They're the "conscientious objectors" of the public-health world: parents who resist giving their children vaccines.
Their numbers are increasing, public-health officials say, although nobody knows exactly how many there are.
Some are parents like Pam Beck, a Vashon Island mom who says she once trusted doctors and public-health officials to know best. But years ago, when two of her children had what she calls extreme reactions to pertussis vaccine, that all changed.
"There's a lot of people here who don't vaccinate," Beck notes. "My daughter-in-law decided not to do it, just to be safe," she said, speaking of her 2 ½-year-old grandchild.
Saturday, pediatricians, public-health officials and researchers wrestled with how to best reach parents like Beck, how to counter irrational fears, whether doctors should "fire" vaccine-resister parents, and whether mandatory vaccination for school attendance should be scrapped.
The conference, "Ethical Issues Related to Vaccination of Children," began Friday and was sponsored by the Treuman Katz Center for Pediatric Bioethics at Children's Hospital & Regional Medical Center.
Now, such resister parents — statistically better educated and better off financially than average — "coast" on the immunity of others, health officials said. Because most children are vaccinated, "herd immunity" mutes or prevents outbreaks of contagious childhood diseases, for the most part.
But, dangerously, an increasing number of families at the other end of the socio-economic spectrum aren't able to vaccinate their children because of cost, being unable to take time away from work, or other barriers, said Dr. Maxine Hayes, state health officer.
"We have a direction where we could lose the herd immunity," she warned.
Many speakers blamed themselves — public health in general or doctors in particular — for not working harder to understand just why these parents are fearful of vaccines and to work with them.
And, they said, it's harder to balance parents' fears of the vaccine with fears of the disease, because many have never seen a child with polio or tetanus, for example, and underestimate their effects.
Certainly, the number of vaccinations recommended for children has mushroomed over the past two decades, said Dr. Stephen Cochi, senior adviser for the Global Immunization Division at the federal Centers for Disease Control and Prevention (CDC). In 1985, children were vaccinated for seven diseases. Now, that number is 16.
Altogether, said Dr. Lainie Friedman Ross, that means children endure about 37 separate vaccination encounters.
"People will become increasingly skeptical as the numbers get larger and larger," said Ross, director of the MacLean Center for Clinical Medical Ethics at the University of Chicago.
So when a parent wants to delay vaccinating an infant against hepatitis B, typically transmitted by sex or contact with blood, she listens. But she'll also warn the parent that blood-to-blood contact can happen in day care, on a school bus, on the playground, or even in the home.
Doctors must listen to resisting parents and try harder to understand their fears, she and others said. "People no longer have blind faith in the health-care community," said Ross, who started a lively debate when she proposed making all childhood vaccinations voluntary.
Required for school
Although vaccinations are required for entry to public school in Washington, parents can sign exemptions for religious, philosophical or medical reasons. Officials think some also sign just to have more time getting their children vaccinated.
In 1999, a handful of counties in Washington state had exemption rates of 5 percent or more. By 2004, the number of such counties had more than doubled.
Speakers said that dropping patients who refuse vaccines for their children only makes the situation worse, perhaps pushing them out of the health-care system entirely.
At the same time, trying to ply them with statistics won't work, because the gulf is usually about values, not numbers, said immunization expert Dr. Edgar Marcuse, associate medical director at Children's.
Compelling anecdotes are always more powerful than statistics, Marcuse said, and become the "data" of the public's outrage.
For example, Dr. Neal Halsey, director of the Institute for Vaccine Safety at Johns Hopkins Bloomberg School of Public Health in Baltimore, noted the lingering fears about thimerosal, the mercury-based preservative once prevalent in childhood vaccines.
Studies have shown no link to autism, he said, and thimerosal no longer appears beyond a trace in any childhood vaccines, except in multiple-dose flu vaccine.
"None of us have any concerns about exposures going on today," he said.
Dr. Jeff Duchin, director of communicable-disease control for Public Health-Seattle & King County, said the public is further confused by laws banning thimerosal in childhood vaccines, such as the one passed this year by the state Legislature. "Although the legislation was undoubtedly well intentioned," he said, "it is an embarrassment because it was unnecessary and misleading."
Carol M. Ostrom: 206-464-2249 or firstname.lastname@example.org