Paul Offit, MD, FAAP

In one week in June, Fresno County, California, reported 229 cases of pertussis, compared with 27 for all of 2009, just one more example of a disease spreading when a vaccine is readily available to prevent it.

The problem of how pediatric professionals should deal with parental concerns about vaccines will be addressed October 4 during an NCE plenary presentation, "America's Anti-Vaccine Movement: A Perspective" (P3070).

"I think we're a little beyond the tipping point, which is to say the current fear of vaccines has now caused an increase in the number of outbreaks of vaccine-preventable diseases," said Paul Offit, MD, FAAP, chief of infectious diseases at the Children's Hospital of Philadelphia and professor of pediatrics at the University of Pennsylvania School of Medicine.

"Herd immunity has broken down," he said. "The purpose of this talk is to examine the birth of the modern American anti-vaccine movement, its strategies, its backers and its impact, and where we are going from here, including possible solutions for this problem. The question is ‘What changes this?' and maybe the answer is that the only thing that changes this is there has to be enough of these diseases coming back that people are so frightened of the diseases that they are compelled again to vaccinate."

The answer could also lie in the old political adage that "all politics is local" and applying it to medicine, Dr Offit said.

"I think that's true here, too. I think that all education about vaccines is at some level local. You can depend on the CDC or the AAP to run national campaigns to raise awareness about the importance of immunization, but ultimately it comes down to the pediatrician. It is the pediatrician where the rubber meets the road in vaccines, along with the nurses and nurse practitioners," he said.

As an example of a local educational opportunity, Dr Offit recounted the recent case of a woman who refused the Tdap vaccine recommended for all new mothers. The nurse who suggested the vaccine did not press the argument by informing the mother that she could expose her newborn to pertussis, which had recently caused the death of another newborn.

"The nurse just said ‘OK' and walked out. That is an interaction where you could potentially save a life, and yet it wasn't pursued by the nurse," Dr Offit said. "That is where you can have more of an impact than any of these national campaigns. That's what matters the most."

Besides the unwarranted fears of side effects of vaccines in the face of scientific evidence to the contrary, pediatric professionals must also deal with parents who do not want children to get so many shots, as well as inadequate funding for vaccines, he said.

"It's hard for the pediatricians. It's not hard to imagine why it is that some of them have not been zealous about getting kids vaccinated on time," Dr Offit said. "The Academy's stance has been ‘work with the parents.' If they want to space out, separate, delay or withhold vaccines, that's OK, but just keep working with them. It's hard to know what the right answer is. Some pediatricians follow that advice to ‘work with the parents' and some don't."

In response, some practices have stopped treating children whose families refuse to allow vaccinations, but that may not be the answer, he said.

"You could argue reasonably that you just lost any chance to convince those parents otherwise, and there are always going to be others who are going to be willing to play it their way," Dr Offit said. "So the question is ‘Which strategy works?' Maybe it is different strategies for different people. That's a testable hypothesis that hasn't really been tested. Sometimes if you limit people's options they are more likely to comply.

"I will talk about what the problem is and possible solutions to the problem. I do think the solutions are local. We always tend to look to our national agencies to stem the tide, but it ultimately comes down to how important the physician, nurse or nurse practitioner thinks the vaccine is."