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ACEP Now: Vol 38 – No 02 – February 2019(click for a larger image) Anti-Vaccination Reasons and Responses
For parents with a libertarian bent, remind them of the libertarian principle that one’s free choice should not impose harm upon others (eg, imposing on someone’s freedom to avoid illness). Individuals should be stopped from participating in the collective imposition of unjust harm, such as vaccine-preventable disease outbreaks.6 Of course, you may neither have the time nor interest in debating libertarian philosophy at the bedside.
Finally, as the above case illustrates, for some infections anti-vaxxers can’t rely on herd immunity derived from the majority who comply to protect their unvaccinated kids.
A Safety Net
So when you take an immunization history and get a “no,” consider it an opportunity for a teaching moment. Ask, “Why?” Let the parent know you’re concerned, too, and that’s why you’ve read up on the actual risks and benefits, which you can explain (and maybe paste a copy of the “Anti-Vaccination Reasons and Responses” table in this article in such patients’ discharge instructions). If you are also a parent, let them know that as well.
Be a safety net and tell these parents why you strongly recommend vaccination.
Dr. Talan is professor of medicine in residence (emeritus) at the David Geffen School of Medicine at University of California, Los Angeles (UCLA) and the chairman emeritus of the department of emergency medicine faculty in the division of infectious diseases at the Olive View–UCLA Medical Center.
References
- Olive JK, Hotez PJ, Damania A, et al. The state of antivaccine movement in the United States: a focused examination of nonmedical exemptions in states and counties. PLoS Med. 2018;15(6):e1002578.
- Taylor LE, Swerdfeger AL, Eslick GD. Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies. Vaccine. 2014;32(29):3623-3629.
- Vennemann MM, Höffgen M, Bajanowski T, et al. Do immunisations reduce the risk for SIDS? A meta-analysis. Vaccine. 2007;25(26):4875-4879.
- Baxter R, Bakshi N, Fireman B, et al. Lack of association of Guillain-Barré syndrome with vaccinations. Clin Infect Dis. 2013;57(2):197-204.
- Flannery B, Reynold SB, Blanton L, et al. Influenza vaccine effectiveness against pediatric deaths: 2010–2014. Pediatrics. 2017;139(5):e20164244.
- Brennan J. A libertarian case for mandatory vaccination. J Med Ethics. 2018;44(1):37-43.
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10 Responses to “How Emergency Physicians Can Advocate for Vaccination”
March 10, 2019
Corey SlovisDavid, thank you for this. Greatly appreciate the summary table along with your insights.
Corey Slovis
March 11, 2019
Dave TalanThanks for the shout out, Corey. I hope you are well and taking care of our UCLA grad faculty. Let me know when I can invite myself to come visit your program, never been to Nashville.
March 10, 2019
JeffThis a way more important topic for us to address in the ED than gun control (which we have inappropriately co-opted ACEP to lobby for). Thank you so much for the practical responses to parents unreasonable excuses.
March 10, 2019
Kerry ACEP ForrestalWas the suit successful?
March 11, 2019
Dave TalanI don’t know. I hope not. The plaintiff’s attorney contacted me and I told him that there was no case and that I thought it outrageous that the family would sue the doctors for a problem that they unfortunately imposed through first, deciding to have their child not get vaccinated, second, not being honest about the child’s vaccination history, and third, refusing antibiotics when they were advised.
March 11, 2019
ANN PayneWonderful !
March 12, 2019
Leo Alonso, D.O.DR.Talan,
Thanks for your timely and well researched article. Emotionally this group of parents causes me the most moral and ethical conflict….child abuse being straightforward illegal with criminal judicial societal repercussions…this cohort of parents are afforded a degree of “free speech/thought/religious” protection while the children and the immunocomprimised suffer the consequences of their ignorance. I try to educate them in a non-judgemental fashion but my experience has been a total shutdown…they have made up their mind. I struggle with the effective approach and your article shed some light. I believe only through legislation requiring vaccinations with minimal to no exemptions will the herd immunity numbers be preserved as we enter the digital era where so much misinformation can be circulated with no counter argument.
March 17, 2019
Erin BurnhamThanks for this nice summary David. I agree that we have a duty to encourage our patients to get vaccinated. I have been even more vocal about vaccinations since the EMTs I supervise had a case of tetanus in a child. Tetanus?!
March 28, 2019
Jack SpringerDave,
Thanks for your articulate summary.
I have found the issue of trying to educate parents to change their perspective on vaccination is like having a political or religious conversation with someone of the opposite “belief”. Mostly unshakeable. Even in the face of an argument that childhood vaccinations are likely the greatest ongoing scientific experiment in history, with an N in the billions, and that they are safer than driving the family car to the ER!
April 10, 2019
Michael Herron.I thought for sure the story was going to take a turn…… we called the department of family and children services, they contacted a judge who issued a restraining order and temporary custody to the state. Child was then given IV antibiotics to treat H.flu, then suddenly developed anaphylactic shock..and died….