A perspective piece from a US paediatrician highlights the frustrations and concerns felt by healthcare professionals around the world.
During an exam with a young girl and her pregnant mother, Professor Dorothy Novick was confronted with a situation which has, sadly, become more common.
The mother was refusing all childhood vaccines, citing the CDC’s recent and ongoing re-examination of its recommendations as the basis for the decision.
Professor Novick, attending physician at the South Philadelphia Primary Care Center in the Children’s Hospital of Philadelphia, and Professor of Clinical Paediatrics at the University of Pennsylvania, published a perspective piece in the New England Journal of Medicine.
“I find myself unexpectedly at a loss for words — a rarity after 30 years in clinical practice,” she wrote.
“It’s not the specifics of her concerns, which are similar to those I have fielded before. It’s not the crushing defeat of hearing her previous vaccine hesitancy evolve into flat-out refusal.
“It is the invoking of the Centers for Disease Control and Prevention (CDC). The agency I have quoted to families as the final authority, the standard for evidence-based recommendations, is now her source of reckless, life-threatening misinformation and guidance.
“I wrestle to formulate a response that will make clear that the current CDC is not the agency we used to know, without overtly blaming its demise on our administration. Keeping politics and ideological debates outside the exam room is an art we practice often as health care providers.”
She explained in the article that she saw families from a diverse range of cultural and sociodemographic backgrounds at her practice, and that part of being able to care for her community was to leave politics out of it.
“We know that we partner best by focusing on the values we share — the health, safety, and well-being of the patient in the room — rather than those that can tear us apart” she wrote.
“But keeping politics outside the exam room has become increasingly challenging since the current administration opened the door and let themselves in.
“I choose my words carefully, determined to focus on the evidence. “What’s happening can be so confusing, and I know there are mixed messages,” I try, wheeling my chair out from behind the desk. “But actually, the science hasn’t changed. There is nothing new that should make us nervous about long-term impacts of vaccines — and with measles going around, I worry about her safety if she isn’t protected.”
The mother questioned why the CDC would say that the MMR vaccine might cause autism. “It’s impossible to know who to believe and who not to,” she said.
For Professor Novick, it’s become shockingly clear who not to believe.
“When the CDC falsely suggested a potential link between the measles–mumps–rubella (MMR) vaccine and autism, and a few weeks later voted to put thousands of infants per year at risk for hepatitis B infection, any residual faith I once had in their expertise was extinguished,” she wrote.
“With the new year has come a new vaccine schedule that drops universal protection against multiple diseases, confirming that the agency we have relied on to guide and support care has turned its back on this mother’s children — the one now practicing pirouettes alongside the exam table and the other not yet born — with a campaign to incite uncertainty and suspicion around one of medicine’s greatest advances.
“Tragically, families are listening.”
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She offered the American Academy of Paediatrics to the mother as a reliable source of information, as well as her practice – a part of the deeply respected hospital full of world-renowned experts – which the woman’s extended family attends.
“But even though a recent survey showed that the majority of parents trust paediatricians to provide reliable vaccine information — and only 14% have “a lot” of confidence in our government’s health agencies — in practice it is starting to feel otherwise,” she wrote.
When the mother said there were so many more vaccines than when she was a child, Professor Novick explained that was the exact reason why the diseases of her youth have practically disappeared.
“A memory surfaces from my days as a paediatric resident. An infant lies curled on the exam table while I wait for fluid to drain from the hollow needle I have slipped into the soft flesh between his vertebrae. The fluid emerges, but instead of a pristine drip comes a slow, cloudy sludge filled with ominous chunks of white material,” she wrote.
“He was the last patient I ever lost to pneumococcal meningitis, thanks to the vaccine that was released 2 years later. It is his little body, flooded with infection, that I think of whenever a parent delays vaccines.”
The mother explained that she did not want to pump her children full of antibiotics or preservatives, and that she regretted the vaccines her daughter received.
“The baby will not be getting any. I am saddened and I am worried, but I cannot say I’m surprised,” Professor Novick wrote.
“In addition to the specific vaccines about which Robert F. Kennedy, Jr.’s CDC is most blatantly sowing fear, distrust, and confusion, parents in my practice and those across the country are increasingly turning down all vaccines with newly empowered vigor.”
The patient was one of the first newborns Professor Novick cared for when she started her paediatric practice. Just six years after graduating from paediatric care, she had returned to the practice with a baby of her own.
“I was overwhelmed with warmth and connection. Now, I tiptoe around the potential landmines that have suddenly appeared between us,” she wrote.
Despite invoking the AAP’s recent release of its own vaccine schedule and explaining that the CDC no longer had a panel of vaccine experts making decisions, the woman remained resolute and a palpable tension filled the room.
“The options before me are clear. I can continue to offer my professional expertise and risk disrupting a therapeutic relationship that has spanned her lifetime and my career. I can explain that I am no longer comfortable caring for her children – an approach to vaccine refusal that is now accepted by the AAP for cases in which other avenues have been exhausted. Or I can warm the room in hopes of a more productive discussion next time,” Professor Novick wrote.
She chose to shift the conversation to the young girl’s upcoming dance recital, and the appointment ended with some planning for the new baby’s arrival.
“As paediatricians trying to protect children from the newly threatening CDC, we are walking multiple fine lines at once, like some sort of high-wire circus act: discrediting the actions of this country’s health agencies while remaining apolitical, emphasizing the evidence while practicing patient-centred care, and prioritizing the trusting relationships that families need for medical decision making while wondering if the time has come to narrow our panels,” she wrote.
Unravelling 80 years of the US’s trust in its health agencies was no small task, she explained, but she had lost patients to RSV, whooping cough and meningitis, and also seen critically ill children with chickenpox, covid and influenza.
“The chances that I will be able to protect my ballet-hopping patient and her soon-to-be brother from vaccine-preventable infections are slim, but they are not nothing,” she wrote.
“My concerns, too, are driven by a fierce protective instinct.”
