review of the scientific literature and the public testimony identified the lack of parental trust in vaccines and vaccine safety to be an important concern. Overall, a large majority of parents rely on the professional advice they receive from their child’s doctor or health care provider, and they report high levels of trust in their doctor’s advice (Freed et al., 2011). However, a recent study reported that 26 percent of parents trusted celebrities as a reliable source of information on the safety of vaccines (Freed et al., 2011). Thus, although the relationship between the parent and the child’s health care provider is a strong determinant of decision making about childhood vaccines, some parents rely on nonprofessional sources of information to make the same decisions (Gust et al., 2008; Serpell and Green, 2006).

In some cases, pediatricians may dismiss parents from their practice if the parents decline vaccines, delay vaccinations, or base their decisions on unscientific information (Flanagan-Klygis et al., 2005). For example, a 2011 study reported that more than 30 percent of Connecticut pediatricians have dismissed families because of their refusal to immunize their children (Leib et al., 2011). AAP discourages the dismissal of parents on the basis of their refusal to immunize their children (Diekema and the AAP Committee on Bioethics, 2005). Furthermore, AAP believes that providers should maintain a relationship with families that decline immunizations so that children continue to receive appropriate medical care. In addition to the value of that care, the continuing relationship provides an opportunity for the pediatrician to encourage parents to consider immunization of their children in the future (Diekema and the AAP Committee on Bioethics, 2005). The committee also notes that the dismissal of families from pediatric practices could further erode trust in the health care system.

A recent study of 209 pediatricians in Washington State reported that parental requests for alternative immunization schedules are not uncommon (Wightman et al., 2011). Overall, 61 percent of these pediatricians agreed that they were comfortable using different schedules if the parents made this request. The three vaccines that most pediatricians were willing to delay were the hepatitis B vaccine (69 percent), varicella vaccine (53 percent), and inactivated poliovirus vaccine (45 percent) (Wightman et al., 2011).

Based on the literature review and public testimony, the committee noted the importance of providers’ knowledge of vaccine safety. Furthermore, the committee found it to be essential that providers use a communication style that elicits parents’ concerns and encourages respectful dialogue to address divergent opinions. Even though health care providers may focus on the benefits of childhood immunizations, they may not adequately discuss the anticipated, higher-prevalence side effects or the potential events that are significantly more rare and severe. Therefore, based on the review of the scientific literature and the public input, the committee believes that



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