Immunization anxiety growing

Anti-vaccine campaigns and the increasing popularity of alternative therapies are prompting more parents to question childhood vaccination programs

By Pamela Clarke

Dr. Peter Nieman, a Calgary pediatrician and father of four, says he sees more parents expressing concerns about the risks of vaccinating their children.

He anticipates that several factors, including the introduction of new vaccines, new methods of administering vaccines (intranasal and ingestion), coupled with an increase in anti-vaccine Web sites and the growing popularity of alternative therapies, will prompt even more people to question what was once a relatively undisputed pediatric practice.

In some provinces, cost to parents of vaccinating their children is a deterrent as well. In Ontario, it can cost parents with three children as much as $2,100 to cover the recommended vaccines, said Dr. Donna Reynolds, associate medical officer of health in Durham region.

Although there are no statistics available to support the assertion that rising parental anxiety will cause childhood immunization levels to decline, public health officials are aware of the grassroots trend.

"My concern is that it is increasing," said Dr. Nelson Ames, medical officer of health for the Interior Health Authority based in Nelson, B.C. "We were improving on (immunization) rates. Now we're levelling off."

He knows of pockets in his region where parents haven't immunized their children, but "they don't come to tell us." Some communities are lower than the provincial average "big time," he said, sometimes as much as 10% below the provincial figure of 93%, a level which has been stable for several years.

"We have some concerns about it lowering as there have been some quite active anti-vaccine programs and Web site campaigns launched. That always does have an impact on a cohort of children," said Dr. Perry Kendall, Provincial Health Officer for B.C.

Anti-vaccine literature

The biggest challenge for the medical community is keeping up with the anti-vaccine literature. "There's been a flurry of materials looking at the rise of autism, even diabetes and asthma, theories linking them to a variety of vaccines. It only takes one article in a medical journal raising the possibility of an association. Even if it's refuted by eight others, it still stands out as being an ironclad warning written by the expert who braves his colleagues to tell the truth," said Dr. Kendall.

"It's very easy to make an assertion, but to do the work to disprove the assertion can take time. We tend to be running behind," he said.

Contrary to many assumptions, parents choosing not to vaccinate their children are not necessarily "hippies."

"It appears they are highly educated and generally middle- to upper-income parents, making conscious decisions because they think the risk of being immunized is greater than the risk of the disease," said Dr. Ames.

The relatively recent introduction of varicella, pneumococcal and meningococcal C vaccinations has also caused some parents to question whether there's a limit to how many vaccines a child can handle.

"It's like marathon running: The more miles you put in, the more likely you'll get injured," said Dr. Nieman. "So the more vaccines you introduce, it has to have an effect on the immune system. The experts tell us it's negligible, don't worry."

He said he also expects new methods of administering a vaccine, such as the intranasal flu vaccines that are now available for healthy children over the age of five, will raise a host of new questions from parents, such as: "What if the kids have allergies? What if they sneeze? Do we revaccinate?"

Paying for vaccines

Another hurdle is getting people accustomed to paying for vaccinations that aren't available free from the public health department.

Dr. Nieman has parents in his community pediatric practice who have decided not to vaccinate their children at all.

"Some of my colleagues have asked people to sign a form for medical/legal reasons. I don't do that. I just document it in the chart and have the discussion," he said. "You can offend some parents if you ask them to sign a document that they've been warned about the dangers of no vaccinations.

"The worst is when some doctors ask the patients to leave their practice," he added. Dr. Nieman chooses to work with the parents, saying: "I'm the advocate for the child and somebody has to guide the parents." He often refers them to peer-reviewed Web sites for information such as www.vaccine safety.edu. "I encourage them to do the research."

"I tell my patients that I'm neither pro nor con. I just deal with the facts," Dr. Nieman said.

While there are yet to be negative ramifications of having pockets of non-immunized people, Dr. Ames said he is concerned about what the future holds. "The 'I'm OK, it's your problem' attitude will ultimately cause problems.

"The altruistic part of me has a problem with that. Immunization isn't just for you, it's for the community," he said. "A core group of people immunized provides protection for all of us."

Dr. Nieman concluded: "Vaccines work so darn well that people forget what happens if we don't vaccinate."