Vaccine Incentives Proposed for Doctors to Woo Parents

Doctors and academics who advise the U.S. on vaccines are considering recommending physicians be compensated for counseling people on the importance of getting shots for their children, even if the parents ultimately choose not to vaccinate.

Draft recommendations presented Wednesday at a meeting of the National Vaccine Advisory Committee in Washington would also suggest establishing a minimum coverage goal for doctors, encouraging them to get more patients inoculated.

The proposals, if adopted, could help doctors and public-health officials bridge a divide with parents who are worried that it’s unsafe for their children to follow government guidelines for vaccines. The measles outbreak that was first identified at Disneyland in California, spreading to 100 people in a dozen states and Mexico, has hardened the battle lines between vaccine advocates and people who think inoculations carry health risks for children, a belief that has been debunked in numerous studies.

Many doctors, scientists and public-health officials point to the spate of measles cases as evidence of the damage that occurs when their vaccine advice isn’t followed. They’re seeking ways to better persuade people who wrestle with the decision to vaccinate, rather than being adamantly against inoculation.

“I’m worried about demonization on both sides of the issue,” said Janesse Brewer, an expert on collaboration in public policy who led vaccine safety discussions for the U.S. from 2008 to 2010. “We have an outbreak that is front and center that clearly demonstrates what we are doing isn’t working. This is the moment to seize upon the fact that everyone wants the same thing -- essentially healthy children and a healthy population.”

Health Department

The proposals on incentives for doctors were presented Wednesday by the co-chairs of a vaccine acceptance working group, Harvard University’s Vish Viswanath and Meharry Medical College’s Charles Mouton.

The committee will meet again in June to finalize its recommendations to the National Vaccine Program Office, run by the Health and Human Services Department. The department uses the proposals to help develop its policies.

The U.S. government has pledged to reduce the number of measles infections acquired within the country to 30 or fewer within five years, compared with more than 600 last year. The prospects aren’t looking good, with immunization rates in many parts of the country already at dangerously low levels for community protection -- and falling.

Measles Trepidation

By 2020, the U.S. government aims to make sure 90 percent of kids have had at least one dose of the measles, mumps and rubella vaccine by age 3. That’s the level thought to provide herd immunity, when so many people are protected against the virus that it can’t get a foothold in the community. In 2008, 92.1 percent of toddlers were vaccinated.

Like a lot of moms, Diane Sjolander had some trepidation about vaccinating her kids. Having a son with autism made her more sensitive to the assertions she’d heard about inoculations leading to health problems.

The former teacher from Maple Grove, Minnesota, got both her children fully vaccinated, and she doesn’t blame the shots for her son’s condition. But she said she’s been offended when she hears criticism of parents who are worried about immunizations, calling people stupid or a danger to society for trying to protect their children.

“If you have a kid with significant issues, you are looking under every rock to see what you can do to make things better,” she said. “If you hear something might be harmful, you don’t go ahead and do it without researching it.”

Delaying Vaccines

While a core group of people in the U.S. have deep philosophical reasons against vaccinations, most people’s beliefs aren’t so trenchant, said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. Almost all Americans get at least some vaccines, with studies showing less than 1 percent of children are completely unimmunized.

While parents who are against vaccination are facing the harshest backlash in the wake of the measles outbreak, another segment of American families chooses to delay vaccinations, rather than skip them altogether. That can be dangerous too, doctors warn.

A child following the current guidelines would receive dozens of shots before she turns 6, with many in the first year of life. Pediatrician Bob Sears -- co-author of the Sears Parenting Library -- said he was seeing a number of patients who didn’t want to vaccinate their children because they weren’t comfortable with the current guidelines.

Alternate Schedule

He established an alternate schedule to space out some of the simultaneous doses and wrote “The Vaccine Book,” which is now one of the best-sellers in the children’s health section on Amazon.com.

While Sears said he doesn’t encourage parents to follow an alternative schedule, he offers it up to give reluctant parents another path to vaccinating their children.

It’s not a good idea to delay vaccines, said Mobeen Rathore, a member of the American Academy of Pediatrics committee on infectious diseases. While spacing out doses rather than skipping them altogether may seem like taking the middle ground, it still creates a dangerous situation for children, Rathore said.

“When you delay a vaccine, you’re increasing the window for which a child can contract that illness,” Rathore said in an interview. “I don’t even call them delayed schedules -- I call them danger schedules.”

Not Trivial

While the California measles outbreak appears to be slowing, cases continue to pop up in other parts of the U.S. Through last week, 121 cases have been reported in the U.S. this year, up from 102 a week earlier, according to the CDC.

“I do hope the silver lining, if there is one from this particular outbreak, is a wake-up call that measles can come back,” Fauci said. “It’s not a trivial infection, even in the normal, uncomplicated cases. For people who get it, it’s devastating.”

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