Saturday, December 17, 2016

Vaccine Pot Pourri

Warning:  If you come to my medical practice, you may be exposed to un-immunized or "under-immunized" children. 

I believe that informed parents are the ones who make healthcare decisions for their children.  Ohio is one of about 13 states that allow parents to accept or refuse any or all recommended immunizations, so parents are in the drivers seat about vaccines.  "Informed Parents" is a key concept in this process.  Physicians are obligated to help the parents to understand the diseases and immunizations in question.  This is a process, not an event.  It is helped considerably by information access via the internet.  We can review information from the Center for Disease Control (CDC): vaccines and preventable diseases and who should not get these vaccines to clarify some of the basic information and go to many other sites to explore further information as desired by the parents.

These discussions are important but often very complex.  Many physicians are time constrained from going very far into the discussion.  A few are angered by parents who don't accept whatever is recommended enthusiastically.  Most parents are pleased to have the vaccines for their children.  Many want to hear more about the potential benefits and harms of the vaccines.  A few want to know more about the potential dangers (and benefits) of the diseases versus the risks and benefits of the vaccines.

I like vaccines for most people.  I like freedom of choice, too.  The concept of the "Greater Good" is a balancer in public health and in medical decision making about vaccine preventable diseases and vaccines.  These concepts go back to the principles of medical ethics, which I reflect on every day.  

  • Principle of respect for autonomy,
  • Principle of nonmaleficence,
  • Principle of beneficence, and.
  • Principle of justice.

I encourage you to look up the Principles of Medical Ethics for an array of definitions of these terms.  Decisions can be shrouded in gray from time to time and generate considerable discussion.  Vaccines versus genetic vulnerability to negative effects of vaccines is a challenging and complex discussion that is often overlooked or misunderstood.  The CDC is sensitive to this issue, but more front line genetic information is needed to identify the small group of vulnerable children and adults who need to stay away from certain vaccines.  The changing nature of microbes is another challenge, especially pertussis.  How do you immunize people from a disease that keeps evolving?

"The ideas that everyone has to get vaccinated for the “greater good,” and that it is acceptable for some children to be sacrificed for the welfare of the rest, does not feel quite right when one-size-fits-all vaccine policies end up targeting the genetically vulnerable as expendable."  From:

Barbara Loe Fisher

We are confronted with many diseases while we are blessed with some great vaccines and some great freedoms.  At the confluence of these, each individual gets to decide how to proceed.  Physicians, patients and parents have responsibilities to do our best to help each other and our society.

What do you think?

1 comment:

  1. I have solved this issue by only doing house calls. Therefore, parents do not have to worry about bringing their child into my office where they may be other unvaccinated children, because "my office" is their home. So, if there are any unvaccinated children there, it is because they chose not to vaccinate!