For many doctors, the request to go “off the schedule” no longer comes as a surprise. They are trying to figure out how to handle parents who delay vaccines for their children or want to skip them altogether.
The decision is tough to hear, says veteran pediatrician Dale Guthrie, MD, of Gilbert Pediatrics.
“I am old enough to remember Haemophilus influenzae type b (Hib) disease and pneumococcal meningitis as a routine occurrence, killing and maiming children every year,” says Guthrie. “When I see parents refuse those vaccines for their babies—at the time in [the babies’] lives when they are the most vulnerable—it really causes me concern.”
Guthrie, a member of the Arizona Chapter of the American Academy of Pediatrics (AzAAP), says he also continues to be amazed at the number of people who still fear a connection between autism and MMR (measles, mumps, rubella) vaccines. Although the research has been discredited, “there are many proponents out there falsely claiming the link to be true, which scares parents,” says Guthrie.
Some parents want to veer from the recommended Centers for Disease Control vaccine schedule because they are not comfortable with the number of immunizations given at the same time, says AzAAP member Farah Lokey, MD, of Southwestern Pediatrics in Gilbert.
“They believe, through whatever research they have done, that too many antigens at once are bad for the immune system,” says Lokey. “I do explain to them extensively that this is untrue and that I believe the CDC schedule is safe and appropriate.”
Surprising study results
How often do these requests to delay or skip vaccines occur? How do physicians react to these requests?
In a study to be published in the April 2015 issue of Pediatrics, the journal of the American Academy of Pediatrics (AAP), pediatricians and family physicians responded to email and mail surveys from June through October 2012 about the frequency of requests from parents with children under age 2 to spread out the recommended vaccine schedule.
Results showed that in an average month, 93 percent of respondents reported requests from parents to skip or delay vaccines.
The majority of the providers who responded reported that they agreed to comply with the parents’ requests, even though the majority—87 percent—also said such delays would put children at risk for contracting vaccine-preventable diseases.
Most respondents said they hoped that agreeing to spread out the vaccines was a way to build trust with families. If providers did not agree to delay or skip, they indicated that these families might leave the practice.
That’s something Lokey has experienced firsthand: “People who have their minds made up make it hard to discuss vaccines. To keep the peace and to keep my patients, I will allow them to space out vaccines.”
Most physicians who responded to the survey reported using different strategies to convince parents to stick with the recommended vaccine schedule—but the physicians thought that few were effective.
Researchers concluded that discussions and interventions need to begin early in pregnancy for parents who are questioning vaccine safety and efficacy.
They also noted that social networks and public messaging have been shown to play an important role in shaping some parents’ vaccination decisions and should be considered when talking to vaccine-hesitant parents.
Getting back on the schedule
With the recent outbreak of measles that led to exposure in the Phoenix area, the consequences of skipping or delaying vaccinations hit home at Gilbert Pediatrics, says Guthrie, referring to the measles exposure of the daughter of colleague Tim Jacks, DO.
“A pediatrician in our office has a young daughter with leukemia. She was exposed to measles while getting a routine blood draw in between chemotherapy treatments. She had received her immunizations but was immuno compromised because of the leukemia treatments. One family who chose not to vaccinate put her at extreme risk,” says Guthrie.
Parents who delay vaccines but who reconsider and decide to get back on the schedule or have “a change of heart or read something which changes their mind do not need to wait for the next well check to get their [children’s] vaccines,” says Guthrie. “They can just call in and come see our staff.”