Dear doctor no longer seeing vaccine-hesitant families,

I know that creating your “no tolerance” office-wide vaccine policy was not easy or came without soul-searching. I can only imagine the heated boardroom meetings and passionate arguments throughout the weeks the policy was being drafted. I trust it is because of your support and love for the families you currently care for that you felt the need to create the policy, and it is with a heavy heart you are watching some families now leave your care.

As a fellow pediatrician in your community, we share the same commitment to providing optimal care to the patients we serve. We both believe fully in the safety and efficacy of vaccines, including the vaccines that we have given on schedule to our own children. We never promote or encourage a non-standard vaccine schedule to any of our families, as evidence suggests this creates an increased risk of illness and death to children. We publicly support vaccination in local and national media. We share the same desire of wanting our families to feel safe in our offices, when well or sick.

It is my opinion, however, that your new policy to exclude the vaccine-hesitant from your office is failing in both evidence and ethical ground. The policy falsely promotes safety to your current patients; it threatens to weaken the health of the community we share, and it cripples the impact of our future pediatricians.

The claim that your vaccine policy increases safety for your families is not founded in evidence, and falsely promotes security.

You may feel that your policy is helping your patients. Anecdotally, you may even experience more families vaccinating under your guidance. The challenge, however, is that we share the need for scientific evidence to make medical decisions; not feelings or anecdote. To date, there is no evidence that an individual medical practice vaccine policy increases patient safety within a medical office. Claiming otherwise misrepresents true infectious risk to your patients, while falsely promoting increased security.

Multiple analyses have been performed surrounding vaccine-preventable disease outbreaks in the past. The results suggest illnesses such as measles and pertussis are spread primarily in public areas and in local ERs, not in physician offices. The few instances in which infections did originate in offices were in areas with sub-optimal vaccination rates or endemic disease.

Our daily reality, even under the most stringent restrictions, is that we all have under-vaccinated children in our offices every day; notably all children under the age of 1. In addition, few vaccinated children have an imperfect response to the vaccine and leave themselves at risk. When these kids arrive ill at our door, there is no guarantee they don’t harbor a significant illness. More practically, ill parents bring children into our clinics every day without us demanding their adult vaccine records. As you know, in recent outbreaks, adults are often the primary vector spreading illness to children, not the other way around.

These real-life dynamics exist in both our waiting rooms, regardless of policy; leaving your claim of protection emotional and short-sighted at best, opportunistic and promotional at worst.

This is not just about your waiting room. It’s about our city.

But even if this were true — that you were creating your office to be a more protective space– no studies have shown such a policy to increase community vaccination rates. It is community vaccination rates that are most protective for our families, not individual office waiting room rates.

By shutting your doors to the vaccine-questioning, and if more practices follow your lead, our community could develop a greater risk of disease. The under-immunized will be driven to our local ERs, urgent care centers, and sub-optimal providers; often sending these children and all future siblings to care providers with little to no training in immunology or vaccinology.

At extreme, the under-immunized will increase in number within the few health spaces that still allow them to pass the threshold, potentially forcing a geographic pocket with dangerously low herd immunity. You now have the making of an epidemic as the under-vaccinated cluster together, waiting for care; then return to work, school, churches, day cares, and play spaces all over our community.

Mathematical models suggest equal distribution of the under-immunized throughout a community is safer for the children of the community as a whole.  The small number of under-immunized are best served in equal distribution among all of us who provide passionate care for the welfare of all children. They are best served by those of us who have sacrificed life-years for exceptional education in child health, and by a group of leaders that share equally in the responsibility for our city.

In turn, our city deserves our greatest collective effort to provide a chance for every child in our community to be vaccinated. We may be their only hope.

We cannot create a weakness in the next generation of pediatricians.

Vaccine hesitancy is as old as the smallpox vaccine and will continue well after we have passed the care of our patients to the next generation of pediatricians. We have an obligation today to empower, train, and educate the next generation of doctors in effective science communication and unparalleled vaccine knowledge. This education cannot happen without allowing medical residents to sit across from families who love their kids and set the record straight about vaccines.

I believe our obligation to promote science continues past our few years of service. We can facilitate a legacy of passionate vaccine educators by having pediatricians-in-training watch what we do, practice what we teach, and then carry that skill forward to a new generation of children. If an increasing number of attending physicians limit the opportunities for vaccine dialog in their offices, how can we ensure this training will be adequate?

Doctor, I have felt the sting of rejection when my efforts to get a child vaccinated have fallen short. It hurts and oozes. And especially in times of disease outbreak, it haunts. But meeting that rejection with an ultimatum of our own does not help the child coming to us for care. It does not help our community where we work and play together. It does not serve the mission in which we are called to serve as pediatricians. It benefits no one.

Consider expanding your policy restrictions to include the allowance of agreed conditions, so more children have the chance to be fully vaccinated by the age of 2 under your care. Allow more time for discussion and dialog throughout formative years to build trust and reliance in those of us most educated in child health.

Sincerely,

Dr. Natasha

Natasha Burgert is a pediatrician who blogs at KC Kids Doc.