Informed Dissent

Just when we thought the controversy of immunization had reached its height, there is yet a new twist being brought to the California legislature. While many parents with school-aged children have been documenting their refusal to have their children immunized with signed waivers brought to school officials, there is now a plan afoot to mandate that these families meet with a health care provider before they sign these waivers. Before they sign these waivers? And that needs to be a law? Where have their doctors been until now?

When my children received their immunizations (on the schedule recommended by both the Centers for Disease Control and the American Academy of Pediatrics, I might add), my pediatrician explained which vaccines they were receiving, what these vaccines would protect against, and what risks were possible with each vaccine: Some may cause fever, some may cause a rash or swelling, some may cause a minor flu-like illness. Some of them cause pain at the injection site for a day or two. The chicken pox (varicella) vaccine, in rare instances, may even cause the chicken pox. Are there potential serious risks? Yes. There are rare allergic reactions, dangerously high fevers, and other awful, sometimes life-threatening reactions that occur in less than 0.001% of those who receive protection against diseases that used to decimate populations. I then give my pediatrician informed consent. Each time.
What amazes me is that pediatricians and primary care physicians who do not immunize patients, or who casually comply with a parent’s choice not to immunize a child, DO NOT review the risks of NOT immunizing every child. I know a mom with three school-aged children whose pediatrician, by routine, does not immunize his patients. Recently, this concerned mother of children ages four to eight asked me, now that her kids are older and presumably less susceptible to immunization-related complications, which vaccines I thought were important to give her kids. Which vaccines I thought were important? Is this really a question we have to ask? “Has your pediatrician ever discussed this?” I asked. “No”. Okay, then. Let’s explore what the Flu, Pertussis, Measles, Mumps, and Polio, to name a few, have to offer the unprotected child.

Well, the flu is a drag. Every flu season, UCLA’s pediatric intensive care unit is filled with previously healthy children suffering from complications of the flu, ranging from high fevers to respiratory failure. Pertussis (whooping cough) is a bummer, and not just because of that noisy cough. It’s an epidemic in many states, including California, and can lead to severe coughing spells, to the point of the child passing out, turning blue, and vomiting every day for 3 to 4 months. If an unimmunized child develops pertussis, and exposes that five-month-old baby down the block, that baby can die. Measles is not pretty; this virus can lead to complications including bronchitis, pneumonia, ear infections, hearing loss, and in one out of 1000 cases even encephalitis (swelling and infection in the brain). Mumps can lead to permanent sterility. And polio, a viral disease that affects the nerves, is really no fun; it can lead to partial or full irreversible paralysis.
But it’s not up to this mom to know and understand all of this. It behooves her pediatrician to clearly state, at each visit, which immunizations her child is NOT receiving, why he is not receiving them, what he will NOT be protected against, what the risks of each illness is, and what the potential complications of each illness may be. Then she can make an informed decision. Informed dissent. Each time.

Apparently, a lot of people, in addition to the mom I mentioned, are asking about the necessary vaccines, because the California State Senate passed AB2109, which mandates that parents consult with a health care provider to discuss the pros and cons of immunization and that said nurse, physician’s assistant, nurse practitioner, or medical, osteopathic, or naturopathic doctor must sign a form attesting to the meeting, before the parent’s signed waiver will be accepted by a California school.

There shouldn’t have to be a law that parents have to meet with a doctor to get a waiver signed. The meeting should have occurred beginning at the baby’s two-month check-up, at the latest. It is the physician’s responsibility to explain to each family why he has chosen to treat their child differently from what the American Academy of Pediatrics and The Centers for Disease Control recommend every year for all children. Each time.

-Nina L. Shapiro, MD