In November 2011 the American Academy of Pediatrics published the results of a national survey of parents of young children regarding their attitudes toward vaccination. It found that more than 1 in 10 parents surveyed currently use an alternative vaccination schedule and that a large proportion of parents that do use the recommended vaccination schedule have misgivings about it, and have considered switching to an alternative, less protective schedule.
So what is going on? Why is childhood vaccination, which has reduced illness and death by margins unimaginable a century ago, being rejected by so many parents? And how have physicians and public health professionals failed to make the case for immunization?
In their article, “I’ve Heard Some Things That Scare Me: Responding With Empathy to Parents’ Fears of Vaccinations,” published in the January/February 2012 issue of Missouri Medicine, the Journal of the Missouri State Medical Association, authors Kenneth Haller, MD, and Anthony Scalzo, MD, examine the science around vaccinations as well as the many messages that parents get from the media, from well intentioned but poorly informed anti-vaccine advocates, and even from doctors that can lead parents to be wary of immunizations for their own children.
Current fears of vaccination were galvanized by the 1998 publication of a research paper in The Lancet, a medical journal in Britain, which proposed a causal relationship between the measles-mumps-rubella (MMR) vaccine and autism in children. Subsequent investigations found unequivocally that the paper's lead author, Andrew Wakefield, had multiple conflicts of interest before and during his research, and had falsified some of the data. The Lancet disavowed and retracted the Wakefield paper, and subsequently he was barred from the practice of medicine in the United Kingdom. Despite that revelation, the anti-vaccine movement remains compelling to many parents because it exploits centuries-old fears of vaccination as well as the plight of families with children diagnosed with an autism spectrum disorder. As the vaccination rate against MMR has fallen, serious illnesses and even deaths have increased from these preventable diseases.
Vaccines may very well be victims of their own success. Happily, the fact that vaccines have been so spectacularly successful at drastically reducing the incidence of diseases like measles, polio, and pertussis, has meant that generations of parents have grown up without the specter of childhood death due to infectious disease. In a society where these diseases have become relatively uncommon, parents may feel that delaying or even refusing vaccination for their children makes sense.
As for autism, though it was first described by researchers in the 1940s, it was not classified as a medical diagnosis until the early 1980s. Since that time many other conditions, such as Asperger’s syndrome, have been added to the category of autism spectrum disorders. This helps to explain why the diagnosis of autism is so much more common today than it was decades ago.
While the science is clear than there is no causal connection between vaccinations and autism, the causes of autism spectrum disorders do remain largely unknown. Unfortunately, in the 1950s, 1960s, and even later, a common attitude among physicians was that autistic children likely had distant, unemotional parents. In effect, parents, already devastated by a child who cannot care for him- or herself, and may no longer speak or even make eye contact, were then burdened with guilt for their child’s condition. No wonder these parents might find satisfaction in an explanation for their child’s affliction that removes blame from them and gives it to the profession that accused them in the first place.
Since vaccination of children is both safe and effective, and there is no credible evidence of a connection between vaccination and autism, many physicians strive to reasonably lay out the scientific evidence for parents who worry about vaccinating their child. Yet they still find that many parents decline the vaccinations.
Drs. Haller and Scalzo propose that if physicians do not acknowledge and address the emotional basis of parental vaccine refusal, they will not be persuasive. While a fact-based explanation of vaccine safety is essential, physicians must recognize that they can and should use their experience and expertise to counter the fear mongering of vaccine deniers.
Anti-vaccine advocates address parents with understanding and empathy: We know your fear. We’re here for you. Unfortunately, many physicians dismiss vaccination concerns as unfounded and uninformed. When physicians do express emotion about vaccination, it often comes across as either anger at parents who just do not care enough to do what is best for their children or annoyance with parents for wasting the physician’s time with such nonsense.
“Healing is about more than prescribing and instructing,” Haller and Scalzo write near the end of their article. “It is also about listening, about saying that physicians were wrong to blame parents when we had no other explanation for autism, and sometimes just sitting in silence as we let parents know that it is okay if they are afraid and that we will walk through that fear with them.”
Kenneth Haller, MD, FAAP, MSMA member since 2004, is Associate Professor of Pediatrics. Anthony J. Scalzo, MD, FAAP, FACMT, FAACT, is Professor of Pediatrics, Director, Division of Toxicology and Medical Director, Missouri Poison Center. Both are at Saint Louis University School of Medicine/SSM Cardinal Glennon Children’s Medical Center.
Editor's note: This article is part of a special series brought to you by Missouri Medicine, the Medical Journal of the Missouri State Medical Association (MSMA). MedHelp, Missouri Medicine, and MSMA are collaborating to educate and empower health consumers by making the latest scientific studies and medical research available to the public. Learn more about MSMA and see more from Missouri Medicine.
This is a summary of the article "'I’ve Heard Some Things That Scare Me' Responding With Empathy to Parents' Fears of Vaccinations" by Kenneth Haller, MD, and Anthony Scalzo, MD, which was originally published in the January/February 2012 issue of Missiouri Medicine. The full article is available here.