“When you’re a new mother, you’re a fi rst-time moth-


er, you’ve never paid attention to this issue before. It just doesn’t matter how much I’ve been dealing with it for how many years; you’re a new mom, and this is the fi rst time you’ve come across this,” she said. “And when someone starts giving out this information and you try to look it up, there’s just so much misinformation on the internet, and you can’t [account for] timing. You have a lot of stuff about autism, although the autism connection has been 100-percent disproven. You can’t tell when articles and things were put out or when people wrote things. So for a new mom, it’s very confusing.” At least once a month, Dr. Swanson says, she’ll have


to reassure a new mom about the safety of vaccines. One who recently asked Dr. Swanson about the safety of im- munizations “has a sister-in-law who lives in another state that’s an anti-vaccinator, and she just inundates her with stuff on her emails and on Facebook, so the mom was really nervous about it,” Dr. Swanson said. “It’s 30 to 45 minutes of my time to try to talk to this mother and explain how important this [vaccination] is and how safe they [vaccines] are.” Austin family physician Erica Swegler, MD, a member


of the Be Wise panel, says she tells patients the autism issue has been settled, but other reports of supposed dan- gers, such as the presence of aluminum adjuvants in vac- cines, still make some apprehensive. The U.S. Centers for Disease Control and Prevention (CDC) says aluminum salts “have been used safely in vaccines for more than 70 years,” and only some vaccines contain adjuvants. “But for some people, it becomes a belief system, a very


strong belief system, and so it’s very hard to alter that,” Dr. Swegler said. “And now that the autism issue has been put to rest, they’re talking about other trace elements in there that they can point to, so now they’re saying, ‘Well, what about the aluminum adjuvants?’ or this or that. When push comes to shove, they will tell you that they just don’t believe in them. It’s hard to sway people from a belief sys- tem with the science.” Dr. Swegler says the physician’s job is to make sure


vaccine skeptics at least hear the results of the science so they can’t hide behind a lack of knowledge. She equates it to treating smokers, who always hear from her that she can help them quit and that quitting is the best thing they can do for themselves. “I don’t stop mentioning it,” she said of immunization.


“I don’t stop putting it out there, and so even if they re- fused last year, when they come in this year, I’m going to offer it to them again. Sometimes circumstances change. Sometimes in the interim, they’ve had a family member with an illness who was immune-suppressed, and they understand better what the implications would be.” Some physicians and practices have ultimately put their foot down. A few years ago, Dr. Vijjeswarapu says


IT’S 30 TO 45 MINUTES OF MY TIME TO TRY TO TALK TO THIS MOTHER


AND EXPLAIN HOW IMPORTANT THIS [VACCINATION] IS AND HOW SAFE THEY [VACCINES] ARE.


he thought about the decisions the parents of some of his patients were making, and he made a decision of his own. If he was seeing patients whose parents, for whatever rea- son, had decided not to vaccinate their children, he was putting other children in his waiting room at risk of con- tracting a preventable disease. Mindful of what he calls an “obligation to protect the youngest,” Dr. Vijjeswarapu began a new approach with vaccine-averse parents. “I gave them a visit to talk to them about vaccines and discuss the importance, and I take my 30 minutes, just a free visit,” Dr. Vijjeswarapu said. “And I [tell them], ‘If you decide to give vaccinations, I’ll take care of you. If not, fi nd the other doctors in town.’” That approach has worked well for Dr. Vijjeswarapu,


who says he’s never had to go further with a parent than one of those talks. In 2015, Austin Regional Clinic (ARC) took similar


steps and announced it would no longer accept new pedi- atric patients whose parents or guardians wouldn’t allow vaccinations, and parents of any existing patients unwill- ing to commit to a vaccination schedule would need to seek medical care elsewhere. (See “Shooting for Safety,” September 2015 Texas Medicine, pages 22–30, or visit www.texmed.org/ShootingForSafety.) Elizabeth Knapp, co-chief of pediatrics at ARC, says


patients generally received the new policy well, and it has “made the conversation more about the safety of our whole practice.” “I think that we’ve had some families that have left ARC,


but I’ve had in my own practice many, many families who have chosen to actually become vaccinated fully because of our policy,” she said


THE JOHNSON COUNTY OUTBREAK An outbreak of a vaccine-preventable disease can serve as an impetus for change. It did for ARC, which shifted to its vaccine requirement policy in part because of a well- publicized measles outbreak that started at Disneyland in December 2014. CDC eventually credited that outbreak


March 2017 TEXAS MEDICINE 29


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