The unvaccinated: To treat or not to treat?

doctor hands behind back unvaccinated children
(Dan Kosmayer/Shutterstock)

The debate continues — should a provider treat an unvaccinated patient? In a 2012 statement, the AAP recommended that pediatricians should not refuse unvaccinated children. A new survey published this month in the journal Pediatrics, however, found that 21 percent of pediatricians do so anyway, “often or always” dismissing families from their practice for refusing at least one infant vaccine.

Ronald Samuels, MD, MPH, associate medical director of Boston Children’s Primary Care at Longwood, is not surprised at the results of the survey. “We see ourselves as a safety net provider and do not feel we can or should turn any patient away, but we worry about the increased risk unvaccinated children present to other patients in the practice. I have very mixed feelings about this.”

Ronald Samuels, MD, MPH
Ronald Samuels, MD, MPH

With last winter’s measles outbreak at Disneyland, pediatricians may be taking a firmer stance in order to protect their other patients, some of whom may have compromised immune systems. Samuels explains, “A child without the measles vaccine may come into the practice with measles and expose children in the waiting room, for instance a child with leukemia. Parents absolutely have the right to make this decision for their children, but they should not have the right to put other children at risk with their decision.”

The good news is that rarely do pediatricians need to make the tough call about whether or not to treat a completely unvaccinated child. Less than 1 percent of parents refuse all infant vaccines, according to the survey. But if ever confronted with an unvaccinated child, Samuels recommends keeping the lines of communication open.

“We should let families know that vaccines are good for the child and for children in general,” he says. “We should educate them on why they’re wrong to not vaccinate their children, and if we don’t, the families will all end up going to a small number of providers who will indulge their mistaken beliefs. I always advise my colleagues to engage the patients, but to avoid agreeing with them.”

Parents absolutely have the right to make this decision for their children, but they should not have the right to put other children at risk with their decision.

Another important issue to take into consideration when deciding whether to treat an unvaccinated child, says Samuels, is whether the strength of the provider-patient relationship will be compromised.

“Ultimately for pediatricians, it’s about trust. If you’re not going to trust me with something as simple as a vaccination, how are you going to trust me with other much more important decisions if they come up?”

Read the full survey in Pediatrics.

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