When vaccines are refused, what doctors must do

The recent measles epidemic in the Western United States has prompted us to reflect on the issue of vaccine refusal.

As president-elect of the American Academy of Pediatrics in 2008, I found myself on "Larry King Live" debating Jenny McCarthy, her pediatrician and her journalist friend because of concerns that childhood vaccines caused autism. Even though there is no scientific evidence to link vaccines with autism, families begin to doubt the safety of vaccines when high-profile entertainers suggest that vaccines are harmful.

The current era of vaccine resistance began in 1982 when NBC aired a program that stated that the diphtheria-tetanus-pertussis (whooping cough) vaccine caused brain damage in 11 babies in England. It took scientists until 2006 to demonstrate that nine of these 11 children had a genetic condition called Dravet's Syndrome and that there was no evidence that the DTP vaccine causes brain damage.

In the late '90s, the Environmental Protection Agency discovered that the addition of multiple new vaccines meant that babies were receiving amounts of a mercury-containing preservative, thimerosal, that exceeded EPA guidelines. Although there has never been a scientific basis for concern about thimerosol, the American Academy of Pediatrics recommended that thimerosol be eliminated from as many vaccines as possible to assure adherence with EPA guidelines and to allay concerns of parents.

Today, parents can go online and read the propaganda of anti-vaccine zealots, making it necessary for pediatricians to explain to parents that vaccines are the most effective public health intervention ever discovered and that vaccines are really safe. When parents refuse vaccines for their children, pediatricians are taken aback because all child health authorities agree that the benefits of childhood immunization far outweigh any risk of rare vaccine-related injury.

I have been practicing high-volume primary care pediatrics for over 37 years and have never seen a child who suffered with any permanent injury or illness because of a childhood vaccine. I have seen children die from vaccine-preventable diseases.

When we encounter parents in our practice who refuse immunizations, we explain that we cannot continue to take care of their children if they do not allow us to give the vaccines for whooping cough and bacterial meningitis during the first six months of life. We try to compromise but insist that their babies at least receive the most essential life-saving vaccines.

There are three main reasons for our policy:

Vaccine refusal has become a very ethically charged topic for pediatricians. We will continue to struggle with these issues and hope that parents will eventually understand that the only reason the U.S. is free of small pox, polio and multiple other vaccine-preventable diseases today is that the vast majority of children have received essential recommended vaccines.

David T. Tayloe Jr., M.D., of Goldsboro is a past president of the American Academy of Pediatrics and the N.C. Pediatric Society.