- Letter from the President
To witness ALF is to witness democracy at work as Academy leaders discuss — and sometimes argue about — important issues for children and pediatricians raised by our members. Resolutions range from the critically consequential to the more elusive and esoteric. Most are approved and addressed by our organization with the Top 10 going to the AAP Board for comment and action. (See related article http://www.aappublications.org/news/2016/04/27/ALF042716.)
This year, two of the Top 10 resolutions concern vaccines. Unfortunately, parental vaccine hesitancy and refusal have become part of daily life for many pediatricians. All of us in pediatrics are committed to prevention, and there is no greater, more effective and safer prevention than vaccines. As a child, I had a friend who contracted polio, and I was a subject in the Salk vaccine trials (I got a placebo).
As a resident and young physician, I saw many children with Haemophilus influenzae meningitis and epiglottitis, pneumococcal meningitis and bacteremia, varicella encephalitis, and measles respiratory disease and encephalitis. These diseases have disappeared from view. However, in their absence, vaccine hesitancy, refusal and exemptions have multiplied. For the first time in many years, I’ve seen two cases of pneumococcal meningitis in 4-year-old children who were not vaccinated. The second case was presented at a morbidity and mortality conference in my department just a few weeks ago.
The last two years, however, have been a turning point. First came the measles epidemic at Disneyland. It verified our longstanding concerns about herd immunity that previously seemed to be falling on deaf ears. Suddenly, the press and the public woke up to the danger of not immunizing children. Perhaps it was the iconic setting of the spread of this disease. Disneyland, a place especially created for children, suddenly became a place that was unsafe for them.
Then California State Sen. Richard Pan, M.D., FAAP, introduced Senate Bill 277, which removed all exemptions for vaccine requirements except true medical conditions. The bill passed last July with the support of pediatricians throughout AAP California District IX.
In late March, we learned that a film by discredited British doctor Andrew Wakefield, M.B., B.S., that contained misinformation about vaccines and autism was scheduled to be screened at the prestigious Tribeca Film Festival in New York City. Individual pediatricians, the AAP and the New York medical establishment responded quickly through social media and statements. In response, the film was pulled from the schedule. There were some protests regarding free speech. But as Oliver Wendell Holmes put it: It’s not protected free speech under the First Amendment to falsely shout fire in a crowded theater.
I believe this year’s ALF resolutions on vaccines are a sign of empowerment not exasperation. We pediatricians are no longer on the defensive regarding immunizing children. The pendulum has swung back toward science, evidence and public health, and our members want us to move forcefully in the direction of protecting children.
The first of the two resolutions asks the AAP leadership to issue a policy statement similar to California Senate Bill 277 calling for elimination of nonmedical exemptions to legally required immunizations for students who attend school, preschool or child care. The second resolution asks AAP leadership to support both pediatricians who decide to discharge patients after reasonable efforts to work with parents who refuse to immunize their children, as well as pediatricians, like me, who are required — or want — to continue to care for those families in spite of their refusal.
The AAP Board, Executive Committee and appropriate committees already were working on such statements before ALF, but it’s important to know that these statements are a top priority for our members. It puts wind in our sails. There are ethical dilemmas to be addressed in these statements, but we need to address those issues directly and not be paralyzed by them.
One final thought about the resolution process. The standard language of a resolution is “Resolved, that the Academy support, oppose, stand with, issue a policy, advocate for….” However, what the resolution process proves is that you, the members, are the Academy. Wouldn’t it be better for the resolutions to resolve that “my” Academy support or advocate or oppose?
Indeed, the AAP is my Academy, your Academy, our Academy! I hope it feels that way to you. If it doesn’t, then start working on a resolution to change it.