the parent and patient from their practice: 6% did so in 2006, while 12% did so in 2013 – a 100% increase. In 2013, they had dismissed an average of about three patients for this reason in the past year, at a mean age of about 11 months.

"Vaccine hesitancy is increasing over time. The perception that immunizations are unnecessary has also increased, and the concern for autism or thimerosal has actually declined," commented Dr. Hough-Telford. "Pediatrician response to vaccine hesitancy has also been changing over time, and the rate of dismissal has doubled in the last 7 years."

Educational efforts have had a limited impact in this setting, she noted. "In fact, there was a study that came out this past March showing that provaccine messages may not or do not increase the intent to immunize, and providing correct educational vaccine information actually decreases both vaccine misperceptions but, counterintuitively, also decreases intent to immunize," she noted (Pediatrics 2014;133:e835-e42).

Session attendee Dr. Kelly Ochoa of Children’s Hospital Los Angeles asked, "Given the evidence from several recent studies showing that educating families about vaccine-preventable illnesses isn’t improving their willingness to get them, what do we do now?"

In the study on provaccine messages, the messages were ineffective mainly among parents whose beliefs were already fixed, Dr. Hough-Telford noted. "We still should do it, but perhaps find out what the parents’ beliefs are before [getting started]."

Session comoderator Dr. Heather Brumberg, a neonatologist in the department of pediatrics at New York Medical College, commented, "Do you think that some education is working, because there is less concern about autism?"

"I do," Dr. Hough-Telford replied. "Between 2006 and 2013, there has been a lot of effort on behalf of pediatricians, the CDC [Centers for Disease Control and Prevention], and the AAP to minimize the concerns about autism ... and to really debunk those myths. So I think that’s why we are seeing this downtick in autism and thimerosal concerns, but it’s very interesting that parents are thinking that immunizations are actually unnecessary. So it’s like they swapped [myths]."

"Have you changed your practice because of the results of the study?" Dr. Brumberg asked.

"Yes, I have, in how I approach parents who are refusing vaccines," said Dr. Hough-Telford, adding that she tries to find out parents’ beliefs before she starts her education efforts, explains to parents why vaccines really are necessary, and alerts them to vaccine-preventable diseases that are occurring in the country.

Dr. Hough-Telford disclosed no relevant conflicts of interest.

VANCOUVER, B.C. – Physician response to parents who refuse to allow their child to be vaccinated is changing, and vaccine refusal is a growing problem, according to an analysis of national survey data.

More often, pediatricians are responding by dismissing these parents and children from their practice.

Researchers led by Dr. Catherine Hough-Telford of the department of pediatrics at the University of Alabama at Birmingham analyzed data from the 2006 and 2013 American Academy of Pediatrics periodic surveys. Analyses were based on 629 and 627 respondents, respectively.

The proportion of pediatricians encountering parents who refused vaccines for their children in the past year rose significantly, from 75% in 2006 to 87% in 2013, a 16% increase she reported at the annual meeting of the Pediatric Academic Societies.

There were decreases in the proportion of refusals in which the stated reason was the child being too small (from 23% to 15%), discomfort (from 42% to 17%), and autism or thimerosal (from 74% to 65%). Meanwhile, there was an increase in the proportion of parents who believed the vaccine was unnecessary (from 63% to 73%).

Nationally, in 2013, the leading reasons parents refused vaccines were believing they were unnecessary and safety concerns, whereas the leading reasons they requested a delay in vaccines were discomfort and concern that a child was getting too many vaccines at one time.

When faced with parental refusal, pediatricians increasingly reported dismissing the parent and patient from their practice: 6% did so in 2006, while 12% did so in 2013 – a 100% increase. In 2013, they had dismissed an average of about three patients for this reason in the past year, at a mean age of about 11 months.

"Vaccine hesitancy is increasing over time. The perception that immunizations are unnecessary has also increased, and the concern for autism or thimerosal has actually declined," commented Dr. Hough-Telford. "Pediatrician response to vaccine hesitancy has also been changing over time, and the rate of dismissal has doubled in the last 7 years."

Educational efforts have had a limited impact in this setting, she noted. "In fact, there was a study that came out this past March showing that provaccine messages may not or do not increase the intent to immunize, and providing correct educational vaccine information actually decreases both vaccine misperceptions but, counterintuitively, also decreases intent to immunize," she noted (Pediatrics 2014;133:e835-e42).

Session attendee Dr. Kelly Ochoa of Children’s Hospital Los Angeles asked, "Given the evidence from several recent studies showing that educating families about vaccine-preventable illnesses isn’t improving their willingness to get them, what do we do now?"

In the study on provaccine messages, the messages were ineffective mainly among parents whose beliefs were already fixed, Dr. Hough-Telford noted. "We still should do it, but perhaps find out what the parents’ beliefs are before [getting started]."

Session comoderator Dr. Heather Brumberg, a neonatologist in the department of pediatrics at New York Medical College, commented, "Do you think that some education is working, because there is less concern about autism?"

"I do," Dr. Hough-Telford replied. "Between 2006 and 2013, there has been a lot of effort on behalf of pediatricians, the CDC [Centers for Disease Control and Prevention], and the AAP to minimize the concerns about autism ... and to really debunk those myths. So I think that’s why we are seeing this downtick in autism and thimerosal concerns, but it’s very interesting that parents are thinking that immunizations are actually unnecessary. So it’s like they swapped [myths]."

"Have you changed your practice because of the results of the study?" Dr. Brumberg asked.

"Yes, I have, in how I approach parents who are refusing vaccines," said Dr. Hough-Telford, adding that she tries to find out parents’ beliefs before she starts her education efforts, explains to parents why vaccines really are necessary, and alerts them to vaccine-preventable diseases that are occurring in the country.

Dr. Hough-Telford disclosed no relevant conflicts of interest.