Vaccine-hesitancy can be difficult for pediatricians to manage. In instances where a parent refuses to vaccinate, the American Academy of Pediatrics (AAP) recommends doctors ask the parents to sign the AAP Refusal To Vaccinate form (last updated in 2013).
However, evidence shows the wording on this form may further entrench the parents against vaccination and may suffer from common medical biases. The following are designed to provide better outcomes with minimal changes to the form.
1. Avoid Absolutes
My child’s doctor […] has answered all of my questions about the vaccine(s).
Almost certainly false. Answering all questions would take too much time. Typical pediatric well-visits are 16.3 minutes. But when substantial concerns arise, vaccine discussions alone take 10–19 minutes, or longer.
Alternative wording:
My child’s doctor […] has answered my questions about the vaccine(s).
2. Avoid Misrepresentation
the purpose of and the need for the recommended vaccine(s).
False: food and water are needed; vaccines are not “needed” though they may be desirable.
Alternative wording:
the purpose of the recommended vaccine(s).
3. Avoid Tautologies
My child’s doctor and the American Academy of Pediatrics, the American Academy of Family Physicians, and the Centers for Disease Control and Prevention all strongly recommend that the vaccine(s) be given according to recommendations.
If they didn’t recommend their own recommendations, they wouldn’t have recommendations.
Alternative wording:
My child’s doctor and the American Academy of Pediatrics, the American Academy of Family Physicians, and the Centers for Disease Control and Prevention all strongly recommend the vaccine(s).
4. Avoid Speculation
If my child does not receive the vaccine(s) according to the medically accepted schedule, the consequences may include — Contracting the illness the vaccine is designed to prevent
(the outcomes of these illnesses may include one or more of the following: certain types of cancer, pneumonia, illness requiring hospitalization, death, brain damage, paralysis, meningitis, seizures, and deafness; other severe and permanent effects from these vaccine-preventable
diseases are possible as well).– Transmitting the disease to others (including those too young to be vaccinated or those with immune problems), possibly requiring my child to stay out of child care or school and requiring someone to miss work to stay home with my child during disease outbreaks.
Speculative fear-mongering isn’t productive. This wording violate’s the AAP’s own evidence: vaccine dialogue should not be confrontational and confrontation is unproductive or possibly counterproductive. Rather, consider the facts-only approach below.
Alternative wording:
The vaccine(s) are designed to prevent diseases which cause certain types of cancer, pneumonia, illness requiring hospitalization, death, brain damage, paralysis, meningitis, seizures, deafness, and other severe and permanent effects.
A vaccine-preventable disease can: transmit to others (including those too young to be vaccinated or those with immune problems), require my child to stay out of child care or school, require someone to miss work to stay home with them.
5. Avoid Manipulation
I know that failure to follow the recommendations about vaccination may endanger the health or life of my child and others
Speculative shaming isn’t productive. This wording violate’s the AAP’s own evidence: vaccine dialogue should not be confrontational and confrontation is unproductive or possibly counterproductive.
Suggested:
Vaccine-preventable diseases can be dangerous to the health or life of my child and others
6. Avoid Subjugation
I therefore agree to tell all health care professionals in all settings what vaccines my child has not received because he or she may need to be isolated or may require immediate medical evaluation and tests that might not be necessary if my child had been vaccinated.
Speculative subjugation isn’t productive. This wording violate’s the AAP’s own evidence: vaccine dialogue should not be confrontational and confrontation is unproductive or possibly counterproductive.
Alternative wording:
For the safety of my child and others, I should not withhold which vaccines my child has not received from health care professionals.
Conclusion
A few relatively minor changes on the Refusal to Vaccinate form may result in improved outcomes for children, parents, and doctors.
