Freedom of choice

Carly Fiorina says parents should have the choice to vaccinate their kids — but it’s doctors who wield the real influence

Plus, the candidate’s policy seems to have a hangup with vaccinating for HPV

Carly Fiorina at a restaurant in Clear Lake, Iowa. Win McNamee/Getty Images

At a town hall event in Iowa last week, aspiring Republican presidential candidate Carly Fiorina came out against mandatory vaccination for children — an issue she frames not as a matter of public health but of personal liberty. Fiorina believes parents have the right to decide whether or not to vaccinate their kids, though she concedes that public schools should be allowed to block kids who haven’t been vaccinated against contagious diseases from attending.

Erroneous claims that there’s a link between vaccination and autism have contributed to a drop in vaccination rates in the U.S., which have in turn been linked to recent outbreaks of measles and a resurgence of preventable diseases like mumps and whooping cough.

Fiorina’s beliefs are actually in line with policies in most states: Vaccination is required for enrollment in public schools, but parents can obtain exemptions on religious or personal grounds. While policy is obviously important, recent research shows that doctors can also play a role in convincing hesitant parents to let their kids get vaccinated. Just reminding parents that they have the option of refusing vaccination can make them more likely to opt out.

Last December, Doug Opel, a pediatrician at Seattle Children’s Hospital, co-authored a paper in the journal Pediatrics that found that parents were much more likely to decline vaccines for their children when doctors presented the shots as a choice, rather than an expectation. Opel and a team of researchers undertook a study of 111 parents, some of whom had reservations about vaccines and some of whom did not. They videotaped the parents’ visits to doctors’ offices and noticed that pediatricians tended to employ one of two strategies when discussing vaccinations. One group of doctors — which they classified as “presumptive” — didn’t frame the vaccinations as an optional procedure; they would introduce the vaccine by saying something like, “We have to do some shots.”

Some doctors, however, engaged the parents in a conversation about whether or not to vaccinate their children (“What do you want to do about shots?”). Odel classified this group as “participatory.” Most of the doctors (74 percent) fell into the first category, and their approach turned out to be far more effective. More than 70 percent of the parents in the “presumptive” group opted for vaccination, whereas most of the parents — 83 percent — in the “participatory” group decided against it. Fiorina seems relatively sympathetic to policies promoting vaccinations against “highly communicable diseases” like measles and mumps, which she thinks schools should be allowed to require. It’s the human papillomavirus (HPV) vaccine that she appears to really be opposing; she recounts her discomfort with a nurse’s insistence that her preteen granddaughter get vaccinated against HPV, a sexually transmitted disease that can cause cervical cancer.

Many opponents of routine HPV vaccination in young girls assume that the vaccine encourages promiscuity or unsafe sex. According to at least one study, that’s the most common reason parents cite for declining to get their kids vaccinated. That fear is unfounded, research over the past few years has shown. For a 2012 study published in the journal Pediatrics, researchers led by Robert Bednarczyk looked at 1,398 girls, about one-third of whom received the HPV vaccine when they were 11 or 12 years old. Bednarczyk researchers followed up with them for three years, and found that vaccination didn’t have a significant effect on pregnancy rates or incidence of other STDs, like chlamydia.

A more comprehensive study appeared this year in the journal JAMA Internal Medicine. Comparing the STD rates of 21,000 vaccinated girls and 186,000 unvaccinated girls in the same region of the U.S. over the course of five years, researchers found that while the vaccinated group did have a slightly higher incidence of diseases like chlamydia, gonorrhea and syphilis, they were also more likely to have an STD before they got vaccinated: at-risk girls were more likely to get vaccinated, but the vaccination itself wasn’t linked to an increase in STDs — leading the researchers to conclude “that vaccination is unlikely to promote unsafe sexual activity.”

The only thing it promotes is less cervical cancer — just like the only real effect of the measles and mumps vaccines is a lower rate of measles and mumps.

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