By Dennis Thompson
29 August 2016
(HealthDay News) – Pediatricians are encountering more parents who refuse to have their children vaccinated, mainly because they don't see the point of vaccines, a U.S. survey found.
In the survey, conducted in 2013, about 87 percent of pediatricians said they had encountered vaccine refusals, an increase from the 75 percent who reported refusals during the last survey from 2006.
The most common reason, provided by three out of every four parents: Vaccines are unnecessary because the diseases they prevent have been wiped out in the United States.
"Because these diseases are gone, people no longer fear them, even though many of them are only a plane ride away," said Dr. Kathryn Edwards, co-author of a new American Academy of Pediatrics report based on the survey. "They don't seem to realize that these diseases do exist in other places, and could come here."
The percentage of pediatricians who always dismiss patients over repeated vaccine refusals has also increased, doubling from 6 percent in 2006 to 12 percent in 2013, the survey found.
In the report, the AAP urges pediatricians to exercise patience with worried parents rather than closing their doors to them.
"Our goal is to work with our patients so they understand the importance of vaccinations, and their questions about vaccines are answered," said Edwards, a member of the AAP Committee on Infectious Diseases.
The reasons parents provide for refusing vaccines have evolved in recent years, pediatricians report.
In 2006, about three of every four parents who refused vaccines said they were worried that vaccines could cause autism -- a theory that's been debunked -- or produce serious side effects.
Fewer parents gave those as reasons in 2013, although many still cite concerns about safety. Concerns over a baby being too small to receive vaccines, or discomfort at having too many shots at once, have also diminished, the survey found.
Instead, most parents are refusing childhood vaccinations because they see vaccines as unnecessary, and that number increased by 10 percent between the two surveys.
BACKGROUND: Parental noncompliance with the American Academy of Pediatrics and Centers for Disease Control and Prevention immunization schedule is an increasing public health concern. We examined the frequency of requests for vaccine delays and refusals and the impact on US pediatricians’ behavior.
METHODS: Using national American Academy of Pediatrics Periodic Surveys from 2006 and 2013, we describe pediatrician perceptions of prevalence of (1) vaccine refusals and delays, (2) parental reasons for refusals and/or delays, and (3) physician dismissals. Questions about vaccine delays were asked only in 2013. We examined the frequency, reasons for, and management of both vaccine refusals and delays by using bivariate and multivariable analyses, which were controlled for practice characteristics, demographics, and survey year.
RESULTS: The proportion of pediatricians reporting parental vaccine refusals increased from 74.5% in 2006 to 87.0% in 2013 (P < .001). Pediatricians perceive that parents are increasingly refusing vaccinations because parents believe they are unnecessary (63.4% in 2006 vs 73.1% in 2013; P = .002). A total of 75.0% of pediatricians reported that parents delay vaccines because of concern about discomfort, and 72.5% indicated that they delay because of concern for immune system burden. In 2006, 6.1% of pediatricians reported “always” dismissing patients for continued vaccine refusal, and by 2013 that percentage increased to 11.7% (P = .004).
CONCLUSIONS: Pediatricians reported increased vaccine refusal between 2006 and 2013. They perceive that vaccine-refusing parents increasingly believe that immunizations are unnecessary. Pediatricians continue to provide vaccine education but are also dismissing patients at higher rates.
Immunizations have led to a significant decrease in rates of vaccine-preventable diseases and have made a significant impact on the health of children. However, some parents express concerns about vaccine safety and the necessity of vaccines. The concerns of parents range from hesitancy about some immunizations to refusal of all vaccines. This clinical report provides information about addressing parental concerns about vaccination.
Immunizations have had an enormous impact on the health of children, and the prevention of disease by vaccination is one of the single greatest public health achievements of the last century. However, over the past decade acceptance of vaccines has been challenged by individuals and groups who question their benefit.1 Increasing numbers of people are requesting alternative vaccination schedules2,3 or postponing or declining vaccination.4 In a national telephone survey of 1500 parents of children 6 to 23 months of age conducted in 2010 with a response rate of 46%, approximately 3% of respondents had refused all vaccines and 19.4% had refused or delayed at least 1 of the recommended childhood vaccines.5 A study conducted in a metropolitan area of Oregon reported that rates of alternative immunization schedule usage have increased nearly fourfold in recent years,3 and in some parts of the country the use of “personal belief exemptions” from vaccinations has grown to rates in excess of 5% of the school-aged population.6
The Periodic Survey of Fellows (PS#66) conducted by the American Academy of Pediatrics (AAP) in 2006 revealed that 75% of pediatricians surveyed had encountered parents who refused a vaccine,7 and a follow-up survey in 2013 (PS#84) revealed that this figure had increased to 87% of pediatricians.8 According to the survey, pediatricians stated that the proportion of parents who refused 1 or more vaccines increased from 9.1% to 16.7% during the 7-year interval between surveys.7,8 Physicians stated that the most common reasons parents refused vaccines were that they believed that vaccines are unnecessary (which showed an increase over the 7-year span) and that they had concerns about autism (which declined between survey years). In both 2006 and 2013, pediatricians reported that they were able to convince approximately 30% of parents to vaccinate their children when they initially refused. Another observational study found that when physicians continued to engage parents, up to 47% of parents ultimately accepted vaccines after initially refusing them.9 Although the majority of parents accept vaccines, the increasing frequency of refusal and the requests for alternative vaccine schedules indicate that there are still significant barriers to overcome.10
The term vaccine hesitancy has emerged to depolarize the “pro” versus “anti” vaccination alignment and to express the spectrum of parental attitudes toward vaccines.1 Vaccine hesitancy has been characterized recently by a committee at the World Health Organization as “a behavior, influenced by a number of factors including issues of confidence (do not trust a vaccine or a provider), complacency (do not perceive a need for a vaccine or do not value the vaccine), and convenience (access).”11 Vaccine-hesitant individuals are a heterogeneous group who hold varying degrees of indecision about specific vaccines or about vaccinations in general. Vaccine-hesitant individuals may accept all vaccines but remain concerned about them, they may refuse or delay some vaccines but accept others, or they may refuse all vaccines. The latter group refusing all vaccines is estimated at approximately 3% of parents, although the prevalence may vary geographically.4,12,13 The concept that parental vaccine hesitancy is a spectrum has been confirmed in several studies4,14,15 and was well described in a recent review by Leask et al12 (Table 1). Some parents who totally refuse vaccines may be fixed and unswayable in their beliefs and may not respond to the pediatrician attempting to change their views. The AAP recommends that pediatricians continue to engage with vaccine-hesitant parents, provide other health care services to their children, and attempt to modify their opposition to vaccines.16–18 Fortunately, most vaccine-hesitant parents are responsive to vaccine information, consider vaccinating their children, and are not opposed to all vaccines. Responding to vaccine-hesitant parents is the focus of this clinical report. [more]