In 2008, President Obama suggested vaccines might be causing autism. In 2009, during the H1N1 swine flu pandemic, there was quickly a vaccine shortage, because the government refused to allow adjuvants, to boost vaccine effectiveness and use less raw material, or multi-dose vials, because they contained a preservative anti-vaccine believers claimed caused autism. 274,000 Americans were hospitalized.

Given the anti-science waffling at the highest levels of government, it is little surprise anti-vaccine sentiment has increasingly taken hold the same way global warming denial has. Today, hotbeds of unvaccinated schools have led to new outbreaks, originating in places like metropolitan San Francisco and Los Angeles. Given all that, it is no surprise that pediatricians are under increasing pressure from parents to ignore sound medical science and adapt the precautionary principle, by 'spreading out' the recommended vaccine schedule for their children and postponing vaccines to avoid a 'toxic cocktail' that residents of places like Marin County and Hollywood insist can harm infants., pointing to a need for improved programs that support timely vaccinations.

A new paper in Pediatrics found that almost all pediatricians and health care providers encounter requests to spread out vaccines and that, despite risks, which is increasing numbers of physicians are agreeing to do so.

"Many physicians reported tension between the need to build trust with families by being willing to compromise on the schedule while simultaneously feeling they were putting children at risk and causing them unnecessary pain by spreading out vaccines on multiple visits," writes Allison Kempe, MD, MPH, professor of pediatrics and director of ACCORDS (Adult and Child Center for Health Outcomes Research and Delivery Science) at the University of Colorado School of Medicine and Children's Hospital Colorado.

Pediatricians and family physicians responded to email and mail surveys between June through October 2012 on the frequency of requests to spread out the recommended vaccine schedule from parents with children under two years of age.

In an average month, 93 percent of respondents reported requests from parents to spread out vaccinations and roughly one-fifth of respondents reported that 10 percent or more of parents made such requests. The majority of providers report agreeing to do so either "often/always" or "sometimes," even though the majority (87 percent) of respondents also said those delays put children at risk for contracting vaccine preventable diseases and thought it was more painful for children to bring them back repeatedly for separate injections (84 percent).

The majority of respondents also felt that they would build trust with families if they agreed to spread out the vaccines, and if they did not agree, families might leave their practice. Physicians reported a wide variety of reasons that parents reported for wanting to spread out the vaccines, including short- and long-term complications, belief that their child is unlikely to get a vaccine-preventable disease, and concern that their child would develop autism.

Most physicians reported using many different strategies to convince parents to stick with the recommended vaccine schedule, but few of those were considered effective. Kempe and her co-authors write that delaying or spreading out vaccines results in higher rates of under-vaccination and puts children and other vulnerable people in the population at risk for vaccine preventable diseases with potentially severe outcomes. 

Discussions and interventions need to begin in early in pregnancy for parents who are questioning vaccine safety and efficacy. Social networks, public messaging and perpetuation of strong social norms for vaccination have been shown to play an important role in shaping some parents' vaccination decisions and should be better utilized. Ultimately, the authors conclude, additional study needs to be directed at finding effective ways of countering misinformation about vaccines being dangerous and at convincing vaccine-hesitant parents to follow the recommended vaccine schedule.

The study was funded by the Centers for Disease Control and Prevention and administered through the Rocky Mountain Prevention Research Center at the University of Colorado Anschutz Medical Campus.

Article: "Pediatrician Response to Parental Requests to Spread Out the Recommended Vaccine Schedule", upcoming in the April issue of Pediatrics.