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Physician response to ban on nonmedical vaccine exemptions will define success
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As public support continues to swell for legislation to eliminate the “personal belief” exemption, requiring all schoolchildren to be vaccinated unless medically prohibited, additional pressures will be placed on physicians treating vaccine noncompliant or vaccine-hesistant patients to increase timely immunization.
Read comments from an expert whom Infectious Diseases in Children asked for their opinion. We welcome you to share your impressions of the mandatory vaccination policies by commenting.
Paul A. Offit, MD
Director, Vaccine Education Center
Children’s Hospital of Philadelphia
Professor of Pediatrics
Perelman School of Medicine
University of Pennsylvania
By eliminating a philosophical exemption, and having only a medical exemption to vaccination, it is believed that it will be more difficult to exempt children from vaccines for bad reasons. In response, I believe one of two things will happen: since it is more difficult to “opt out” of vaccination, more children will be vaccinated or vaccine noncompliant parents will try to find other ways to get around this. For example, parents may choose to home-school their children or attempt to find a doctor who is sympathetic to the notion that people should not have to vaccinate their children against their parent’s will.
Home schooling represents the worst-case outcome because what parents are doing is creating pockets of wholly unvaccinated children. With home schools, you are going to essentially have communities for the unvaccinated, where the immunization rate is not low, it is zero, which is just asking for an epidemic.
Alternatively, parents can try to find a doctor who is willing to make up a medical exemption, such as a family history of immune disorders or neurological disorders. While neither of those represent true contraindications, the doctor may be willing to do that. There will be an understanding among vaccine noncompliant patients that there are doctors out there who are sympathetic to their cause and willing to write bogus medical exemption forms. I hope that I am wrong. I would like to think that pediatricians or family practitioners are far more responsible than that, because that would represent the exact opposite of what they have been charged to do, which is to protect children from harm. Furthermore, should there be an outbreak among those children, those physicians should be the first who are held accountable.
I am curious to see how this legislation will play out. I would like to believe in a better world in which Sen. Richard Pan, MD, and Sen. Ben Allen, the authors of this legislation in California, will get their wish: That more children will be vaccinated, and not to continue to have children put at risk for suffering, hospitalization, or death by vaccine-preventable diseases.
The question now is whether this progress will be undone by parents who have unfounded fears about vaccines or whether it will be undone by physicians who set aside their responsibility of caring for children and put them needlessly in harm’s way. We will have to wait and see.
Disclosure: Offit reports no relevant financial disclosures.