Back to: Just the Inserts Training Course

Have you heard of a declination or vaccine refusal form at a pediatrician’s office? Most likely, the pediatrician obtained a template of this form from the American Academy of Pediatrics (AAP). The AAP is a professional organization that provides a plethora of resources for pediatricians concerning vaccine acceptance. Per the AAP, using a declination form can “induce a wavering parent to accept [the pediatrician’s vaccine] recommendations.” In addition to signing this form, the AAP “recommends that [the pediatrician] revisit the immunization discussion at each subsequent appointment and carefully document the discussion.”

Here are some of the statements within the template:

• I [the parent] understand 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).
• I [the parent] understand if my child does not receive the vac-cine(s) according to the medically accepted schedule, the consequences may include 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.
• I know that failure to follow the recommendations about vaccination may endanger the health or life of my child and others with whom my child might come into contact.
• I therefore agree to tell all health care professionals in all set-tings what vaccines my child has not received because he or she[…]”

After reading through the vaccine inserts, do you see where these statements are flawed?

First, many of the “outcomes of illness” mentioned in the first bullet are also manufacturer-listed adverse reactions to several vaccines. Additionally, according to the “Limitation of Effectiveness” section of vaccine inserts, children can still “contract the illness the vaccine is designed to prevent” even if they get the vaccine. It can be argued that a child vaccinated for an illness is not only at risk for the “outcomes of illness” due to the vaccine’s limitation of effectiveness, but also the known potential adverse reactions to the vaccine.

Second, we know from the “Shedding” section that recently vaccinated children can transmit a vaccine-strain disease to others as well as the wild strain. The second bullet is not exclusive to unvaccinated children. Same for the third bullet.

I am not professionally trained in law and am not providing legal advice. However, I’ve been warned by those in the legal profession that the third statement should be a cause of concern for parents to sign. I personally will not sign a document saying I am endangering “the health or life of my child and others with whom my child might come into contact.” That statement is incredibly flawed and inaccurate based on every single government resource cited on this website.

Lastly, the final bullet assumes that only unvaccinated children are contagious. Again, we know this isn’t true based on everything we discussed in the “Shedding” section. You may not see these exact statements on your pediatrician’s declination form as this is just a template. If you do want to sign it, make sure you read and agree with every statement prior to signing.

What do I do if a pediatrician says I have to sign one? They do not have authority to force you to sign a declination form. As long as the form isn’t required by the state you live in, you do not have to sign it. Per the AAP, your refusal to sign will be documented in your child’s medical record. However, the pediatrician will likely no longer offer services to you if you don’t sign it. That’s okay!

In a later section, you’ll learn tips on how to find a provider who honors informed consent and parental choice! But first, remember when we talked about The Vaccine Perspective Spectrum? Let’s figure out where fall on it in the next lesson.