This was going to be a Facebook post, but it got very long for that, so forgive me if I ramble:
I’ve seen a lot of posts recently about pediatricians refusing to treat children whose parents choose not to vaccinate. The statements from the doctors have ranged from “sorry, but we need to look out for the well-being of all our patients, and we have many who cannot be vaccinated who we are trying to protect” to basically “eff you, you anti-science scum”.
At first, I was on board with the mentality that if you are unvaccinated by choice, your pediatrician is making a wise decision in excluding you from the practice (although I wasn’t really happy with the “eff you” presentation some doctors have – bedside manner is really important). After thinking about it for a while, I’m conflicted.
I agree that doctors have a responsibility to protect the unvaccinated-by-requirement from the unvaccinated-by-choice – I’d be super pissed if Dylan caught a disease she hadn’t yet been vaccinated against from an anti-vaxxer’s kid at her doctor’s office. But we also have to consider what we’re doing to the child whose parents choose not to vaccinate.
Everything that follows is based on the following beliefs/assumptions:
1. The goal of people who are pro-vaccine should be to get as many people as possible vaccinated rather than ostracize those who aren’t.
2. We should do everything we can to make sure a child doesn’t suffer from the sins of his or her parents.
Allowing pediatricians to bar unvaccinated-by-choice children from their practices does nothing to further either of these!
-If pro-vax pediatricians don’t see children of anti-vaxxers, they’re basically giving up on the possibility of the child being vaccinated. That may help at-risk children while they are sitting in their office at that moment in time, but the public health concern still remains – the unvaccinated children are still in the community and still likely to pass any vaccine-preventable diseases they have to at-risk children. Barring anti-vaxxers’ kids from the practice basically lets the doctor say, “not my circus, not my monkeys”. I don’t know if we should reward or accept that perspective.
-If pro-vax pediatricians refuse to see children of anti-vaxxers, these parents have two options for their children’s care – see an anti-vax pediatrician or seek no medical care at all. I don’t think either of these is desirable. An anti-vax pediatrician is likely to hold other views that conflict with medical/scientific research and put the child’s health in further danger, and no medical care is expensive to the child later in life *and* to us (because we’re likely to be subsidizing that care with either our health insurance premiums or our Medicaid taxes).
So if I’m saying that pro-vax doctors shouldn’t bar children of anti-vaxxers (and I hope I’m remembering well not to say “anti-vax children” because the children aren’t anti-vaxxers) from their practices, what are our alternatives?
First is persistence on the part of the pediatrician. Every time a parent brings an unvaccinated child into the practice (and I do mean every – this includes immunocompromised kids), the pediatrician should inquire as to why and do their best to get the kid vaccinated. For immunocompromised kids, this may not be possible. For kids who had a reaction to the vaccine, maybe there’s a new vaccine that the kid may not react to – but if you don’t ask the parent and just accept “unvaccinated kid”, you can’t know. For kids whose parents chose not to vaccinate, the pediatrician needs to engage that parent about the reasons they aren’t vaccinating (“I understand that you’re worried about the ingredients in vaccines – can we discuss which ingredients you’re concerned about?”) and educate and advocate with love and logic. And they need to do it at every appointment until that kid is vaccinated. If the pediatrician truly approaches the matter with compassion and parent gets still gets mad and leaves the practice, that’s unfortunate, but neither ignoring the elephant in the room nor banning the parent from the practice gets that child vaccinated. Persistent education and advocacy *might* get the kid vaccinated; telling the parent they aren’t welcome *never* will.
But what do we do about the presence of anti-vaxxers’ kids co-mingling with our unprotected kids in the waiting room? That’s one I don’t have a good answer for. Maybe pediatricians can have blocks of time where they only schedule anti-vaxxer kids and fully immunized kids (who, granted, don’t have guaranteed immunity, but have a much better chance than a 9-month-old infant or a third grader on chemo)? Separate waiting rooms for pro-vax and anti-vax families? It’s a tricky situation, I know. But I firmly believe that working it out to give these children access to quality medical care and their parents persistent reminders of accurate medical information regarding vaccines is both the practical way to peak vaccination rates and our responsibility as a moral and ethical society to make the most effective health care possible accessible to all children.