Many of the concerns heard by the nearly 750 pediatricians and family practice physicians surveyed for the study were about known, short-term effects from vaccines, such as pain and fever.
But many others were about unproven, or disproved, allegations that vaccines can cause everything from autism to diabetes, according to results published in the January issue of the American Journal of Preventive Medicine. The survey was performed in the year 2000, and funded by the Association of Teachers of Preventive Medicine and the Centers for Disease Control and Prevention.
And that, says lead researcher Gary Freed, M.D., M.P.H., means that children's doctors need to be understanding of parents' concerns, equipped with the latest information on vaccine safety, and ready to react to vaccination concerns or refusals.
As the "front lines" in the nation's vaccine delivery system, he says, physicians and other children's health providers need to help parents understand the benefits of vaccination, the state of knowledge on vaccine safety concerns, and the individual and societal risks of leaving their children unvaccinated.
"Physicians are in a unique position to both quantify parental concerns about vaccine safety, and provide information on the impact of those concerns on their decision making as parents," says Freed, the director of the Division of General Pediatrics at the U-M Health System and the Percy and Mary Murphy Professor of Pediatrics and Child Health Delivery at the U-M Medical School. "All of us must be sensitive to parents' concerns, and well prepared to respond to them."
Freed and his colleagues in the Child Health Evaluation and Research (CHEAR) Unit surveyed a random national sample of pediatricians and family physicians. Of the 743 who responded to the survey, the number of physicians reporting that at least one parent had refused a vaccination for his or her child in the last year was large: 93 percent of pediatricians and 60 percent of family physicians.
Pediatricians were about twice as likely as family physicians to say that refusals had been rising. Conversely, family physicians were more likely than pediatricians to say that refusals were falling.
When it came to concerns expressed by parents before they allowed their children to receive a vaccine, more than two-thirds of all the physicians -- 69 percent -- felt that the number of concerns had increased substantially over the past year.
Concerns about long-term serious complications were most likely to be cited by the physicians as being on the rise, with about 28 percent saying they had heard more of such concerns in the last year. Nineteen percent said immune system effects was the most common area of concern that was on the rise, while 16 percent said the concern they heard most and were hearing more often was from parents who wondered how much children really needed all the vaccines recommended by the CDC.
When asked about the frequency with which parents expressed concerns about known vaccine effects and unproven effects, about one-third of all the physicians said they sometimes or often heard concerns about the kinds of effects listed on the CDC's Vaccine Information Statements (VIS), such as pain and fever. But a roughly equal proportion of all physicians said they sometimes or often hear parental concerns about effects that aren't on the VISs and haven't been shown to be linked to vaccines.
Pediatricians were more likely than family physicians to report that parents sometimes or often voiced concerns about effects listed on the VIS, as well as unsubstantiated risks of neurologic effects such as autism, and sudden infant death syndrome. There was no difference between the two groups in frequency of concerns they heard about chronic diseases (asthma, diabetes) allegedly linked to vaccination.
Freed says that the upward trend in parents' vaccine concerns has been suspected for years, as the news media, Internet sites, word-of-mouth and other mechanisms have spread allegations of serious unreported health effects from vaccines, including theories about vaccine preservatives and multiple-disease-preventing vaccines. But the new study quantifies the level to which those concerns are being expressed to physicians -- and shows how those physicians reacted to the concerns and refusals.
"Many of the worries that parents are voicing are addressed by the Vaccine Information Statements, and we found that the vast majority of physicians surveyed had those documents on hand to give to parents at the time of vaccination," says Freed. "But many other issues raised by parents aren't covered in a VIS, because there's no solid evidence linking them with vaccines. These concerns, which often involve fears of more serious health risks than the risks described in the VIS, are what we always need to be ready to respond to."
For parents who act on their concern by refusing to allow one or more vaccines to be given to their children, Freed notes that physician reaction varied in the survey data. Ninety percent of the physicians who encountered a single refusal said they noted it on the child's chart, and 19 percent said they required the parent to sign a record of their refusal -- a proportion that rose to 27 percent when all vaccines were refused.
Seventy-three percent of physicians encountering a parent who refused a single vaccine would discuss the vaccine again with the parent at a later visit, and an equal number said they provided additional information to the parent. The proportions were lower when the physicians were asked what they did for parents who refused all vaccines for their children.
"In all, we see that physicians are hearing both concerns and vaccination refusals on an increasing basis, but that they're trying to be sensitive by offering additional information," says Freed. "This kind of responsiveness needs to increase, especially when it comes to unsubstantiated and rumored risks, if we are to continue to be able to protect children from these vaccine-preventable diseases."
Freed's co-authors: Sarah J. Clark, MPH, Beth F. Hibbs, RN, MPH, and Jeanne Santoli, M.D., MPH.
Journal
American Journal of Preventive Medicine