Ask Dr. Gramma Karen: Family Members Disagree on Vaccinations for Children

child getting vaccine
Photo By Volodymyr Maksymchuk/shutterstock

There seems to be a lot in the news about parents opposed to vaccinations. They claim they have read the research and don’t want to take the risk of their child getting autism or having other side effects.

What advice you would you offer when some family members are opposed to getting their children or grandchildren vaccinated? For example, a young mom and dad disagree, or the grandparents disagree with the young parents.

What if someone in the family took a child/grandchild to be vaccinated against the wishes of another family member?

Your thoughts?

The issue of children’s vaccinations is important for two main reasons: (1) vaccinations have to do with life and death issues; (2) the number of parents opting out from medically recommended vaccinations has increased in the last few years.

The Pro-Vaccination and Anti-Vaccination Debate

This increase in unvaccinated children has had dire results. For example, during a California outbreak of pertussis (whooping cough) in 2010, more than 9,000 cases were reported, and 10 infants died. It was the worst outbreak of whooping cough in 60 years. California “hot spots” with unusually high rates of children not being vaccinated were identified; e.g., almost 15% of kindergartners in the affluent communities of Malibu and Santa Monica did not get vaccinated, and 27.5% were reported for the Montecito Union School District in Santa Barbara. These percentages of unvaccinated youngsters are, in some cases, four and five times higher than just 10 years ago.

In her new book, On Immunity: An Inoculation, award-winning author Eula Biss explains why there has been a rise in the number of unvaccinated children. Many parents opposed to vaccinations cite social issues for their position. They believe that there is a conspiracy between government and vaccination developers falsely claiming that vaccines do not cause diseases such as autism. Even though there is no evidence linking children’s vaccinations and autism, many parents continue to disbelieve the science and contend that profit-driven big pharmaceuticals cannot be trusted to release truthful information about the safety of vaccinations; that their parental rights are being trampled by mandates to get their children vaccinated.

Ms. Biss points out that many parents opposed to vaccinations are highly-educated, involved parents who are trying to do what they believe is right for their children. In their defense, parents who say there are risks associated with vaccinations are, in fact, on solid ground. As pointed out by Jeffrey Kluger, who oversees TIME’s science and technology reporting, there are risks associated with vaccinations, but looking at the side effects reported from 1989, an “ . . . approximate generation-long period during which 78 million American children were safely vaccinated, preventing an estimated 322 million illnesses and 732,000 deaths. If you’re crunching the numbers (and it’s not hard to do) that factors out to a .0048% risk of developing what is overwhelmingly likely to be a transient [temporary] problem – in exchange for a lifetime of immunity from multiple lethal diseases”.

The nub of the contention between parents who vaccinate their children and those who don’t comes down to understanding how the rise of personal-belief exemptions (PBEs) impacts “herd immunity.”

Read Next | What Shots Does My Baby Receive and When?

Personal Belief Exemptions (PBEs)

PBEs: “All fifty states have legislation requiring specified vaccines for students. Although exemptions vary from state to state, all school immunization laws grant exemptions to children for medical reasons. Almost all states, except Mississippi and West Virginia, grant religious exemptions for people who have religious beliefs against immunizations. Nineteen states allow philosophical exemptions for those who object to immunizations because of a personal, moral or other beliefs.”

The use of PBEs has significantly increased. Extreme, but noteworthy examples cited by reporter Gary Baum: “The parents of 57 percent of the children at a Beverly Hills preschool and of 68 percent at one in Santa Monica had filed personal-belief exemptions from having their kids vaccinated”.

Herd Immunity

Herd immunity arises when a high percentage of the population is protected through vaccination against a virus or bacteria, making it difficult for a disease to spread because there are so few susceptible people left to infect. As explained by Johns Hopkins University’s Jessica Atwell, the required percentage of vaccinations to ensure herd immunity varies by disease: for pertussis (whooping cough) and measles, it’s between 93 and 95 percent.

Atwell explains that “So if even a seemingly small number of kids across the state aren’t getting their shots, the immunity rate of the entire community can drop below safe levels. When that happens, lots of people are put at risk: infants who are too young to get shots, children who haven’t had their full series of shots yet, and those who can’t get vaccinated for medical reasons such as pregnancy or immune-system problems. And, of course, the exempted, unvaccinated children are also at risk”.

In a nutshell: the 93 to 95 percent herd immunity requirements become jeopardized in a given community when the number of PBEs for young children exceeds 5%. Hence, the bitterness parents of vaccinated kids have towards parents opposed to vaccinations.

Read Next | What Do You Do When Religious Neighbors Start Proselytizing to Your Kids?

Efforts to Decrease Number of PBEs

Legislators and pediatricians are the two main groups that are reducing the number of PBEs. Legislation in Washington, Oregon, and California (with bills in process in other states) is having significant impact by: (1) requiring parents with PBEs to reauthorize their exemptions on a regular basis; (2) providing online data and information about vaccinations; (3) requiring a doctor’s signature on a PBE. This third action has resulted in one-on-one consultations in which a pediatrician can try to influence an anti-vaccination parent to reevaluate his/her decision.

Also, because most pediatricians consider preventing disease through vaccines a primary goal of their job, parents seeking a doctor to sign off on a PBE often end up talking with several pediatricians because it is difficult to find a pediatrician who opposes vaccinations. After hearing several pediatricians explain why they support and insist on vaccinations, many parents decide to get their children vaccinated.

Regarding your questions about family members not being in agreement about getting the children/grandchildren vaccinated, here is what I have learned:

  • Most pediatricians will refuse to continue to care for children who are not vaccinated. They do not want unvaccinated people in their waiting rooms exposing others who are too young to be vaccinated or have medical issues precluding them from receiving vaccinations. In addition, as family medicine practitioner Kristin Bissell, M.D., a member of The Hartford Healthcare Medical Group, points out, “In addition to exposing other patients, if an unvaccinated child presents with an illness, we are forced to consider diseases that we have never even seen in the course of our training.”
  • Any custodial parent can have his/her child vaccinated. If two custodial parents are in disagreement, that is a domestic issue unless one parent takes legal action against the other. The courts tend to rule in favor of the parent who wants his/her child vaccinated. (Google “legal battles when one parent is anti-vaccination” for specific cases.)
  • Anyone besides a custodial parent who brings a child in for vaccinations would need written authorization from a custodial parent; some pediatricians require the authorization to be notarized.

I hope this information helps you and your family to make decisions to keep everyone as healthy as possible, as well as decrease the chances of any of them putting at risk other family members or others with whom they interact.

Ask Dr. Gramma Karen is published every other Tuesday.
E-mail queries to [email protected]

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Ask Dr. Gramma Karen: Helping Young Parents and Grandparents Deal with Thorny Issues

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The views and opinions expressed on this blog are purely the blog contributor’s. Any product claim, statistic, quote or other representation about a product or service should be verified with the manufacturer or provider. Writers may have conflicts of interest, and their opinions are their own.

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