International Conference Debates Vaccination Hesitancy and Parental Refusal

The Treuman Katz Center for Pediatric Bioethics at Seattle Children’s Hospital, the nation’s first center dedicated solely to the study of research and healthcare for children, concluded its second annual conference on Saturday, July 15, 2006 in Seattle.

Experts in the Field Discuss the Successes and Challenges of Childhood Vaccinations

The Treuman Katz Center for Pediatric Bioethics at Seattle Children’s Hospital, the nation’s first center dedicated solely to the study of research and healthcare for children, concluded its second annual conference on Saturday, July 15, 2006 in Seattle.


Stephen L. Cochi, MD, MPH, National Immunization Program, Centers for Disease Control, discussed the opportunities and challenges facing childhood vaccinations. Vaccines are one of the most important tools we have to protect the health of our nation’s most vulnerable citizens, our children, said Cochi.

In 1985 the number of vaccines in the routine childhood immunization schedule was 7; in 2006 that number reached 16. Vaccines are protecting more children against more diseases than ever before in history, said Cochi.

In spite of the success, physicians face several substantial challenges in providing vaccinations, including maintaining a steady supply of vaccines and addressing unfounded fears about vaccine safety. If we hope to prevent disease and reduce morbidity from vaccine preventable diseases, we must achieve and maintain public confidence in vaccines, said Cochi.

In order to maintain vaccine supplies, stockpiles of vaccines need to be expanded, support for regulatory agencies must be increased and streamlined, and national campaigns should be implemented to emphasize the value of vaccines.

Edgar K. Marcuse, MD, MPH, associate medical director at Children’s Hospital and Regional Medical Center and professor of pediatrics at the University of Washington, spoke to the conference attendees about the origins of immunization hesitancy.

“The majority of parents understand the benefits of immunizations and support existing policies, but many parents have important misconceptions that could erode their confidence in immunizations.”

Concern for safety is, by far, the most significant reason parents give for refusing vaccines for their children. Compared to parents who vaccinate their children, those who refuse tend to be older, better educated and of similar income and race.

Dr. Marcuse pointed to the dilemma pediatricians face from parents concerned about an association between thimerosal and autism.

While the evidence has overwhelmingly concluded that there is no association between thimerosal and autism, “most parents have no clear idea how to evaluate the credibility of the source of immunization information. The media value news over scientific ‘truth’, controversy over education, regard balance as evidence of journalistic integrity, and equate one expert with another.”

Douglas S. Diekema, MD, MPH, Treuman Katz Center for Pediatric Bioethics, Children’s Hospital and Regional Medical Center, and associate professor of pediatrics at the University of Washington, presented the case for vaccine refusal: parent conviction, child best-interest and community good.

Dr. Diekema posed the questions about parental duty to vaccinate their children and when is it justifiable to restrict individual freedom. Dr. Diekema argued that one circumstance that justifies that action would be when the action or decision places another individual at substantial risk of serious harm.

But that is only the case if no less restrictive alternative exists that would be equally effective at preventing the harm.

“Individuals have a duty to prevent harm to others in the population,” said Diekema. “Vaccination programs exist to reduce harm to those within the population. So, those who refuse vaccination may put others at risk of harm.”

Parents have several reasons for vaccine hesitancy. Dr. Diekema suggests that the physician’s obligation is to obtain parental consent to vaccinate and work respectfully with the family and physicians should not fire families who refuse to vaccinate, but instead continue dialogue with the family.

Showing respect for parental concerns is the best way to break through barriers. Parents need a clear understanding of what is at stake, Diekema concluded.

“This is the core fundamental to protecting kids,” said Diekema. “There is nothing we can do to protect them more than vaccinations.”

Joel Frader, MD, MA, Medical Humanities and Bioethics, Northwestern University spoke about the physician’s response to parents who refuse to vaccinate their children. In a random survey of 1004 American Academy of Pediatrics members, 39% of physicians said they would dismiss or fire a patient family if they refused all vaccinations, said Frader.

“Physicians who refuse to do these things are undermining the trust in their profession and do not advance the health and welfare of children”, said Frader. “They will ultimately drive children to care by less qualified individuals.”

Lainie Friedman Ross. MD. PhD, University of Chicago, MacLean Center for Clinical Medical Ethics, discussed the limits of requiring vaccines for children — public health versus individual autonomy. There are three universal vaccine exemptions: medical, religious and philosophical.

“In balancing public health and individual freedom, the state has an obligation to ensure that all nonexempt children are fully immunized”, said Ross. “State intervention becomes justifiable in times of epidemics when non-immunization poses risks to the public.”

More Information

For more information on the conference, visit the conference website.

To download b-roll of debates at the event please use the satellite coordinates below:

Monday, 17 July 2006
0330-0345 EDT (0030-0045 PDT)

  • C-Band: Galaxy 11, transponder 20 center
  • Orbital slot: 91° W.L.
  • Downlink Frequency: 4100 MHz V, Audio: 6.2/6.8 MHz
  • Trouble #s: (206) 404-4172, (206) 404-4013

About the Conference

The Treuman Katz Center for Pediatric Bioethics at Seattle Children’s Hospital, the nation’s first center dedicated solely to the study of research and health care for children, hosted its second annual conference on July 14-15, 2006 in Seattle.

The conference featured national experts leading discussions on vaccine policy, availability and research. Conference participants offered viewpoints on issues ranging from a parent’s right not to immunize their child to a physician’s right to “fire” a non-immunized patient.

Childhood vaccinations against a multitude of infectious agents have been hailed as one of the most important health interventions of the 20th century. Vaccinations have eradicated smallpox infection worldwide and polio in North America. Pediatric immunizations are responsible for preventing millions of childhood deaths each year.

Despite this success, some parts of the world have not benefited as much from vaccine development and delivery. Even in the United States, where most children have access to effective vaccines, some parents are reluctant to vaccinate their children.

About Seattle Children’s

Seattle Children’s Hospital, Foundation and Research Institute together deliver superior patient care, advance new discoveries and treatments through pediatric research, and raise funds to create better futures for patients. Consistently ranked as one of the top 10 children’s hospitals in the country by U.S. News & World Report, Seattle Children’s Hospital specializes in meeting the unique physical, emotional and developmental needs of children from infancy through young adulthood. Through the collaboration of physicians in nearly 60 pediatric subspecialties, Seattle Children’s Hospital provides inpatient, outpatient, diagnostic, surgical, rehabilitative, behavioral, and emergency and outreach services to families from around the world.

Located in downtown Seattle’s biotech corridor, Seattle Children’s Research Institute is pushing the boundaries of medical research to find cures for pediatric diseases and improve outcomes for children all over the world. Internationally recognized investigators and staff at the research institute are advancing new discoveries in cancer, genetics, immunology, pathology, infectious disease, injury prevention, bioethics and much more.

Seattle Children’s Hospital and Research Foundation and Seattle Children’s Hospital Guild Association work together to gather community support and raise funds for uncompensated care, clinical care and research. The foundation receives nearly 80,000 gifts each year, from lemonade stand proceeds to corporate sponsorships. Seattle Children’s Hospital Guild Association is the largest all-volunteer fundraising network for any hospital in the country, serving as the umbrella organization for 450 groups of people who turn an activity they love into a fundraiser. Support from the foundation and guild association makes it possible for Seattle Children’s care and research teams to improve the health and well-being of all kids.

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