PHYSICIAN CONCERNS ABOUT VACCINE ADVERSE-EFFECTS AND POTENTIAL LITIGATION

Objective: To understand physician concerns about litigation and belie fs regarding vaccine safety. Design: A stratified random sample of fam ily physicians, pediatricians, and general practitioners younger than 65 years who were in office-based practices across the United States w as selected from the American Medical Association list that includes n onmembers. A standardized telephone survey was conducted by trained in terviewers in 1995. Participants: Physicians seeing 5 or more patients per week younger than 6 years and having 50% or more primary care pat ients were eligible for the study. Results: Of the 1236 physicians who were surveyed, 32% and 13% overestimated the risk for serious adverse effects related to pertussis and measles vaccines, respectively. Amon g physicians who thought that serious adverse effects from diphtheria and tetanus toxoids and pertussis vaccine (DTP) were unlikely, 15% wer e highly concerned about litigation; however, among those with higher ratings of the likelihood of serious adverse effects, 38% were highly concerned about vaccine litigation (P<.01). Of those aware of the Vacc ine Injury Compensation Program, only 41% believed that it afforded a high level of liability protection; 22% believed that it gives little protection, and 37% gave an intermediate answer. Among physicians high ly concerned about vaccine litigation, 22% were unlikely to recommend the third dose of DTP for a child with a fever of 39.4 degrees C and n o other symptoms after the second dose of DTP, whereas among those exp ressing little concern about litigation, only 12% were unlikely to vac cinate (P<.05). Although some physicians were concerned about litigati on, most (86%) encouraged vaccination even if a parent was argumentati ve about possible adverse effects. Conclusion: Physicians' perceptions about the risk for adverse effects and protection afforded by the Vac cine Injury Compensation Program influence their concern about litigat ion and, to a lesser extent, their reported likelihood to administer i mmunizations.