Handling Immunization Refusal in the Anti-Vaccination Era

A growing number of parents are refusing to have their children vaccinated against preventable diseases, making it more important than ever for practices to clearly outline policies and procedures related to immunization. Today, the anti-vaccination movement is in full force, and measles has made a dramatic comeback in a matter of months.

Physicians, particularly pediatricians, must tread carefully when faced with vaccine refusal, using a combination of education and documentation to both encourage healthy immunization practices and protect themselves against abandonment claims.

Setting Policies

All practices, regardless of specialization, should develop a clear policy statement regarding patient immunization. Whether this policy permits or refuses to treat unvaccinated individuals, the availability of such a statement will help patients understand the current environment and will provide clear expectations for ongoing care.

Practice staff must then be educated on the details regarding this policy so that they can effectively communicate information to patients and their families. This policy should be clearly displayed for incoming patients on practice websites and also be available in the form of a handout.

Education is Best

It’s the physician’s responsibility to not only provide healthcare for patients, but to help them make educated decisions about their health and their children’s health. When faced with vaccine hesitancy, physicians have a number of resources available to help educate concerned parents on the importance, safety, and efficacy of vaccines. By sitting down and discussing the risks and benefits of vaccines, parents are able to make informed choices about their children’s healthcare.

The Center for Disease Control provides comprehensive conversation materials to help physicians during encounters with parents exhibiting immunization hesitancy. Physicians should document this interaction for future reference, noting specific handouts and education materials discussed.

Informed Refusal

Education is often not enough to convince parents that vaccines are the healthiest choice for their child. Some practices may then choose to terminate the physician-patient relationship. This is an individual decision that should be evenly enforced as stated in the practice’s patient immunization policy.

If a practice chooses to continue to treat children whose parents have refused immunizations, we strongly recommend that parents are asked to complete an informed refusal document. Documentation in this case should indicate that the parent was told why the vaccine is recommended, informed of the risks and benefits, and informed of the possible consequences of immunization refusal, as well as the specific education materials provided. Curi members can click here or search for our Quick Start Guide (Chapter XII) once signed in to read about how to avoid liability when terminating patients who refuse vaccination. The American Academy of Pediatrics (AAP) has created a sample informed refusal document that providers can implement in their practice. Additionally, the AAP created a document discussing how to minimize liability with vaccine hesitant parents.

Old Enough to Make Their Own Decisions?

Minors may be able to receive vaccinations without their parent or guardian’s permission under specific circumstances in 15 U.S. states, including Alabama, Alaska, Arkansas, Delaware, Idaho, Illinois, Kansas, Louisiana, Maine, Massachusetts, Montana, Nevada, Oregon, Pennsylvania, South Carolina, Tennessee, Washington, and West Virginia.

In the wake of measles outbreaks, additional states are considering making changes to their laws to permit minors to receive vaccinations without parental consent. However, federal implementation of such legislation is not currently a topic of discussion. Before treating a minor against parental wishes, be sure to explore the laws regarding consent for health services in your particular state.

Curi members are encouraged to reach out to our Risk Management department at 800-662-7917 for specific information about their individual state’s laws regarding treatment with vaccinations and how to set effective vaccine policies.