As the current measles outbreak has stretched from California to New York, the loud and emotional debate over vaccinations has swelled up in doctors' offices, kitchens and offices across Georgia.
Although the state has yet to see a case of measles, some parents who have chosen not to vaccinate are reconsidering their position. Others are digging in. All the while, area doctors are seeing an uptick in appointments for vaccinations, even as they try to figure out ways to get reluctant parents to weigh the potential consequences of opting out.
“All parents want to keep their babies safe,” said Dr. Saad Omer, a leading international vaccine researcher and an associate professor of global health, epidemiology and pediatrics at Emory University.
How to do that is the issue.
Respecting parents’ concerns
Dr. Deneta Sells, founder of Intown Pediatric and Adolescent Medicine in Atlanta, has seen her office swamped with parents worried about the measles. A significant number, but not a majority, of those parents are those who did one round of vaccinations for their children but did not get subsequent booster shots as recommended by the Centers for Disease Control and Prevention.
Dr. Sells said few parents flatly reject vaccinations (the CDC estimates just 3 or 4 percent), but she worries about them most.
“I respectfully tell them that I disagree,” Sells said. “I ask them every time they come in if they’ve changed their minds.
“Some just really believe it’s not necessary. They say they’ll pray or they’ll take their chances with nature, or they don’t want to put something they think isn’t natural into their children’s bodies. It blows my mind.”
One thing she does not do is turn unvaccinated children away, as some doctors do.
“If you kick them out, you can’t convince them. If we turn them away they’ll go find a provider or practitioner who believes as they do, and then they never get the shots,” Sells said.
When to vaccinate?
Dr. Marion Owen of Whole Family Medicine in Decatur said many parents have come to her after being “fired” by other doctors who refuse to treat unvaccinated kids.
She prefers that all children be fully vaccinated, she said, but she doesn’t adhere to the CDC immunization schedule, which calls for most vaccines to be given before a child is 18 months old.
Vaccinating an infant or toddler against serious childhood illnesses is urgent and necessary, she said. But, in her view, vaccinating against adult diseases such as hepatitis can wait, allowing the immune system to mature and strengthen as it learns to combat colds and other less serious threats.
“I try to respect the immune system’s process and not interfere with it,” Owen said.
She can take that approach, she said, because the parents she serves have both the inclination and the means to bring their children in often. When she served a population for whom doctor visits were a rarity, she followed the CDC schedule.
Omer, the vaccine researcher, disagrees with that position, saying it unnecessarily puts children at risk. The practice of delayed administration has risen almost in lock-step with the decline of certain diseases, he said. People who have not lived through epidemics that sickened and crippled millions now focus on the side effects of the vaccines, because that is all they see.
“Vaccines are a victim of their own success,” he said.
And CDC epidemiologist Philip J. Smith said the agency’s recommended schedule has been shown again and again to be the best way “to protect the health of the most vulnerable portion of the population.”
A good record
Georgia has been strong over the past several years in terms of vaccination rates of kindergarten-aged children, with less than 1 percent qualifying for exemptions in the 2013-14 school year.
All states allow for medical exemptions for children undergoing chemotherapy or who have auto-immune disorders. Some states also allow for philosophical or religious exemptions. Georgia allows only for refusal based on religious belief.
Paradoxically, the relative rarity of unvaccinated children can create a false sense of security among the parents of those children, researchers say. Omer calls it “the free rider problem.” But parents are wrong to assume that their child is protected because he or she is surrounded by children who have been vaccinated, he said.
Smith, who has studied why parents do or don’t vaccinate their children, said the most critical element is the level of trust between the parent and the child’s doctor. That outweighs other factors, such as the parent’s perception of how serious a threat a disease poses or whether vaccines work, he said.
“If (trust) is not there, not much can be done,” he said. Building trust, he said, requires a doctor to spend time with parents, “listening to parents’ concerns, being mindful of parents’ concerns, and being respectful.”
At the same time, he said, doctors must never give up, broaching the subject of immunizations every time they see a child who is not fully vaccinated.
“All kids need to be vaccinated against measles,” he said.
Met with hostility
None of this has changed the mind of Lisa Provost.
Provost, 42, and her husband have daughters ages 10 and 8. Ironically, their children have been vaccinated, though they have not gotten the recommended booster shots.
Provost said when she had her first child, she and her husband were “full-on vaccination.” But after the oldest child got her first round of vaccines as a baby, she developed a severe case of eczema all over her body. She then developed asthma.
After that, “I began to do the uncomfortable research on vaccines,” Provost said. “I didn’t want to find information that the things I was supposed to do for my child, that were supposedly good, were potentially dangerous.”
She and her husband eventually took their child to a homeopathic practitioner and eventually made the decision to stop vaccinating both children. The youngest had had a round of shots by then, but hasn’t since.
Provost said she understands parents who make the choice to vaccinate, but she believes the vaccines caused at least one of her children harm.
She is also aware that her position is one under fire as measles spread from state to state. When she tells people, “more often than not I’m met with hostility,” she said. “I’m immediately reclassified as a crazy conspiracy theorist.”
To her, however, she is doing what is in her children’s best interest.
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