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O'Leary ST, Opel DJ, Cataldi JR, Hackell JM. Strategies for Improving Vaccine Communication and Uptake. Pediatrics 2024; 153:e2023065483. [PMID: 38404211 DOI: 10.1542/peds.2023-065483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/27/2024] Open
Abstract
Vaccines have led to a significant decrease in rates of vaccine-preventable diseases and have made a significant impact on the health of children. However, some parents express concerns about vaccine safety and the necessity of vaccines. The concerns of parents range from hesitancy about some immunizations to refusal of all vaccines. This clinical report provides information about the scope and impact of the problem, the facts surrounding common vaccination concerns, and the latest evidence regarding effective communication techniques for the vaccine conversation. After reading this clinical report, readers can expect to: Understand concepts and underlying determinants of vaccine uptake and vaccine hesitancy.Understand the relationship between vaccine hesitancy and costs of preventable medical care.Recognize and address specific concerns (eg, vaccine safety) with caregivers when hesitancy is present.
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Affiliation(s)
- Sean T O'Leary
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, Colorado
| | - Douglas J Opel
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Jessica R Cataldi
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, Colorado
| | - Jesse M Hackell
- Department of Pediatrics, New York Medical College, Valhalla, New York
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2
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McGreevy J, Rhodes R. Behavior Contracts and Lessons from Parenting "Rotten" Kids. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:67-70. [PMID: 36595013 DOI: 10.1080/15265161.2022.2146797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
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3
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Pediatric primary care immunization policies in New York State. Vaccine 2022; 40:1458-1463. [DOI: 10.1016/j.vaccine.2022.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 11/18/2022]
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Considering a COVID-19 vaccine mandate for pediatric kidney transplant candidates. Pediatr Nephrol 2022; 37:2559-2569. [PMID: 35333972 PMCID: PMC8949834 DOI: 10.1007/s00467-022-05511-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 12/02/2022]
Abstract
The world continues to face the effects of the SARS-CoV-2 pandemic. COVID-19 vaccines are safe and effective in protecting recipients, decreasing the risk of COVID-19 acquisition, transmission, hospitalization, and death. Transplant recipients may be at greater risk for severe SARS-CoV-2 infection. As a result, transplant programs have begun instituting mandates for COVID-19 vaccine for transplant candidacy. While the question of mandating COVID-19 vaccine for adult transplant candidates has garnered attention in the lay and academic press, these discussions have not explicitly addressed children who may be otherwise eligible for kidney transplants. In this paper we seek to examine the potential ethical justifications of a COVID-19 vaccine mandate for pediatric kidney transplant candidacy through an examination of relevant ethical principles, analogous cases of the use of mandates, differences between adult and pediatric kidney transplant candidates, and the role of gatekeeping in transplant vaccine mandates. At present, it does not appear that pediatric kidney transplant centers are justified to institute a COVID-19 vaccine mandate for candidates. Finally, we will offer suggestions to be considered prior to the implementation of a COVID-19 vaccine mandate.
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5
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Navin MC, Wasserman JA, Opel DJ. Reasons to Accept Vaccine Refusers in Primary Care. Pediatrics 2020; 146:peds.2020-1801. [PMID: 33159001 DOI: 10.1542/peds.2020-1801] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Mark C Navin
- Department of Philosophy, Oakland University, Rochester, Michigan; .,Departments of Foundational Medical Studies and
| | - Jason A Wasserman
- Departments of Foundational Medical Studies and.,Pediatrics, Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Douglas J Opel
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington; and.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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Deem MJ, Kronk RA, Staggs VS, Lucas D. Nurses' Perspectives on the Dismissal of Vaccine-Refusing Families From Pediatric and Family Care Practices. Am J Health Promot 2020; 34:622-632. [PMID: 32077306 DOI: 10.1177/0890117120906971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Dismissal of families who refuse mandated childhood vaccines from pediatric practices has become more common among US pediatricians over the past 2 decades. While nurses (registered nurses [RNs] and advanced practice registered nurses [APRNs]) often are the first health-care professional to encounter parents' vaccine hesitancy and serve as a primary source of information, there are no published data on nurses' perspectives on dismissal as a response to vaccine refusal. This study examined nurses' perspectives on dismissal of vaccine-refusing families from primary care practices. DESIGN Cross-sectional survey administered electronically from February to September 2018. Data analysis was conducted from November 2018 to March 2019. SETTING Data were collected electronically from a national sample of nurses. SUBJECTS A convenience sample of 488 primary care nurses (74% APRNs) was recruited and enrolled in the study through collaboration with 4 professional nursing associations. MEASURE AND ANALYSIS A cross-sectional survey was conducted from February to September 2018. We explored correlates of nurses' (n = 488) attitudes toward dismissal by modeling attitude scores as a function of practice and respondent characteristics. We also modeled odds of encountering vaccine refusal and odds of reporting dismissal of a vaccine-refusing family in the last 12 months, each as a function of respondents' practice characteristics. RESULTS Eighty-four percent of respondents encountered vaccine refusal in the previous 12 months, and 22% reported that their practice had dismissed a vaccine-refusing family within the previous 12 months. Twenty-eight percent agreed/strongly agreed that they would dismiss or support a decision to dismiss families who refuse all vaccines, and 12% supported dismissal of families for refusal of some but not all vaccines. Thirty-nine percent of respondents disagreed/strongly disagreed with dismissing families who refuse all vaccines, and 50% disagreed/strongly disagreed with dismissal for refusal of some but not all. CONCLUSION Almost all nurses working in primary care encounter vaccine refusal, and most consider all Centers for Disease Control and Prevention-recommended childhood vaccines to be important to public health. There is significant polarization of nurses' attitudes toward the appropriateness of dismissal as a response to vaccine refusal. We recommend the development of professional nursing guidelines for responding to vaccine refusal. However, because there are no data on the community health impact of dismissal policies, we recommend further research on outcomes of dismissal policies to inform such guidelines.
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Affiliation(s)
- Michael J Deem
- School of Nursing, Duquesne University, Pittsburgh, PA, USA.,Center for Healthcare Ethics, Duquesne University, Pittsburgh, PA, USA
| | | | - Vincent S Staggs
- Biostatistics and Epidemiology, Health Services and Outcomes Research, Children's Mercy Hospital, Kansas City, MO, USA.,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Denise Lucas
- School of Nursing, Duquesne University, Pittsburgh, PA, USA
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Garcia TB, O'Leary ST. Dismissal policies for vaccine refusal among US physicians: a literature review. Hum Vaccin Immunother 2020; 16:1189-1193. [PMID: 32078411 DOI: 10.1080/21645515.2020.1724742] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Childhood vaccination is one of the greatest public health achievements of the 20th century, yet increasingly, parents question the safety of and need for vaccines. This has led to increased rates of vaccine delay and refusal and outbreaks of vaccine-preventable diseases. Physicians struggle with how to respond to families who refuse vaccines, as there are few known effective interventions to convince a family to vaccinate. In the United States, the practice of dismissing families for vaccine refusal appears to be increasing as a strategy for dealing with vaccine refusal. In this review, we review the literature surrounding this controversial practice, starting with the impact that vaccine-refusing families have on medical practices, followed by a review of dismissal policies of US physicians, and ending with a discussion of the ethics of this practice.
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Affiliation(s)
- Tamara B Garcia
- Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
| | - Sean T O'Leary
- Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA.,Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Aurora, CO, USA
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Forster M. Ethical position of medical practitioners who refuse to treat unvaccinated children. JOURNAL OF MEDICAL ETHICS 2019; 45:552-555. [PMID: 31249107 DOI: 10.1136/medethics-2019-105379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 06/02/2019] [Accepted: 06/13/2019] [Indexed: 06/09/2023]
Abstract
Recent reports in Australia have suggested that some medical practitioners are refusing to treat children who have not been vaccinated, a practice that has been observed in the USA and parts of Europe for some years. This behaviour, if it is indeed occurring in Australia, has not been supported by the Australian Medical Association, although there is broad support for medical practitioners in general having the right to conscientious objection. This paper examines the ethical underpinnings of conscientious objection and whether the right to conscientious objection can be applied to the refusal to treat unvaccinated children. The implications of such a decision will also be discussed, to assess whether refusal to treat unvaccinated children is ethically justifiable. The best interests of both existing and new patients are crucially important in a doctor's practice, and the tension between these two groups of patients are contemplated in the arguments below. It is argued that on balance, the refusal to treat unvaccinated children constitutes unjustified discrimination.
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MacDonald NE, Harmon S, Dube E, Taylor B, Steenbeek A, Crowcroft N, Graham J. Is physician dismissal of vaccine refusers an acceptable practice in Canada? A 2018 overview. Paediatr Child Health 2018; 24:92-97. [PMID: 30996599 DOI: 10.1093/pch/pxy116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/28/2018] [Indexed: 12/25/2022] Open
Abstract
Despite robust evidence that routine immunization is effective and safe, some parents refuse some or all vaccines for their children. In 2007, concern that Canadian paediatricians and family physicians might be considering dismissal of vaccine refusers from their practices prompted an ethical, legal, and public health analysis which concluded that dismissal was professionally problematic. We now reassess this important issue in the Canadian context updating ethical, legal, and public health considerations highlighting changes since 2007. In light of the recent strengthening of Ontario's school immunization requirements that include stiffer steps to qualify for a medical, conscience, or religious belief exemption, physicians and health care workers may be under more pressure from vaccine refusers in their practice leading some to contemplate dismissal or even consider no longer offering immunizations at all in their practice. Given the challenges that vaccine refusers may present, we offer an overview for managing vaccine refusal by parents/patients in a medical practice.
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Affiliation(s)
- Noni E MacDonald
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia
| | - Shawn Harmon
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia.,JK Mason Institute for Medicine, Life Sciences and Law, University of Edinburgh, Edinburgh, UK
| | - Eve Dube
- Institut National de Santé Publique du Québec and Université Laval, Québec, Québec
| | - Beth Taylor
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia
| | - Audrey Steenbeek
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia
| | - Natasha Crowcroft
- Public Health Ontario, Laboratory Medicine and Pathobiology and Dalla Lana School of Public Health University of Toronto, Toronto Ontario
| | - Janice Graham
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia.,Technoscience and Regulation Research Unit, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia
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Deem MJ, Navin MC, Lantos JD. Considering Whether the Dismissal of Vaccine-Refusing Families Is Fair to Other Clinicians. JAMA Pediatr 2018; 172:514-516. [PMID: 29710105 DOI: 10.1001/jamapediatrics.2018.0259] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Michael J Deem
- School of Nursing, Duquesne University, Pittsburgh, Pennsylvania.,Center for Healthcare Ethics, Duquesne University, Pittsburgh, Pennsylvania
| | - Mark C Navin
- Department of Philosophy, Oakland University, Rochester, Michigan
| | - John D Lantos
- Bioethics Center, Children's Mercy Hospital, Kansas City, Missouri.,School of Medicine, University of Missouri, Kansas City
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Affiliation(s)
- Johan C Bester
- 1 University of Nevada, Las Vegas (UNLV) School of Medicine, Las Vegas, NV, USA
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Abstract
Techniques from behavioral economics-nudges-may help physicians increase pediatric vaccine compliance, but critics have objected that nudges can undermine autonomy. Since autonomy is a centrally important value in healthcare decision-making contexts, it counts against pediatric vaccination nudges if they undermine parental autonomy. Advocates for healthcare nudges have resisted the charge that nudges undermine autonomy, and the recent bioethics literature illustrates the current intractability of this debate. This article rejects a principle to which parties on both sides of this debate sometimes seem committed: that nudges are morally permissible only if they are consistent with autonomy. Instead, I argue that, at least in the case of pediatric vaccination, some autonomy-undermining nudges may be morally justified. This is because parental autonomy in pediatric decision-making is not as morally valuable as the autonomy of adult patients, and because the interests of both the vaccinated child and other members of the community can sometimes be weighty enough to justify autonomy-infringing pediatric vaccination nudges. This article concludes with a set of worries about the effect of pediatric vaccination nudges on parent-physician relationships, and it calls on the American Academy of Pediatrics to draw on scientific and bioethics research to develop guidelines for the use of nudges in pediatric practice and, in particular, for the use of pediatric vaccination nudges.
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Affiliation(s)
- Mark C Navin
- Department of Philosophy, Oakland University, 746 Mathematics and Science Center, Rochester, MI, 48309-4401, USA.
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13
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Grossman Z, Ashkenazi S, Rubin L. How are we responding to vaccine-hesitant parents? THE LANCET CHILD & ADOLESCENT HEALTH 2017; 1:9-11. [PMID: 30169232 DOI: 10.1016/s2352-4642(17)30040-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 07/19/2017] [Accepted: 07/20/2017] [Indexed: 11/28/2022]
Affiliation(s)
| | - Shai Ashkenazi
- Department of Paediatrics, Schnaeider Children's Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lisa Rubin
- Department of Maternal and Child Health, Public Health Service, Ministry of Health, Jerusalem, Israel; School of Public Health, University of Haifa, Haifa, Israel
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Cave E. Voluntary vaccination: the pandemic effect. LEGAL STUDIES (SOCIETY OF LEGAL SCHOLARS) 2017; 37:279-304. [PMID: 32336855 PMCID: PMC7165755 DOI: 10.1111/lest.12144] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 06/14/2016] [Accepted: 06/17/2016] [Indexed: 06/01/2023]
Abstract
Justification of a voluntary vaccination policy in England and Wales rests on tenuous foundations. Two arguments against voluntary vaccination are gaining ground. The first is that globalisation necessitates preparedness strategies for pandemics. Assuming sufficient supply, compulsory vaccination of adults and children constitutes a potential policy option in the context of a severe, vaccine-preventable pandemic outbreak. The second argument is that children have a right to preventive medicine and thus to vaccination. The influence of the UN Convention on the Rights of the Child and its emphasis on parents as the trustees of their children's best interests, and the increasingly global nature of our collective and individual responsibilities with respect to the transmission of vaccine-preventable disease present challenges to the right to refuse vaccination on our own behalf and on behalf of our children. Exploring methods of compulsion and persuasion utilised across Europe, the USA and Australia, this paper argues that necessity and proportionality must be reassessed, and national public health law and policy setting out a graduated and proportionate approach to compulsory vaccination developed as a matter of priority.
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Abstract
Immunizations have led to a significant decrease in rates of vaccine-preventable diseases and have made a significant impact on the health of children. However, some parents express concerns about vaccine safety and the necessity of vaccines. The concerns of parents range from hesitancy about some immunizations to refusal of all vaccines. This clinical report provides information about addressing parental concerns about vaccination.
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Affiliation(s)
| | - Jesse M Hackell
- Pomona Pediatrics PC, A Division of Children's and Women's Physicians of Westchester, Boston Children's Physicians, Pomona, New York
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Sade RM. Introduction: Ethical and Legal Issues in Pediatrics. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2016; 44:228-230. [PMID: 27338598 DOI: 10.1177/1073110516654117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Robert M Sade
- Robert M. Sade, M.D., is Distinguished University Professor, Professor of Cardiothoracic Surgery and Director of the Institute of Human Values in Health Care at the Medical University of South Carolina. He currently chairs the Ethics Committee of the American Association for Thoracic Surgery and the Cardiothoracic Ethics Forum, and is Associate Editor (Ethics) of the Annals of Thoracic Surgery. He is a former chair of the Society of Thoracic Surgeon's Standards and Ethics Committee and the American Medical Association's Council on Ethical and Judicial Affairs
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