Studies Probe Attitudes of Physicians Toward Vaccines and Patients Who Shun Vaccines

Younger physicians express more skepticism about vaccine safety or efficacy, a survey has found. (Image: Sean Locke/

Physicians’ personal attitudes toward vaccine safety, as well as their approaches to handling parents who refuse to have their children vaccinated, were highlighted in 2 studies presented at the Infectious Diseases Society of America meeting in Boston.

A survey of 551 primary care physicians by Saad B. Omer, MPH, PhD, MBBS, assistant professor of global health at Emory University’s Rollins School of Public Health, found that while physician support for vaccination remains very high in general, younger physicians were more likely than older ones to express concern about the safety or efficacy of vaccines. Younger physicians were 15% less likely to believe in the efficacy of vaccines than their older counterparts.

In addition, those who had graduated from medical school more recently were more likely than their more experienced counterparts to express skepticism about the safety of the inactivated polio vaccine; the oral polio vaccine; the measles, mumps, and rubella vaccine; and the varicella vaccine. Omer attributed the differences to decreasing experience with vaccine-preventable illnesses among younger physicians.

“If you have seen a case of whooping cough or treated Haemophilus influenza type b meningitis, that experience is more visceral,” Omer said. “That [experience] may have an impact at an individual and institutional level.”

Bruce Gellin, MD, MPH, director of the National Vaccine Program at the US Department of Health and Human Services, who moderated a press briefing about the results of these studies, said that this trend of increasing vaccine skepticism parallels changing attitudes seen in society at large, as fewer individuals have experience with the consequences of vaccine-preventable illnesses. These trends suggest an area where greater education efforts are needed, he noted.

A second survey of 909 Midwestern pediatricians found these clinicians frequently encounter vaccine skepticism or vaccine refusal from parents, although the rates of such parental skepticism vary widely. These pediatricians reported that the percentage of parents who sought to alter vaccine schedules varied per practice from 1% to 50%, while the percentage of parents who refused vaccines outright also varied from practice to practice, from a low of 0% to a high of 40%.

“Vaccine avoidance was a problem in every state we surveyed,” said Thomas W Tryon, MD, associate professor of pediatrics at the University of Missouri-Kansas City School of Medicine and immediate past president of the Missouri chapter of the American Academy of Pediatrics who presented the results.

Such concerns were most often directed at the measles, mumps, rubella vaccine; the human papillomavirus vaccine; and the influenza vaccine. The number 1 way physicians respond to such skepticism is to offer counseling to the parents, with more than 60% of physicians referring parents to evidence-based literature. Overall, about 21% of physicians surveyed reported they would dismiss from their practice parents who refused to allow their children to be vaccinated; rates varied greatly from state to state, with 0.9% of Minnesota physicians reporting they would resort to dismissal vs 38% of Iowa physicians. Physicians in states with the highest rates of parental refusal were most likely to tolerate it, while those in states where the practice was less common were likely to take a harder stance.

“In my private practice, I wouldn’t take care of kids whose parents refused to vaccinate them,” Tryon said. He explained that he was concerned that unvaccinated children in the waiting room could infect vulnerable children such as young infants or medically ill children.

Categories: Immunization, Infectious Diseases, Pediatrics, Primary Care/Family Medicine