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.
- 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.