Vaccinated Children vs. Unvaccinated Children -- What Are the Risks?

Alison M. Buttenheim, PhD, MBA, assistant professor at Penn Nursing answers parents' questions about childhood vaccines. Dr. Buttenheim is a public health researcher and social demographer who studies parent behavior and child health.

Q: What are vaccine refusal and delay?

A: Some parents decide not to have their children receive one or more of the vaccines recommended by the Centers for Disease Control, the American Academy of Pediatrics, and the Advisory Committee on Immunization Practices. Other parents choose to delay one or more vaccines. For example, if a child is scheduled to receive three shots at age two months, a parent might delay one of those shots for a few weeks or months. While some parents do this out of concern that too many needles at once may be traumatic for the child, research shows the unpleasant experience for the child is from the overall experience of getting shots, and not the specific number of shots given: Spreading out shots over several visits is actually more upsetting for most children.

Q: Are vaccine refusal and delay legal?

A: Each state has a required immunization schedule for entry into day care and school settings. Each state can also determine the process by which parents may claim an exemption from the schedule for their children. All states have provisions for medical exemptions, for example if the child has a specific immune disorder or an allergy that may make the vaccine unsafe for that child. Many states also have provisions for religious, philosophical, or personal belief exemptions, although the requirements to obtain these exemptions vary considerably from state to state. If a parent obtains an exemption according to state law, then the child may legally enroll in and attend day care or school.

Q: What prompts parents to refuse or delay vaccines for their children?

A: There has been a lot of research recently to try to understand parents' hesitancy around vaccines. One reason that has received a lot of media coverage is the unfounded idea that vaccines cause autism or other developmental or neurological conditions. This idea was first promoted in the late 1990s by a British doctor whose research has since been thoroughly discredited by the scientific community. Several rigorous scientific studies conducted since then have demonstrated that there is no link between vaccines and autism. However, this idea really persists in the minds of parents.

There are two other reasons for refusals or delays that we've heard in our research talking to parents. The first is the concern that the immunization schedule contains too many vaccines, which parents worry may overtax a child's immune system. Fortunately, this is not correct. The immunological challenge presented by the entire vaccination schedule is tiny compared to what a baby might encounter just crawling around on a floor or going on a trip to the supermarket. A baby's immune system is wonderfully designed to respond to these challenges, whether from bacteria on a toy or from the components of a vaccine.